Interaction between ferric carboxymaltose and denosumab causing severe hypocalcaemia and hypophosphataemia in a patient without chronic kidney disease

Coadministration of ferric carboxymaltose and denosumab may cause hypocalcaemia and hypophosphataemia; however, this interaction is not well-described in the literature and has typically been described in patients with chronic kidney disease (CKD). We present a case of this interaction in a patient without preexisting CKD. We suggest the use of alternative iron preparations and an interval of at least 4 weeks between administrations.

Cardiovascular Disease in Adult Cancer Survivors: a Review of Current Evidence, Strategies for Prevention and Management, and Future Directions for Cardio-oncology

PURPOSE OF REVIEW

Cardiovascular disease is long-term complication of both cancer and anti-cancer treatment and can have significant ramifications for health-related quality of life and mortality. This narrative review explores the current evidence linking cardiovascular disease and cancer, as well as exploring strategies for the prevention and management of cardiovascular disease, and outlines future opportunities in the field of cardio-oncology.

RECENT FINDINGS

Cancer confers risk for various cardiovascular diseases including heart failure, cardiomyopathy, arrhythmia, coronary heart disease, stroke, venous thromboembolism, and valvular heart disease. Cancer treatment, in particular agents such as platinum-based chemotherapy, anthracyclines, hormonal treatments, and thoracic radiotherapy, further increases risk. While cardiovascular disease can be identified early and effectively managed in cancer survivors, cardiovascular screening and management does not typically feature in routine long-term cancer care of adult cancer survivors. Cancer and cancer treatment can accelerate the development of cardiovascular disease. Further research into screening and management strategies for cardiovascular disease, along with evidence-based guidelines, is required to ensure adult cancer survivors receive appropriate long-term care.

Cancer diagnosis, cancer treatment, and association with cardiovascular disease in older adults: Results from ASPREE

12086

Background: New treatments and early detection measures have led to declines in cancer mortality rates and a growing population of cancer survivors at risk of short- and long-term effects of cancer and cancer treatment (C&CT), including cardiovascular disease (CVD). Although shared risk factors may contribute, several C&CT-related mechanisms including inflammation, treatment-related cardiotoxicity, and coagulation disorders may play a role. There are several studies exploring the link between C&CT and CVD; however, many do not examine risk stratified by cancer type or disease extent, nor investigate the impact of different treatment modalities. Methods: This analysis utilized data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, an international, multi-center, double-blinded randomized controlled trial that investigated the benefits and risks of aspirin in healthy older people. Multivariate time-dependent Cox regression models (adjusted for clinically significant factors including age, gender, smoking, and metabolic disease) were used to investigate the impact of C&CT on myocardial infarction, stroke, hospitalization for heart failure, and a composite endpoint combining these. Crude incidence rates were estimated using a competing risks regression model. Subgroup analysis was performed by metastatic status, cancer type, and treatment modality. Results: Of the 19,114 ASPREE participants (56% female; median age 75.1 years; median follow up 4.7 years), 1,933 received a post-randomisation cancer diagnosis. Participants with cancer had a greater rate and risk of CVD than those without cancer (15.3 per 1000 person-years (/1000pyrs] vs 10.5/1000pyrs, respectively; Hazard Ratio [HR] = 1.70, 95% Confidence Interval [CI] 1.32-2.10). The greatest increase in risk was seen for hospitalization for heart failure (HR 2.00, 1.18-3.38, 95% CI 1.18-3.38), although increases in risk were also seen for myocardial infarction, all-stroke, and ischaemic stroke. In subgroup analysis by cancer type, blood cancer (HR 2.33, 95% CI 1.25-4.36), lung cancer (HR 2.76, 95% CI 1.23-6.19), and melanoma (HR 1.97, 95% CI 1.02-3.82) were associated with an increased risk of composite CVD. ‘Any cancer treatment’ conferred increased risk of hospitalisation for heart failure (HR 1.78, 95% CI 1.15-2.75), although individual treatment modalities, including cytotoxic chemotherapy, targeted therapy, and radiotherapy conferred increased risks of various cardiovascular outcomes. Conclusions: Our findings indicate that both cancer and anti-cancer treatment confer risk for CVD in the elderly, the magnitude of which varied depending on cancer type and treatment modality. Given the implications of cardiovascular events for quality of life and mortality, these results support the integration of CVD screening and management into routine care for cancer survivors.

The experiences, attitudes and understanding of research amongst medical students at an Australian medical school

BACKGROUND

Research engagement plays an integral role in developing clinicians that practice effective, evidence-based medicine. Research participation by clinicians, however, is declining. Given the link between research during medical school and future research output, promotion of medical student research is one avenue by which this shortage can be addressed. Student research attitudes and participation in Australia are not well-documented in the literature. This study therefore aims to investigate research practices, motivators, and barriers amongst Australian medical students in order to determine whether there is a need for further integration of research within Australian medical school curriculums.

METHODS

A cross-sectional study design was used to explore research experience and attitudes, as well as the enablers and barriers to research amongst students enrolled in all years of the five-year medical course at Monash University. A questionnaire was created by combining questions from several surveys on medical student research and comprised Likert scales, multiple choice options and free-text responses assessing research experience, attitudes, motivators, and barriers.

RESULTS

Seven hundred and four respondents (69.4% female; survey response rate 36.7%) reported variable research experience and interest. Less than half of the cohort (n = 296; 44.9%) had contributed to a research project. Increasing employability for specialty training programs was the primary motivating factor (n = 345; 51.9%) for pursuing research, with only 20.5% (n = 136) citing an interest in academia as a motivator. Time constraints (n = 460; 65.3%) and uncertainty surrounding how to find research opportunities (n = 449; 63.8%) were the most common barriers to research.

CONCLUSIONS

Medical students at Monash University are interested in but have limited experience with research. Students are, however, primarily motivated by the prospect of increasing employability for specialist training; medical schools should therefore focus on encouraging intrinsic motivation for pursuing research. Greater integration of research education and opportunities within medical school curricula may also be required to provide students with the skills necessary to both pursue research and practice evidence-based medicine.