Palliative and Supportive Care

According to the results of a landmark study published in a recent issue of the Journal of Clinical Oncology (20:4040-4049, 2002), how painkillers are delivered can make a major difference in patient outcome. The trial, supported by

Thrombocytopenia remains a significant clinical problem for patients with cancer. Management approaches include watchful waiting, platelet transfusions, and the use of pharmacologic agents. Although platelet

Over the past decade, interest has been growing in the quality of life of men with prostate cancer. Traditionally considered a group with few psychological complications, 10% to 20% of men with prostate cancer are found to have clinically significant levels of psychological distress. This article reviews the prevalence of psychiatric symptomatology among prostate cancer patients, the psychological challenges of coping with the disease, and general guidelines for treatment. [ONCOLOGY 16:1448-1467, 2002]

Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate

The US Food and Drug Administration (FDA) has approved granisetron (Kytril) for the prevention and treatment of postoperative nausea and vomiting. The approval was based on the results of recent clinical trials.

WASHINGTON-Although leukemia patients with neutropenia need antibiotics promptly when fever strikes, hospital procedures can delay administration for many hours, according to Cathy Mazzone, RN, MS, OCN, patient care manager, National Institute on Aging, Bethesda, Maryland. A thorough analysis of the approach to neutropenia fever management by a busy leukemia unit cut the wait to just over an hour, she said at the 27th Annual Congress of the Oncology Nursing Society (abstract 22).

The objectives of this study were to assess the safety and efficacy of darbepoetin alfa (Aranesp) administered every 2 weeks in anemic patients with solid tumors receiving chemotherapy. This was an open-label, randomized,

Studies on human erythropoietin (EPO) demonstrated that there is a direct relationship between the sialic acid-containing carbohydrate content of the molecule and its serum half-life and in vivo biological activity, but an

Nausea and vomiting are the toxicities of chemotherapy most feared by the cancer patient. However, increased understanding of the mechanisms of nausea and vomiting has led to greatly improved control of this toxicity.

Our objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic

Cancer-related anemia, in addition to having detrimental effects on quality of life and adding the risk and inconvenience of blood transfusions, may also be associated with decreased survival or time to progression. Yet

Our objective was to evaluate the effects of darbepoetin alfa (Aranesp) on hemoglobin and transfusions in anemic patients with cancer undergoing chemotherapy, and the impact of age, sex, baseline hemoglobin, chemotherapy

BOSTON-The elderly may suffer more from the side effects of chemotherapy, but toxicity should not necessarily prevent them from receiving life-saving or palliative treatment, according to two speakers at the 14th international meeting of the Multinational Association for Supportive Care in Cancer (MASCC) and International Association for Oral Oncology.

The safety and efficacy of darbepoetin alfa (Aranesp) at 3.0 µg/kg administered every 2 weeks and recombinant human erythropoietin (rHuEPO) given as 40,000 U weekly or 150 U/kg three times weekly were evaluated by

Since our first "Quality of Life in Current Oncology Practice and Research" symposium was held at St. Mary Medical Center in Long Beach, California in February 1989, and published in ONCOLOGY in May 1990, there has been a marked increase in the use of quality of life measures to determine the outcomes of interventions in clinical oncology. Measuring the effects of anemia treatment with quality of life tools is a fine example of the importance of these tools to gauge the impact and clinical significance of interventions. It is, therefore, both timely and relevant that we dedicate our fifth symposium to the management of anemia in patients with cancer.

To support evidence-based clinical guidelines on erythropoietin use for anemia in oncology, we conducted systematic reviews of controlled trials on four patient groups. These were patients with treatment-related anemia; patients with disease-related anemia; patients transplanted with allogeneic hematopoietic stem cells; and those transplanted with autologous hematopoietic stem cells.

The US Food and Drug Administration (FDA) has approved darbepoetin alfa (Aranesp) for the treatment of chemotherapy-induced anemia in patients with nonmyeloid malignancies. Darbepoetin alfa is a recombinant erythropoietic protein that requires fewer injections than previous treatments used for this indication. The agent maintains its level in the blood approximately three times longer than epoetin alfa (Epogen, Procrit), thus giving health-care providers the ability to treat anemia related to chemotherapy with less-frequent dosing than the current standard of care.

Octreotide (Sandostatin), a somatostatin analog, has a wide range of uses in the management of cancer patients. It is a unique molecule that specifically binds to somatostatin receptor subtype 2. This property of activating the receptor can result in a multitude of physiologic actions (for example, inhibition of synthesis and release of peptides in endocrine and neoplastic cells, antiangiogenesis, antisecretory effect in the gastrointestinal mucosa, anticholecystokinin activity retarding gallbladder motility, and reduction in splanchnic blood flow). In addition, in vitro experiments confirm that octreotide has cytostatic activity against a variety of malignancies. Octreotide is now widely used in the treatment of hormonal syndromes that result from a variety of neuroendocrine and endocrine neoplasms. Its dramatic effect in controlling malignant carcinoid syndrome and hormone-induced diarrhea (for example, from gastrinoma and VIPoma) has been well documented. However, the chronic use of octreotide can result in steatorrhea and gallstone formation.

Diarrhea is a common problem in patients receiving pelvic irradiation with concurrent chemotherapy. Virtually all patients develop diarrhea of varying severity during the course of the treatment. The incidence and severity of diarrhea vary with the chemotherapy type and dose, radiotherapy field size, daily fraction size, and total dose of radiation given. Diarrhea (any grade) occurs in 30% to 87% of patients receiving chemotherapy and in 20% to 49% of patients receiving pelvic radiotherapy. The incidence of severe and life-threatening (grade 3/4) diarrhea ranges from 20% to 40% in patients receiving combined chemoradiotherapy.

Recommendation for the Management of Patients With Chemotherapy-Induced Diarrhea

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. Of the 28,000 patients diagnosed each year, more than 95% will die of pancreatic cancer. Therefore, the focus of therapy for most patients is palliative care. In fact, the most active single-agent therapy for advanced disease-gemcitabine (Gemzar)-was first compared to fluorouracil (5-FU) with relief of disease symptoms as a primary end point. However, the survival with gemcitabine remains approximately 6 months for advanced disease, and no new agent, either alone or in combination, has exceeded this time frame in phase III study.

ORLANDO-Allowing advanced cancer patients to start palliative care without giving up aggressive treatment substantially increased end-of-life hospice enrollment in one study and reduced cost of care in another. Both studies were presented at the

ORLANDO-The largest prospective evaluation of quality of life (QOL) in chemotherapy-naïve patients with advanced non-small-cell lung cancer (NSCLC) found that first-line treatment with docetaxel (Taxotere) plus a platinum agent achieved

THOUSAND OAKS, California-The US Food and Drug Administration has approved Amgen’s Aranesp (darbepoetin alfa) for the treatment of chemotherapy-induced anemia in patients with nonmyeloid malignancies. Aranesp, a recombinant erythropoietic protein, has a half-life approximately three times longer than that of epoetin alfa (Epogen, Procrit); thus, fewer injections are required by the patient.

Depression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be

NASHVILLE-Interim results from a small pilot study suggest oncologists might be able to give epoetin alfa (Procrit) in a high-dose regimen that lengthens the time between injections once anemic patients reach maintenance levels of hemoglobin (ASCO abstract 1469).

NEW YORK-Eligard 7.5 mg (leuprolide acetate for injectable suspension) is now commercially available for the palliative treatment of advanced prostate cancer, Sanofi-Synthelabo Inc. announced in a news release. The new formulation of the

WASHINGTON-The high rates of cancer in minority communities, some researchers have suggested, may derive from lifestyle factors detrimental to health. But a traditional public health approach emphasizing individual risk factors, poverty, lack of insurance, and limited access to medical services does not suffice to explain ethnic disparities in health behavior and health outcomes, said Kathy Sanders-Phillips, PhD, Distinguished Scientist in Drug Abuse and director of the research program in epidemiology, Howard University.

COLUMBIA, South Carolina-A dose escalation trial of darbepoetin alfa (Aranesp) found the new erythropoietic agent can boost hemoglobin rates in most cancer patients with chronic anemia, a group not usually treated with erythropoietic therapy (ASCO abstract 1465).

NEW YORK-Weekly injections of epoetin alfa (Procrit) might protect breast cancer patients against anemia and improve their quality of life during adjuvant chemotherapy.