Critical reviews in oncology/hematology
-
Crit. Rev. Oncol. Hematol. · May 2002
ReviewWhat is the proper threshold for platelet transfusion in patients with chemotherapy-induced thrombocytopenia?
Platelet transfusion therapy is an integral part of modern oncological practice and is used to treat hemorrhage associated with thrombocytopenia. More commonly, platelets are transfused to prevent hemorrhage in thrombocytopenic patients. ⋯ Many studies now support the safety of more conservative transfusion regimes that reduce patient exposure to donors and conserve precious resources, without an increase in risk of hemorrhage. This review presents the data to support the use of a prophylactic transfusion threshold of <10x10(9)/l in patients without risk factors for hemorrhage and who have ready access to emergent medical care.
-
Crit. Rev. Oncol. Hematol. · Dec 2001
ReviewNovel therapeutic approaches to cancer patients with bone metastasis.
Bone metastases are a common event in advanced cancer. Breast, lung, prostate and thyroid neoplasms have striking osteotropism. Bone metastatic cancer may be associated with catastrophic consequences for the patients. ⋯ Up to date, there are not standard criteria for the irradiation of bone metastases and bone pain relief may be reached using a variety of fractionation schemes. Radionuclide therapy is the systemic use of radioisotopes for bone pain. It is currently regarded as suitable for comparison with wide-field irradiation, but appears to have major disadvantages in terms of pain relief and toxicity.
-
Crit. Rev. Oncol. Hematol. · Nov 2001
ReviewReality and fugues in physicians facing death: confrontation, coping, and adaptation at the bedside.
This paper addresses the psychological effects and fears of physicians in their private and professional lives. It specifically looks at their experiences, perceptions, behavior, and vulnerability, especially when confronted with death and dying. The concepts of empathy, fears of oncologists, the mechanisms used for adaptation and coping, recommendations and interventions are presented. The success of a physician can be measured by the empathic yet objective relationship he/she establishes with the patient, while simultaneously building clear emotional and professional boundaries.
-
Crit. Rev. Oncol. Hematol. · Sep 2001
Prevalence of functional disability among elderly patients with cancer.
This study is part of a larger multicenter prospective study conducted in Italy to assess the efficacy of the comprehensive geriatric assessment (CGA) among elderly patients with cancer (i.e. aged 65 years or older). The prevalence of functional limitations, and its association with selected characteristics, was investigated among 303 elderly patients consecutively admitted at the Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico, Aviano (Northeast Italy), between 1995 and 1998. These patients had a median age of 72 years (range, 65-94), and were affected by haematological (n=182) or solid tumours (n=121). ⋯ Overall, 17% of the patients had a limitation for ADL, and 59% for IADL, the prevalence of functional disabilities increased with age. Specifically, 8% of patients had continence limitations and 13% had limitations in taking the prescribed drugs. By multivariate analysis, a poor PS turned out to be a strong independent determinant of both ADL and IADL disabilities.
-
Crit. Rev. Oncol. Hematol. · Jul 2001
Randomized Controlled Trial Multicenter Study Clinical TrialBiodistribution and dosimetry results from a phase III prospectively randomized controlled trial of Zevalin radioimmunotherapy for low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma.
Radiation dosimetry studies were performed in patients with non-Hodgkin's lymphoma (NHL) treated with 90Y Zevalin (90yttrium ibritumomab tiuxetan, IDEC-Y2B8) on a Phase III open-label prospectively randomized multicenter trial. The trial was designed to evaluate the efficacy and safety of 90Y Zevalin radioimmunotherapy compared to rituximab (Rituxan, MabThera) immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed NHL. An important secondary objective was to determine if radiation dosimetry prior to 90Y Zevalin administration is required for safe treatment in this patient population. ⋯ 90Y Zevalin administered to NHL patients at non-myeloablative maximum tolerated doses delivers acceptable radiation absorbed doses to uninvolved organs. Lack of correlation between dosimetric or pharmacokinetic parameters and the severity of hematologic nadir suggest that hematologic toxicity is more dependent on bone marrow reserve in this heavily pre-treated population. Based on these findings, it is safe to administer 90Y Zevalin in this defined patient population without pre-treatment (111)In-based radiation dosimetry.