The purpose of this study was to examine treatment practices for cancer therapy-associated decreased left ventricular ejection fraction (LVEF) detected on echocardiography and whether management was ...consistent with American College of Cardiology/American Heart Association guidelines.
Patients treated with anthracyclines or trastuzumab are at risk of cardiotoxicity. Decreased LVEF represents a Class I indication for drug intervention according to American College of Cardiology/American Heart Association guidelines.
Patients receiving anthracycline or trastuzumab at Stanford University from October 2005 to October 2007 and who had undergone echocardiography before and after receiving an anthracycline or trastuzumab were identified. Chart review examined chemotherapy regimens, cardiac risk factors, imaging results, concomitant medications, and cardiology consultations.
Eighty-eight patients received therapy with an anthracycline or trastuzumab and had a pre-treatment and follow-up echocardiogram. Ninety-two percent were treated with anthracyclines, 17% with trastuzumab after an anthracycline, and 8% with trastuzumab without previous treatment with anthracycline. Mean baseline LVEF was 60%, with 14% having a baseline <55%. Forty percent had decreased LVEF (<55%) after anthracycline and/or trastuzumab treatment. Of these patients, 40% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy, and 54% cardiology consultation. Of patients with asymptomatic decreased LVEF, 31% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 35% beta-blocker therapy, and 42% cardiology consultation. Of those with symptomatic decreased LVEF, 67% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 100% beta-blocker therapy, and 89% cardiology consultation.
Many cancer survivors are not receiving treatment consistent with heart failure guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving cardiotoxic therapy.
This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of ...whether such psychosocial support affects survival have been mixed.
One hundred twenty-five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive-expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive-expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety.
Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site-by-condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen-receptor (ER) status and treatment condition (P = .002) such that among the 25 ER-negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER-negative controls (median, 9.3 months), whereas the ER-positive participants showed no treatment effect.
The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences.
A core component of NCCN's mission is to improve and facilitate equitable cancer care. Inclusion and representation of diverse populations are essential toward this goal of equity. Within NCCN's ...professional content, inclusivity increases the likelihood that clinicians are prepared to provide optimal oncology care to all patients; within NCCN's patient-facing content, it helps ensure that cancer information is relevant and accessible for all individuals. This article describes changes that have been made in the language and images used in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and the NCCN Guidelines for Patients to promote justice, respect, and inclusion for all patients with cancer. The goals are to use language that is person-first, nonstigmatizing, inclusive of individuals of all sexual orientations and gender identities, and anti-racist, anti-classist, anti-misogynist, anti-ageist, anti-ableist, and anti-fat-biased. NCCN also seeks to incorporate multifaceted diversity in images and illustrations. NCCN is committed to continued and expanding efforts to ensure its publications are inclusive, respectful, and trustworthy, and that they advance just, equitable, high-quality, and effective cancer care for all.
ABSTRACTCarlson, LA, Lawrence, MA, and Kenefick, RW. Hydration status and thermoregulatory responses in drivers during competitive racing. J Strength Cond Res 32(7)2061–2065, 2018—Stock car drivers ...are exposed to high ambient temperatures, further complicated by the fact that they are encapsulated in protective clothing; however, the hydration status of these drivers has not been determined. This study quantified the degree of fluid losses during a competitive event in hot conditions. Nine male stock car drivers (29.6 ± 9.4 years, 177.8 ± 3.0 cm, 81.5 ± 18.5 kg) were studied during a Pro Series Division NASCAR race. Sweat rate (SR) and dehydration was determined through nude body weights (BWs). Prerace BW was 81.5 ± 18.5 kg and decreased to 81.1 ± 18.5 kg after race (p = 0.001). Body weight loss after race was 0.77 ± 0.3% and mean SR was 0.63 ± 0.4 L·h. Intestinal core temperature increased from 38.0 ± 0.4 to 38.5 ± 0.4° C after race (p = 0.001). Skin temperature increased from 35.8 ± 0.8 to 36.9 ± 0.8° C after race (p = 0.001), whereas the core-to-skin temperature gradient narrowed from 2.2 ± 0.9 to 1.6 ± 0.9° C, before race to after race (p = 0.001). Heart rates after race were 89 ± 0.0% of the driversʼ age-predicted maximum heart rate (HR). Fluid losses during competitive racing can be significant. Without a fluid replacement strategy, fluid losses may exceed 3% of BW and could negatively impact driving performance in longer races.
Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has ...led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and American Society of Clinical Oncology each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.
As part of the NCCN 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care, Lucy Kalanithi, MD, wife of now-deceased best-selling author Paul Kalanithi (
), and ...Heather Wakelee, MD, Paul's oncologist, discussed-for the first time together in a public forum-Paul's experience of going from a neurosurgery resident to a patient with cancer with a terminal diagnosis. Robert Carlson, MD, moderated the discussion.
In his Keynote Address at the NCCN 20th Annual Conference, Robert W. Carlson, MD, reflected on the achievements of NCCN and described how the organization will continue to grow under his leadership. ...Recognizing that the founding of NCCN was by a group of visionary leaders who came together 20 years ago to assure access of patients to high-quality cancer care, Dr. Carlson said "All our efforts within NCCN are focused on improving the quality, effectiveness, and efficiency of patient care, so that our patients can live better lives."
Chemistry on the icy surface of Europa is heavily influenced by the incident energetic particle flux from the jovian magnetosphere. The majority (>75%) of this energy is in the form of high energy ...electrons (extending to >10MeV). We have simulated the electron irradiation environment of Europa with a vacuum system containing a high-energy electron gun for irradiation of ice samples formed on a gold mirror cooled with a cryostat. Pure water films of a arrow right 42.6 mu m thickness were grown at 100K and then either cooled (to 80K), warmed (to 120K) or left at 100K and subsequently irradiated with 10keV electrons. The production of hydrogen peroxide (H2O2) was monitored by observation of the 2850cm-1 (3.5 mu m) band. Equilibrium concentrations of H2O2, in units of percent by number H2O2 relative to water, were found to be 0.043% (80K), 0.029% (100K), and 0.0063% (120K). These values are 33%, 22%, and 5%, respectively, that of the reported surface concentration on the leading hemisphere of Europa (Carlson, R.W., Anderson, M.S., Johnson, R.E., Smythe, W.D., Hendrix, A.R., Barth, C.A., et al. 1999. Science 283(5410), 2062-2064) and less than the equilibrium concentrations formed by ion irradiation. In addition to the ice film temperature, the current of electrons was varied between different experiments to determine the production and destruction of H2O2 as a function of both electron flux and ice temperature. Variation in current was found to have little effect on the results other than accelerating arrival at radiolytic equilibrium.
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