Showing papers by "Aminah Jatoi published in 2008"
TL;DR: The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine disorders).
1,948 citations
TL;DR: This study represents one of the largest, single-institution, retrospective reviews of adjuvant therapy in patients after R0 resection of carcinoma of the pancreas and overall survival was better in patients who received adjUvant CT-RT.
Abstract: Purpose To determine prognostic factors and impact of adjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) after resection of pancreatic adenocarcinoma. Patients and Methods We performed a retrospective review 472 consecutive patients who underwent complete resection with negative margins (R0) for invasive carcinoma (T1-3N0-1M0) of the pancreas between 1975 and 2005 at the Mayo Clinic in Rochester, MN. Exclusion criteria included metastatic or unresectable disease at surgery, positive surgical margins, and indolent tumor types (islet cell tumors and mucinous cystadenocarcinoma). Median RT dose was 50.4 Gy in 28 fractions; 98% of RT patients also received concurrent fluorouracil-based CT. Results Six patients died within 30 days of surgery. For the 466 surviving patients, median follow-up was 32.4 months; median OS was 21.6 months. Median OS after adjuvant CT-RT was 25.2 versus 19.2 months after no adjuvant therapy (P = .001). Two-year OS was 50% versus 39%, and 5-year OS was 28% versu...
247 citations
TL;DR: The authors examined the use of tetracycline for rash prevention and found it to be safe and effective in patients with a history of EGF-related rash.
Abstract: Epidermal growth factor receptor inhibitors are emerging as effective therapies for patients with non-small cell lung cancer, colorectal cancer, pancreas cancer, head and neck cancer and other malignancies [1,2,3,4]. These agents are well tolerated, but a rash is reported to occur in greater than 50% of treated cancer patients [1,4]. Developing on the face, trunk, and upper extremities, this rash is often acneiform in appearance, mild in severity, and quick to resolve even with ongoing cancer therapy. However, more severe (grade 3+) or more persistent rashes can also occur, particularly with the administration of epidermal growth factor receptor antibodies [4].
How are these rashes typically managed? When severe, cessation of the epidermal growth factor receptor inhibitor is sometimes considered. The rash then usually resolves, thereby allowing uneventful reinstitution of cancer therapy [5]. This approach can be disquieting for cancer patients, especially in light of data that point to rash development as a surrogate marker for tumor response and improved survival [6]. Anecdotal reports have also described rash attenuation after the initiation of other therapies, including systemic antibiotics such as tetracycline [7,8]. The latter is commonly used for acne, and the clinical similarity of typical acne and epidermal growth factor receptor inhibitor-induced skin rash suggests that this antibiotic might play a role in preventing or treating these drug-induced rashes [9,10,11]. Additionally, tetracycline carries anti-inflammatory effects which might also help with rash palliation [12].
Despite such anecdotal reports, to our knowledge, no published placebo-controlled trial has ever examined the role of tetracycline in preventing rashes induced by epidermal growth factor receptor inhibitors. In view of the waxing and waning nature of these rashes and the anxiety they evoke, it is important to begin to seek rigorous evidence on the use of tetracycline for rash prevention. Thus, the North Central Cancer Treatment Group conducted this placebo controlled trial to test the role of tetracycline in rash prevention in patients starting cancer therapy with an epidermal growth factor receptor inhibitor.
168 citations
TL;DR: Those who reported engaging in regular physical activity reported a better overall QOL, better QOL on all five domains of QOL functioning, and fewer symptoms compared to those with a sedentary lifestyle.
73 citations
TL;DR: Rexin-G is well tolerated in doses up to 6 x 10(11) CFU in patients with recurrent pancreatic cancer, but there was no evidence of clinical antitumor activity.
48 citations
TL;DR: Although it cannot conclude that a rash-related death from this class of agents can never occur, this systematic review provides evidence-based guidance on how best to counsel cancer patients who develop a rash from an epidermal growth factor receptor inhibitor.
Abstract: Rash from epidermal growth factor receptor inhibitors is common and negatively impacts the quality of life of cancer patients. Published guidelines recommend holding cancer therapy if the rash is severe. Does this recommendation hinge solely on improving patients' quality of life, or does it also hinge on the prevention of a potentially fatal, cutaneous adverse event? In other words, do patients die from rashes from epidermal growth factor receptor inhibitors? To our knowledge, the latter question has never before been asked and answered in an evidence-based fashion. Therefore, we conducted a systematic review of the published, prospectively conducted clinical trial literature on epidermal growth factor receptor inhibitors. The primary aim was to determine whether rash-related death has ever been reported in such trials. Among 117 such trials, which included 8,998 cancer patients, the rate of rash development was >50%, as expected. However, there were no reported deaths from a rash. Although we cannot conclude that a rash-related death from this class of agents can never occur, this systematic review provides evidence-based guidance on how best to counsel cancer patients who develop a rash from an epidermal growth factor receptor inhibitor. It suggests that quality of life issues should remain at the forefront as cancer patients and health care providers make decisions about holding cancer therapy.
39 citations
Journal Article•
TL;DR: Dietary counseling does not appear to improve QOL significantly in patients with cancer, however, an observed trend toward benefit underscores the need for further study.
Abstract: Results have been mixed as to whether dietary counseling improves clinical outcomes in cancer patients. This systematic review and meta-analysis of randomized trials assessed the effect of dietary counseling on quality of life (QOL). It included only randomized trials that focused on dietary counseling and that relied upon a standardized QOL measurement. Five trials that met these and all other a priori eligibility criteria were identified; they are the focus of this meta-analysis. When these five studies were examined in aggregate, the standardized mean difference in QOL scores among patients who received dietary counseling was 0.56 (95% confidence interval,-0.01-1.14; P = 0.06). Dietary counseling does not appear to improve QOL significantly in patients with cancer. However,an observed trend toward benefit underscores the need for further study.
37 citations
TL;DR: Although this regimen was well tolerated, the tumor response rate was lower than that anticipated at 23% (95% confidence interval: 10%, 40%), thereby prompting premature study closure.
30 citations
TL;DR: The limited palliative options available to patients with cancer-associated weight loss underscore the need for continued laboratory and clinical investigation.
Abstract: Purpose of review The past 2 years have yielded interesting observations that have challenged our understanding of and approach to treating cancer-associated weight loss in patients with advanced, incurable malignancies. This review provides an update of such observations and places them within the context of previous work. Recent findings The mechanisms that underlie cancer-associated weight loss remain elusive, but recent studies suggest that this weight loss might be mediated by downregulation of insulin-like growth factor-1; macrophage inhibitory cytokine-1 has also been implicated. Although recent clinical trials have not provided major additions to the armamentarium of palliative approaches, such laboratory-based findings provide targets for future palliative trials. Summary The limited palliative options available to patients with cancer-associated weight loss underscore the need for continued laboratory and clinical investigation.
26 citations
TL;DR: Chemotherapy-treated cancer patients and their companions have knowledge deficits concerning osteoporosis and educational initiatives to increase awareness may be of value.
22 citations
TL;DR: The clinical aspects of EGFR inhibitor-induced rash, which occurs most commonly with use of these agents, are reviewed, and some of the challenges faced in attempting palliation treatment are discussed.
Abstract: The epidermal growth factor receptor (EGFR) inhibitors represent a relatively new class of cancer agents that also provide new challenging side effects for cancer patients. This article reviews the clinical aspects of EGFR inhibitor-induced rash, which occurs most commonly with use of these agents, and discusses some of the challenges faced in attempting palliation treatment.
TL;DR: Patients with schizophrenia sometimes receive substandard medical care, particularly among lung cancer patients with underlying schizophrenia, according to this study.
Abstract: Objective: Patients with schizophrenia sometimes receive substandard medical care. This study explored such disparities among lung cancer patients with underlying schizophrenia.
Methods: This retrospective study focused on patients with pre-existing schizophrenia (or in some instances schizoaffective disorder) and a lung cancer diagnosis made between 1980 and 2004. ‘Disparity’ was defined as a patient's having been prescribed less aggressive therapy for a potentially curable cancer based on state-of-the-art treatment standards for the time and for the cancer stage. Qualitative methods were used to assess healthcare providers' decision-making.
Results: 29 patients were included. The median age was 59 years; 38% were men. Twenty-three had non-small cell lung cancer and 6 small cell lung cancer; 17 had potentially curable cancers. Five of 17 had a ‘disparity’ in cancer care: (1) no cancer therapy was prescribed because of chronic obstructive pulmonary disease; (2) no cancer therapy was prescribed because of infection; (3) no chemotherapy was prescribed because the patient declined it; radiation was provided; (4) no chemotherapy was prescribed because of the patient's schizophrenia symptoms; radiation was administered; and (5) no surgery was performed because of disorientation from a lobotomy; radiation was prescribed. Comments from healthcare providers suggest reflection and ethical adjudication in decision-making.
Conclusion: Schizophrenia was never the sole reason for no cancer treatment in patients with potentially curable lung cancer. This study provides the impetus for others to begin to assess the effect of schizophrenia on lung cancer management in other healthcare settings. Copyright © 2007 John Wiley & Sons, Ltd.
TL;DR: Chemotherapy appears to provide modest benefit to newly diagnosed colorectal cancer patients with severe hyperbilirubinemia, and patients who received only supportive care lived a median of 28 days.
Abstract: Colorectal cancer is no longer considered a chemotherapy-resistant malignancy. A 1985 study outlined the benefits of first-line, single agent 5-fluorouracil, describing tumor response rates of only 23% and a median survival of only 8.7 months (Burocker et al 1985). No extra benefits were reported with the addition of other chemotherapy drugs (Burocker et al 1985).
Contrast these dismal results to more recent findings. Goldberg and colleagues (2004) demonstrated that a multidrug, first-line regimen, which consisted of oxaliplatin, leucovorin, and 5-fluorouracil, yielded a tumor response rate of 45%, nearly double that reported earlier, and stretched the median survival by over two-fold, to 19.5 months. Such findings underscore the major therapeutic strides that have occurred in the management of patients with metastatic colorectal cancer and demonstrate that this previously chemotherapy-resistant malignancy can now be viewed as chemosensitive.
Have such breakthroughs changed our approach? Are we now at the point where patients, who were formerly considered marginal candidates for chemotherapy, can be prescribed it routinely? Specifically, should patients with liver metastases and marked hyperbilirubinemia now be prescribed chemotherapy in the hope of improving their hepatic function and improving their clinical outcomes? To our knowledge, these questions have not yet been answered because large, prospective clinical trials typically require that patients enroll with normal or near-normal organ function. Moreover, to date, only small case reports, some of which are not totally relevant to the questions posed above, have served to provide guidance on clinical management (Van Laethem et al 2003; Gupta et al 2007; Moosmann et al 2007). Hence, the purpose of the present study was to report outcomes within a group of colorectal cancer patients with severe hyperbilirubinemia presumably from liver metastases in an effort to provide more substantive guidance in answering the question of whether these patients benefit from state-of-the-art chemotherapy.
TL;DR: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients’ wishes when seemingly contradictory information appears in other parts of the medical record.
Abstract: Background
The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer.
TL;DR: This 126-patient study seems to be the largest, clinical experience to date of patients with small cell carcinoma of the esophagus, but even this sizable experience lacks the power to detect a subtle improvement in survival with the addition of surgery to an already potentially curative approach.
TL;DR: Findings are sobering: over this 15-year period, no statistically significant trends were detected to indicate an increase in the number of women authors and, ultimately, improve rates of academic promotion for women interested in cancer palliative care.
Abstract: Background. Women physicians in the United States publish less than men and advance academically at a slower pace. Do such gender-based disparities also occur in cancer palliative care, a field in which women appear to hold a strong interest? Methods. We undertook a detailed survey of the cancer palliative care literature. We selected 5 cancer palliative care journals on the basis of their high impact factors, and we assessed authorship for the years 1990, 1995, 2000, and 2005. We determined gender and highest educational degree for all US first and last authors. Results. A total of 794 authors are the focus of this report. In 2005, 50% of first authors were women, but only 14% were women physicians. Similarly, 39% of senior authors were women during this year, but only 8% were women physicians. Over this 15-year period, no statistically significant trends were detected to indicate an increase in the number of women authors. Conclusions. These findings are sobering. Future efforts might focus on strategies to improve rates of authorship and, ultimately, improve rates of academic promotion for women interested in cancer palliative care.
TL;DR: A survey of prostate cancer patient advocates found the importance of patient education in promoting informed clinical decision-making and a perceived need for patient-centered research by providers and educators.
Abstract: Background. Interacting with patients, researchers, and administrators, patient advocates have a unique vantage point. Yet, few prior studies have sought to understand these individuals or to seek their opinions on cancer issues. Methods. A survey to address the foregoing was developed and mailed to advocates within the National Cancer Institute’s Prostate Cancer SPORE Program. Results. A total of 10 of 19 advocates responded. All were men, most were retired, and all had faced a diagnosis of prostate cancer. Two major themes emerged: (1) the importance of patient education in promoting informed clinical decision-making and (2) a perceived need for patient-centered research by providers and educators. Conclusions. Prostate cancer patient advocates provide a broad range of opinions on the spectrum of cancer care. Similar studies among advocates involved in other malignancies may be worthwhile.
TL;DR: The importance of adverse event reporting in cancer supportive and palliative agents should go beyond that which is mandated by the Food and Drug Administration (FDA), and funding agencies and practicing oncologists should remain vigilant for such adverse events during the testing of new agents and after their approval.
Abstract: Background: Over 10 years after their approval as cancer supportive and palliative care agents, erythropoietin and the bisphosphonates began to show unexpected, serious adverse events, which resulted in dramatic changes in how they were subsequently prescribed to cancer patients. Objective: The purpose of this opinion piece is to reexamine what happened. Methods: We relied on the published literature as well as the investigators' own experience and preliminary data. Conclusion: The importance of adverse event reporting in cancer supportive and palliative agents should go beyond that which is mandated by the Food and Drug Administration (FDA). Funding agencies and practicing oncologists should remain vigilant for such adverse events during the testing of new agents and after their approval. They should be willing to report such events without delay.
TL;DR: A planned, interim, 6-patient toxicity analysis confirms the safety of pemetrexed, carboplatin, radiation with subsequent surgery, as prescribed in the North Central Cancer Treatment Group trial N044E, in patients with locally advanced esophageal cancer.
Abstract: Purpose: This brief report describes a planned, interim, 6-patient toxicity analysis that confirms the safety of pemetrexed, carboplatin, radiation with subsequent surgery, as prescribed in the North Central Cancer Treatment Group trial N044E, in patients with locally advanced esophageal cancer.
Methods: Six patients with locally advanced, potentially resectable esophageal cancer received pemetrexed 500 mg/m² and carboplatin AUC = 6 on days 1 and 22 with 5040 centigray of concomitant radiation in 28 fractions over 5.5 weeks followed by esophagectomy as a prelude to a phase II multi-institutional trial.
Results: Only 1 of the 6 patients experienced a grade 4 adverse event (neutropenia). This patient also experienced a grade 3 depression. Of the remaining 5 patients, three experienced at least one grade 3 adverse event (neutropenia, nausea/vomiting, and esophagitis). There were no deaths. Incidentally, one patient manifested a complete pathologic response, three a partial pathologic response, and one stable disease.
Conclusion: These preliminary observations on safety suggest that this regimen can be further studied in this clinical setting.
TL;DR: Elderly and younger patients were comparable based on gender, cancer site (gastric versus esophagus versus gastroesophageal junction), and body mas...
Abstract: 9507 Background: Do elderly patients with metastatic esophageal/gastric cancer do as well as their younger counterparts with chemotherapy? To our knowledge, this question remains unaddressed in pat...