Foreign travel for advanced cancer patients: a guide for healthcare professionals

Nanotherapeutics targeting autophagy regulation for improved cancer therapy

The clinical efficacy of current cancer therapies falls short, and there is a pressing demand to integrate new targets with conventional therapies. Autophagy, a highly conserved self-degradation process, has received considerable attention as an emerging therapeutic target for cancer. With the rapid development of nanomedicine, nanomaterials have been widely utilized in cancer therapy due to their unrivaled delivery performance. Hence, considering the potential benefits of integrating autophagy and nanotechnology in cancer therapy, we outline the latest advances in autophagy-based nanotherapeutics. Based on a brief background related to autophagy and nanotherapeutics and their impact on tumor progression, the feasibility of autophagy-based nanotherapeutics for cancer treatment is demonstrated. Further, emerging nanotherapeutics developed to modulate autophagy are reviewed from the perspective of cell signaling pathways, including modulation of the mammalian target of rapamycin (mTOR) pathway, autophagy-related (ATG) and its complex expression, reactive oxygen species (ROS) and mitophagy, interference with autophagosome-lysosome fusion, and inhibition of hypoxia-mediated autophagy. In addition, combination therapies in which nano-autophagy modulation is combined with chemotherapy, phototherapy, and immunotherapy are also described. Finally, the prospects and challenges of autophagy-based nanotherapeutics for efficient cancer treatment are envisioned.

Traveling With Cancer: A Guide for Oncologists in the Modern World

PURPOSE

Travel for patients with cancer has become more achievable because of gains in quality of life and overall survival. The risk assessment of these patients is complex, and there is a paucity of data to which clinicians can refer. We present the challenges of traveling with cancer and a review of the literature.

METHODS

A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A search using the terms "cancer," "advanced cancer," "metastases," "brain edema," "lymphoedema," "pneumothorax," "pleural effusion," "pericardial effusion," pneumonitis," "hypoxia," "end-of-life," and "shunt," combined with "flying" and "air travel," was conducted. The PubMed and Cochrane databases were searched for English-language studies up to December 2018. Studies, case reports, or guidelines referring to travel in the context of adult patients with malignancies were included. A total of 745 published articles were identified; 16 studies were included. An inclusive approach to data extraction was used.

RESULTS

There were no specific criteria to deem a patient with cancer fit to travel. Neurologic, respiratory, and cardiac implications, and time from recent surgery or procedure need to be considered There was a lack of high-quality studies to inform decisions, but the British Thoracic Society and Aerospace Medical Association Medical Guidelines included recommendations for fitness to fly for patients with cancer.

CONCLUSION

In the absence of large prospective studies, individual fitness to travel should be assessed on a case-by-case basis, bearing in mind that maximizing a patient's ability to safely travel is an important goal for many individuals with cancer.

Infections of the Central Nervous System in Returning Travelers and Immigrants

PURPOSE OF REVIEW

This review highlights current knowledge in travel-related neuroinfectious diseases, providing insight on approaches to prevention, diagnosis, and treatment of infections of the central nervous system (CNS) in travelers and immigrants.

RECENT FINDINGS

Updates on travel vaccine recommendations including vaccine-specific interactions with immunosuppressive agents, advances in Zika virus and dengue virus vaccine development, new diagnostic criteria for neurocysticercosis, updates on treatment approaches for tuberculosis meningitis. Increasing rates of travel are leading to the spread of known infectious diseases and the emergence of new diseases in travel medicine. Among these infections, neuroinfectious diseases carry significant morbidity and mortality. To reduce the effect of travel-related illness, appropriate pre-travel measures and up-to-date diagnostic and treatment strategies are essential for optimal outcomes. This review highlights important travel information relevant to neuroinfectious diseases for several populations including immunocompetent, immunocompromised, pregnant, and infant/children travelers. It also outlines the travel risk, clinical presentation, diagnosis, and management of a select list of neuroinfectious diseases by region, including neurocysticercosis, Zika virus, tuberculosis meningitis, rabies, and tick-borne encephalitis.

International travel patterns and travel risks of patients diagnosed with cancer

BACKGROUND

Immunocompromised travelers living with cancer can be at increased risk of travel-related illnesses. Their international travel patterns and associated risks remain largely unknown.

METHODS

This was a retrospective cohort study of all patients diagnosed with cancer who presented for pre-travel health advice between January 1, 2003 and June 30, 2011. Demographics, travel patterns, and infectious diseases exposure risks of immunocompromised travelers were characterized and compared with those of immunocompetent travelers. Reported travel-related illnesses were assessed in both groups.

RESULTS

A total of 149 travelers were included in this study. Fifty-one percent had solid tumors, 32% had hematological malignancies, and 17% underwent stem cell transplantation. Seventy travelers (47%) were immunocompromised. Immunocompromised travelers had similar demographics, trip itineraries, and infectious diseases exposure risks to hepatitis A, malaria, typhoid fever, and yellow fever as immunocompetent travelers. Most of the reported travel-related illnesses were of minor nature.

CONCLUSION

Travelers with cancer who have impaired immunity had similar infectious diseases exposure risks and travel patterns as travelers whose cancer is cured or in remission. Improved understanding of travel patterns and risks of patients with cancer may assist in providing more focused pre-travel health interventions to this complex subset of travelers.

Management of secondary lymphedema related to breast cancer

AbstractOBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer.QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed,and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett's levels of evidence. The literature search focused on primary research and systematic reviews.MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises,previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading.CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral.