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Expert Panel: Little support for delaying cosmetic procedures after isotretinoin
In most cases, there is little evidence to support delaying cosmetic procedures, such as laser therapy or chemical peels, in patients who have recently been treated with isotretinoin for acne, according to a consensus statement from the American Society of Dermatologic Surgery (ASDS).
An expert panel convened by the ASDS issued specific recommendations that supported safe, early initiation of cosmetic procedures in most cases. It noted that the likelihood of any potential harms from initiating cosmetic procedures after recent isotretinoin treatment is “low to very low” and that such harms have been reported only in case reports and case series.
Notable exceptions included dermabrasion and full-face ablative resurfacing; the experts recommended against having such procedures within 6 months of isotretinoin use because of potentially increased risks of adverse events in some patients.
“Potential benefits of this guideline include early access to scar treatments for many patients who are at the highest risk for scarring and, thereby, potentially improved patient quality of life,” Abigail Waldman, MD, of the department of dermatology at Brigham and Women’s Hospital, Boston, and her coauthors wrote in the consensus statement (Dermatol Surg. 2017 Oct;43[10]:1249-62). This is the first consensus statement document published by the ASDS to address this topic.
Isotretinoin was approved by the Food and Drug Administration in 1982 for treating severe and nodulocystic acne. Because of a perceived higher risk of scarring or irritation associated with isotretinoin use, standard clinical practice has been to avoid performing laser procedures, chemical peels, waxing, dermabrasion, and incisional or excisional cutaneous surgeries on patients within 6 months of their using isotretinoin, according to the authors. A warning regarding the potential for scarring with cosmetic procedures meant to smooth the skin is even included in the patient information leaflet for isotretinoin.
“This is in contradistinction to the observation that nodulocystic or severe inflammatory acne patients who have recently completed treatment with isotretinoin are among those most likely to benefit from treatment of their acne scars with modalities such as laser, dermabrasion, or chemical peels,” the experts wrote in the consensus recommendations.
Following a review of the 36 source documents, the task force concluded that, for patients currently or recently receiving isotretinoin, evidence was “insufficient” to justify delaying treatment with superficial chemical peels, vascular lasers, and nonablative modalities, such as hair removal lasers and lights. They also stated that superficial and focal dermabrasion “may also be safe when performed by a well-trained clinician” in a clinical setting.
The panel recommendations covered the following four key areas:
- Dermabrasion. Treating specific facial areas while the patient is on isotretinoin or within 6 months of discontinuation “is not associated with increased risk of scar or delay in wound healing, and there is no evidence in the literature that supports a need to delay treatment,” they wrote. In contrast, they did not recommend full-face or mechanical dermabrasion with rotary devices within the 6-month window because it may be “associated with increased risk of adverse events in selected patients.”
- Lasers and energy devices. Similarly, the panel found no evidence that would justify delaying use of vascular lasers, hair removal lasers and lights, and nonablative or ablative fractional devices among patients recently treated with isotretinoin. However, they said fully ablative treatment of the entire face or regions other than the face should “generally be avoided until 6 months after completion of isotretinoin treatment because of the likely elevated risk of avoidable adverse events.”
- Chemical peels. Patients currently on isotretinoin or who have recently discontinued it can safely undergo superficial chemical peels, according to the panel. For medium or deep chemical peels, there was “insufficient data … to preclude a recommendation in this case,” the panel wrote.
- Other surgeries. Because of the risk of dry eyes, isotretinoin should be discontinued prior to laser eye surgery. For incisional and excisional cutaneous surgery, the data on isotretinoin were insufficient to make any recommendations, the experts concluded, though they acknowledged that in some cases, the surgeries may be “medically necessary.”
Most of these recommendations were based on case series and cohort studies, the panel said, rather than higher-quality, randomized clinical trials, which are “generally impractical and not likely forthcoming in this setting.” Moreover, they cautioned that insufficient evidence to make a recommendation should not be misconstrued as a confirmation of safety or a warning about risk.
Overall, the results of the analysis suggested that “procedural interventions during or soon after isotretinoin treatment can safely and effectively address acne scarring and similar disorders, thus providing relief to patients without the need for protracted waiting,” the authors wrote.
In August, another expert panel’s recommendations were published, which concluded that skin procedures, including superficial chemical peels, laser hair removal, minor cutaneous surgery, manual dermabrasion, and fractional ablative and fractional nonablative laser procedures, can be performed safely on patients who have recently been or are currently being treated with isotretinoin (JAMA Dermatol. 2017 Aug 1;153[8]:802-9).
The authors of the ASDS statement reported no relevant financial conflicts.
In most cases, there is little evidence to support delaying cosmetic procedures, such as laser therapy or chemical peels, in patients who have recently been treated with isotretinoin for acne, according to a consensus statement from the American Society of Dermatologic Surgery (ASDS).
An expert panel convened by the ASDS issued specific recommendations that supported safe, early initiation of cosmetic procedures in most cases. It noted that the likelihood of any potential harms from initiating cosmetic procedures after recent isotretinoin treatment is “low to very low” and that such harms have been reported only in case reports and case series.
Notable exceptions included dermabrasion and full-face ablative resurfacing; the experts recommended against having such procedures within 6 months of isotretinoin use because of potentially increased risks of adverse events in some patients.
“Potential benefits of this guideline include early access to scar treatments for many patients who are at the highest risk for scarring and, thereby, potentially improved patient quality of life,” Abigail Waldman, MD, of the department of dermatology at Brigham and Women’s Hospital, Boston, and her coauthors wrote in the consensus statement (Dermatol Surg. 2017 Oct;43[10]:1249-62). This is the first consensus statement document published by the ASDS to address this topic.
Isotretinoin was approved by the Food and Drug Administration in 1982 for treating severe and nodulocystic acne. Because of a perceived higher risk of scarring or irritation associated with isotretinoin use, standard clinical practice has been to avoid performing laser procedures, chemical peels, waxing, dermabrasion, and incisional or excisional cutaneous surgeries on patients within 6 months of their using isotretinoin, according to the authors. A warning regarding the potential for scarring with cosmetic procedures meant to smooth the skin is even included in the patient information leaflet for isotretinoin.
“This is in contradistinction to the observation that nodulocystic or severe inflammatory acne patients who have recently completed treatment with isotretinoin are among those most likely to benefit from treatment of their acne scars with modalities such as laser, dermabrasion, or chemical peels,” the experts wrote in the consensus recommendations.
Following a review of the 36 source documents, the task force concluded that, for patients currently or recently receiving isotretinoin, evidence was “insufficient” to justify delaying treatment with superficial chemical peels, vascular lasers, and nonablative modalities, such as hair removal lasers and lights. They also stated that superficial and focal dermabrasion “may also be safe when performed by a well-trained clinician” in a clinical setting.
The panel recommendations covered the following four key areas:
- Dermabrasion. Treating specific facial areas while the patient is on isotretinoin or within 6 months of discontinuation “is not associated with increased risk of scar or delay in wound healing, and there is no evidence in the literature that supports a need to delay treatment,” they wrote. In contrast, they did not recommend full-face or mechanical dermabrasion with rotary devices within the 6-month window because it may be “associated with increased risk of adverse events in selected patients.”
- Lasers and energy devices. Similarly, the panel found no evidence that would justify delaying use of vascular lasers, hair removal lasers and lights, and nonablative or ablative fractional devices among patients recently treated with isotretinoin. However, they said fully ablative treatment of the entire face or regions other than the face should “generally be avoided until 6 months after completion of isotretinoin treatment because of the likely elevated risk of avoidable adverse events.”
- Chemical peels. Patients currently on isotretinoin or who have recently discontinued it can safely undergo superficial chemical peels, according to the panel. For medium or deep chemical peels, there was “insufficient data … to preclude a recommendation in this case,” the panel wrote.
- Other surgeries. Because of the risk of dry eyes, isotretinoin should be discontinued prior to laser eye surgery. For incisional and excisional cutaneous surgery, the data on isotretinoin were insufficient to make any recommendations, the experts concluded, though they acknowledged that in some cases, the surgeries may be “medically necessary.”
Most of these recommendations were based on case series and cohort studies, the panel said, rather than higher-quality, randomized clinical trials, which are “generally impractical and not likely forthcoming in this setting.” Moreover, they cautioned that insufficient evidence to make a recommendation should not be misconstrued as a confirmation of safety or a warning about risk.
Overall, the results of the analysis suggested that “procedural interventions during or soon after isotretinoin treatment can safely and effectively address acne scarring and similar disorders, thus providing relief to patients without the need for protracted waiting,” the authors wrote.
In August, another expert panel’s recommendations were published, which concluded that skin procedures, including superficial chemical peels, laser hair removal, minor cutaneous surgery, manual dermabrasion, and fractional ablative and fractional nonablative laser procedures, can be performed safely on patients who have recently been or are currently being treated with isotretinoin (JAMA Dermatol. 2017 Aug 1;153[8]:802-9).
The authors of the ASDS statement reported no relevant financial conflicts.
In most cases, there is little evidence to support delaying cosmetic procedures, such as laser therapy or chemical peels, in patients who have recently been treated with isotretinoin for acne, according to a consensus statement from the American Society of Dermatologic Surgery (ASDS).
An expert panel convened by the ASDS issued specific recommendations that supported safe, early initiation of cosmetic procedures in most cases. It noted that the likelihood of any potential harms from initiating cosmetic procedures after recent isotretinoin treatment is “low to very low” and that such harms have been reported only in case reports and case series.
Notable exceptions included dermabrasion and full-face ablative resurfacing; the experts recommended against having such procedures within 6 months of isotretinoin use because of potentially increased risks of adverse events in some patients.
“Potential benefits of this guideline include early access to scar treatments for many patients who are at the highest risk for scarring and, thereby, potentially improved patient quality of life,” Abigail Waldman, MD, of the department of dermatology at Brigham and Women’s Hospital, Boston, and her coauthors wrote in the consensus statement (Dermatol Surg. 2017 Oct;43[10]:1249-62). This is the first consensus statement document published by the ASDS to address this topic.
Isotretinoin was approved by the Food and Drug Administration in 1982 for treating severe and nodulocystic acne. Because of a perceived higher risk of scarring or irritation associated with isotretinoin use, standard clinical practice has been to avoid performing laser procedures, chemical peels, waxing, dermabrasion, and incisional or excisional cutaneous surgeries on patients within 6 months of their using isotretinoin, according to the authors. A warning regarding the potential for scarring with cosmetic procedures meant to smooth the skin is even included in the patient information leaflet for isotretinoin.
“This is in contradistinction to the observation that nodulocystic or severe inflammatory acne patients who have recently completed treatment with isotretinoin are among those most likely to benefit from treatment of their acne scars with modalities such as laser, dermabrasion, or chemical peels,” the experts wrote in the consensus recommendations.
Following a review of the 36 source documents, the task force concluded that, for patients currently or recently receiving isotretinoin, evidence was “insufficient” to justify delaying treatment with superficial chemical peels, vascular lasers, and nonablative modalities, such as hair removal lasers and lights. They also stated that superficial and focal dermabrasion “may also be safe when performed by a well-trained clinician” in a clinical setting.
The panel recommendations covered the following four key areas:
- Dermabrasion. Treating specific facial areas while the patient is on isotretinoin or within 6 months of discontinuation “is not associated with increased risk of scar or delay in wound healing, and there is no evidence in the literature that supports a need to delay treatment,” they wrote. In contrast, they did not recommend full-face or mechanical dermabrasion with rotary devices within the 6-month window because it may be “associated with increased risk of adverse events in selected patients.”
- Lasers and energy devices. Similarly, the panel found no evidence that would justify delaying use of vascular lasers, hair removal lasers and lights, and nonablative or ablative fractional devices among patients recently treated with isotretinoin. However, they said fully ablative treatment of the entire face or regions other than the face should “generally be avoided until 6 months after completion of isotretinoin treatment because of the likely elevated risk of avoidable adverse events.”
- Chemical peels. Patients currently on isotretinoin or who have recently discontinued it can safely undergo superficial chemical peels, according to the panel. For medium or deep chemical peels, there was “insufficient data … to preclude a recommendation in this case,” the panel wrote.
- Other surgeries. Because of the risk of dry eyes, isotretinoin should be discontinued prior to laser eye surgery. For incisional and excisional cutaneous surgery, the data on isotretinoin were insufficient to make any recommendations, the experts concluded, though they acknowledged that in some cases, the surgeries may be “medically necessary.”
Most of these recommendations were based on case series and cohort studies, the panel said, rather than higher-quality, randomized clinical trials, which are “generally impractical and not likely forthcoming in this setting.” Moreover, they cautioned that insufficient evidence to make a recommendation should not be misconstrued as a confirmation of safety or a warning about risk.
Overall, the results of the analysis suggested that “procedural interventions during or soon after isotretinoin treatment can safely and effectively address acne scarring and similar disorders, thus providing relief to patients without the need for protracted waiting,” the authors wrote.
In August, another expert panel’s recommendations were published, which concluded that skin procedures, including superficial chemical peels, laser hair removal, minor cutaneous surgery, manual dermabrasion, and fractional ablative and fractional nonablative laser procedures, can be performed safely on patients who have recently been or are currently being treated with isotretinoin (JAMA Dermatol. 2017 Aug 1;153[8]:802-9).
The authors of the ASDS statement reported no relevant financial conflicts.
FROM DERMATOLOGIC SURGERY
Key clinical point: Contrary to current recommendations,
Major finding: Experts convened by the American Society of Dermatologic Surgery found that, in most cases, the likelihood of potential harms of initiating cosmetic procedures after recent isotretinoin use is “low to very low,” and those that did occur were reported only in case reports and case series rather than in higher-quality clinical trials.
Data source: A consensus review of 36 source documents obtained by a literature review, the results of which were then validated by peer review.
Disclosures: The authors reported no relevant financial conflicts.
Better trials, more cooperation needed to improve continuous glucose monitoring devices
When continuous glucose monitoring (CGM) devices were first introduced, many thought they would revolutionize intensive insulin therapy for patients with diabetes. More than 15 years later, uptake is increasing but still remains low.
An expert working group convened by the (Diabetes Care. 2017 Oct 25. doi: 10.2337/dci17-0043).
“The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes,” John R. Petrie, MD, of the University of Glasgow, Scotland, and members of the working group wrote in the joint scientific statement.
Barriers to the uptake of CGM devices include cost and “human factors” issues such as the need for more audible alarms and easier-to-read displays, according to the joint statement. A lack of standardization in displaying results and uncertainty over the best way to use CGM data are also obstacles to widespread adoption.
The working group called for a systematic premarketing and postapproval evaluation of CGM system performance, as well as greater investment in clinical trials, including head-to-head comparisons and large independent registry studies. Other recommendations include the need for standardization of glucose data reporting, improved consistency and accessibility of postmarketing safety reports, and increased communication and cooperation between the various stakeholder groups.
The most important recommendation from the working group is the call for stakeholders to cooperate and communicate regularly, said A. Jay Cohen, MD, medical director of the Endocrine Clinic in Memphis, Tenn.
“That’s going to drive the momentum of change that’s going to help patients, and it’s also going to drive innovation,” he said.
After reviewing the joint scientific statement, Dr. Cohen said he would strongly encourage collaboration between stakeholders in government, insurance, clinical practice, industry, and patients to advance the use of CGM systems.
“The CGM systems have been not evolutionary, but revolutionary, in improvement in care for persons with diabetes and their families,” Dr. Cohen said. “They are a game changer, and besides … this unequivocally saves employers and insurers money, so it’s very cost effective in a very intuitive way.”
The joint scientific statement is based on review of more than 50 data sources, including recent clinical trials, research abstracts, regulatory authority databases, manufacturing company documents, and the clinical experience of the committee members.
“The guidelines set forth by this scientific statement will greatly inform providers and further advance the standardization, accuracy, and safety of CGM systems,” William T. Cefalu, MD, chief scientific, medical, and mission officer of the ADA, said in a statement.
Most members of the working group have relationships with industry, but industry “is considered to have had no impact on the manuscript or its content by reviewers from the ADA and EASD.”
When continuous glucose monitoring (CGM) devices were first introduced, many thought they would revolutionize intensive insulin therapy for patients with diabetes. More than 15 years later, uptake is increasing but still remains low.
An expert working group convened by the (Diabetes Care. 2017 Oct 25. doi: 10.2337/dci17-0043).
“The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes,” John R. Petrie, MD, of the University of Glasgow, Scotland, and members of the working group wrote in the joint scientific statement.
Barriers to the uptake of CGM devices include cost and “human factors” issues such as the need for more audible alarms and easier-to-read displays, according to the joint statement. A lack of standardization in displaying results and uncertainty over the best way to use CGM data are also obstacles to widespread adoption.
The working group called for a systematic premarketing and postapproval evaluation of CGM system performance, as well as greater investment in clinical trials, including head-to-head comparisons and large independent registry studies. Other recommendations include the need for standardization of glucose data reporting, improved consistency and accessibility of postmarketing safety reports, and increased communication and cooperation between the various stakeholder groups.
The most important recommendation from the working group is the call for stakeholders to cooperate and communicate regularly, said A. Jay Cohen, MD, medical director of the Endocrine Clinic in Memphis, Tenn.
“That’s going to drive the momentum of change that’s going to help patients, and it’s also going to drive innovation,” he said.
After reviewing the joint scientific statement, Dr. Cohen said he would strongly encourage collaboration between stakeholders in government, insurance, clinical practice, industry, and patients to advance the use of CGM systems.
“The CGM systems have been not evolutionary, but revolutionary, in improvement in care for persons with diabetes and their families,” Dr. Cohen said. “They are a game changer, and besides … this unequivocally saves employers and insurers money, so it’s very cost effective in a very intuitive way.”
The joint scientific statement is based on review of more than 50 data sources, including recent clinical trials, research abstracts, regulatory authority databases, manufacturing company documents, and the clinical experience of the committee members.
“The guidelines set forth by this scientific statement will greatly inform providers and further advance the standardization, accuracy, and safety of CGM systems,” William T. Cefalu, MD, chief scientific, medical, and mission officer of the ADA, said in a statement.
Most members of the working group have relationships with industry, but industry “is considered to have had no impact on the manuscript or its content by reviewers from the ADA and EASD.”
When continuous glucose monitoring (CGM) devices were first introduced, many thought they would revolutionize intensive insulin therapy for patients with diabetes. More than 15 years later, uptake is increasing but still remains low.
An expert working group convened by the (Diabetes Care. 2017 Oct 25. doi: 10.2337/dci17-0043).
“The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes,” John R. Petrie, MD, of the University of Glasgow, Scotland, and members of the working group wrote in the joint scientific statement.
Barriers to the uptake of CGM devices include cost and “human factors” issues such as the need for more audible alarms and easier-to-read displays, according to the joint statement. A lack of standardization in displaying results and uncertainty over the best way to use CGM data are also obstacles to widespread adoption.
The working group called for a systematic premarketing and postapproval evaluation of CGM system performance, as well as greater investment in clinical trials, including head-to-head comparisons and large independent registry studies. Other recommendations include the need for standardization of glucose data reporting, improved consistency and accessibility of postmarketing safety reports, and increased communication and cooperation between the various stakeholder groups.
The most important recommendation from the working group is the call for stakeholders to cooperate and communicate regularly, said A. Jay Cohen, MD, medical director of the Endocrine Clinic in Memphis, Tenn.
“That’s going to drive the momentum of change that’s going to help patients, and it’s also going to drive innovation,” he said.
After reviewing the joint scientific statement, Dr. Cohen said he would strongly encourage collaboration between stakeholders in government, insurance, clinical practice, industry, and patients to advance the use of CGM systems.
“The CGM systems have been not evolutionary, but revolutionary, in improvement in care for persons with diabetes and their families,” Dr. Cohen said. “They are a game changer, and besides … this unequivocally saves employers and insurers money, so it’s very cost effective in a very intuitive way.”
The joint scientific statement is based on review of more than 50 data sources, including recent clinical trials, research abstracts, regulatory authority databases, manufacturing company documents, and the clinical experience of the committee members.
“The guidelines set forth by this scientific statement will greatly inform providers and further advance the standardization, accuracy, and safety of CGM systems,” William T. Cefalu, MD, chief scientific, medical, and mission officer of the ADA, said in a statement.
Most members of the working group have relationships with industry, but industry “is considered to have had no impact on the manuscript or its content by reviewers from the ADA and EASD.”
FROM DIABETES CARE
Skills training improves psychosocial outcomes for young cancer patients
Compared with standard psychosocial care, a one-on-one skills-based intervention improved psychosocial outcomes in adolescents and young adults with cancer, according to results of a pilot randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
The novel intervention was associated with improved patient resilience, cancer-specific quality of life, and hope, plus fewer cases of depression, said lead study author Abby R. Rosenberg, MD, director of palliative care and resilience research at Seattle Children’s Research Institute.
Brief, developmentally-targeted psychosocial interventions are promising for this population of adolescents and young adults with cancer, Dr. Rosenberg said in a press conference at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Adolescents and young adults with cancer tend to have poor psychosocial outcomes, possibly because they have not yet developed skills that would help them manage hardships they encounter as a result of having cancer, according to Dr. Rosenberg.
She and her colleagues previously designed and tested the intervention, called Promoting Resilience in Stress Management (PRISM). The intervention is brief and focuses on helping patients develop skills in stress management, goal setting, positive reframing, and benefit finding.
The clinical evaluation of PRISM presented at the symposium included 100 English-speaking patients aged 12-25 who had new or recently recurrent cancer. They were randomized to the skills-based intervention or standard psychosocial care.
In the PRISM group, the adolescents and young adults participated in four in-person one-on-one training sessions lasting 30-60 minutes, plus a facilitated family meeting. Patients were surveyed at baseline and again at 6 months to measure the impact of the intervention.
A total of 36 patients in the PRISM arm and 38 in the usual-care arm completed the study. Most attrition was due to medical complications or death, the investigators said.
Results showed that, compared with standard psychosocial care, the skills-based intervention was associated with significant improvements in resilience (+2.3; 95% confidence interval, 0.7-4.0), hope (+2.8; 95% CI, 0.5-5.1), quality of life (+6.3; 95% CI, –0.8-13.5), and a trend toward less distress (–1.6; 95% CI –3.3-0.0).
Fewer cases of depression occurred in the PRISM group compared with the standard care group (two versus eight cases), Dr. Rosenberg added.
The psychosocial toll of cancer can be significant, especially in a vulnerable population such as adolescents and young adults, according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York. “The intervention by Rosenberg and her coauthors represents an important beacon of hope for improving the cancer experience for this population,” Dr. Epstein said.
Compared with standard psychosocial care, a one-on-one skills-based intervention improved psychosocial outcomes in adolescents and young adults with cancer, according to results of a pilot randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
The novel intervention was associated with improved patient resilience, cancer-specific quality of life, and hope, plus fewer cases of depression, said lead study author Abby R. Rosenberg, MD, director of palliative care and resilience research at Seattle Children’s Research Institute.
Brief, developmentally-targeted psychosocial interventions are promising for this population of adolescents and young adults with cancer, Dr. Rosenberg said in a press conference at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Adolescents and young adults with cancer tend to have poor psychosocial outcomes, possibly because they have not yet developed skills that would help them manage hardships they encounter as a result of having cancer, according to Dr. Rosenberg.
She and her colleagues previously designed and tested the intervention, called Promoting Resilience in Stress Management (PRISM). The intervention is brief and focuses on helping patients develop skills in stress management, goal setting, positive reframing, and benefit finding.
The clinical evaluation of PRISM presented at the symposium included 100 English-speaking patients aged 12-25 who had new or recently recurrent cancer. They were randomized to the skills-based intervention or standard psychosocial care.
In the PRISM group, the adolescents and young adults participated in four in-person one-on-one training sessions lasting 30-60 minutes, plus a facilitated family meeting. Patients were surveyed at baseline and again at 6 months to measure the impact of the intervention.
A total of 36 patients in the PRISM arm and 38 in the usual-care arm completed the study. Most attrition was due to medical complications or death, the investigators said.
Results showed that, compared with standard psychosocial care, the skills-based intervention was associated with significant improvements in resilience (+2.3; 95% confidence interval, 0.7-4.0), hope (+2.8; 95% CI, 0.5-5.1), quality of life (+6.3; 95% CI, –0.8-13.5), and a trend toward less distress (–1.6; 95% CI –3.3-0.0).
Fewer cases of depression occurred in the PRISM group compared with the standard care group (two versus eight cases), Dr. Rosenberg added.
The psychosocial toll of cancer can be significant, especially in a vulnerable population such as adolescents and young adults, according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York. “The intervention by Rosenberg and her coauthors represents an important beacon of hope for improving the cancer experience for this population,” Dr. Epstein said.
Compared with standard psychosocial care, a one-on-one skills-based intervention improved psychosocial outcomes in adolescents and young adults with cancer, according to results of a pilot randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
The novel intervention was associated with improved patient resilience, cancer-specific quality of life, and hope, plus fewer cases of depression, said lead study author Abby R. Rosenberg, MD, director of palliative care and resilience research at Seattle Children’s Research Institute.
Brief, developmentally-targeted psychosocial interventions are promising for this population of adolescents and young adults with cancer, Dr. Rosenberg said in a press conference at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Adolescents and young adults with cancer tend to have poor psychosocial outcomes, possibly because they have not yet developed skills that would help them manage hardships they encounter as a result of having cancer, according to Dr. Rosenberg.
She and her colleagues previously designed and tested the intervention, called Promoting Resilience in Stress Management (PRISM). The intervention is brief and focuses on helping patients develop skills in stress management, goal setting, positive reframing, and benefit finding.
The clinical evaluation of PRISM presented at the symposium included 100 English-speaking patients aged 12-25 who had new or recently recurrent cancer. They were randomized to the skills-based intervention or standard psychosocial care.
In the PRISM group, the adolescents and young adults participated in four in-person one-on-one training sessions lasting 30-60 minutes, plus a facilitated family meeting. Patients were surveyed at baseline and again at 6 months to measure the impact of the intervention.
A total of 36 patients in the PRISM arm and 38 in the usual-care arm completed the study. Most attrition was due to medical complications or death, the investigators said.
Results showed that, compared with standard psychosocial care, the skills-based intervention was associated with significant improvements in resilience (+2.3; 95% confidence interval, 0.7-4.0), hope (+2.8; 95% CI, 0.5-5.1), quality of life (+6.3; 95% CI, –0.8-13.5), and a trend toward less distress (–1.6; 95% CI –3.3-0.0).
Fewer cases of depression occurred in the PRISM group compared with the standard care group (two versus eight cases), Dr. Rosenberg added.
The psychosocial toll of cancer can be significant, especially in a vulnerable population such as adolescents and young adults, according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York. “The intervention by Rosenberg and her coauthors represents an important beacon of hope for improving the cancer experience for this population,” Dr. Epstein said.
FROM PALLONC 2017
Key clinical point: A one-on-one skills-based intervention improved psychosocial outcomes, compared with standard psychosocial care, in adolescents and young adults with cancer.
Major finding: The skills-based intervention was associated with improvements in resilience (+2.3; 95% CI, 0.7-4.0), hope (+2.8; 95% CI, 0.5-5.1), quality of life (+6.3; 95% CI, –0.8-13.5), and distress (–1.6; 95% CI –3.3-0.0).
Data source: A pilot study of 100 English-speaking cancer patients aged 12-25 who were randomly assigned to the skills-based intervention or standard psychosocial care.
Disclosures: The study was partly funded by the National Institutes of Health. The authors reported having no financial disclosures.
ACIP recommends third MMR dose, if outbreak risk
The Advisory Committee on Immunization Practices voted Oct. 25 to recommend a 3rd dose of measles, mumps, and rubella (MMR) vaccine for individuals at mumps risk from an outbreak.
The recommendation applies to individuals who already have been vaccinated with the usual two doses of MMR “who are identified by public health as at increased risk for mumps because of an outbreak,” according to draft text of the recommendation. This practice would “improve protection against mumps disease and related complications.”
Young adults are at highest risk, she said.
Key evidence supporting the ACIP’s recommendation includes one recent study suggesting a 3rd dose of MMR is effective for mumps outbreak control (N Engl J Med. 2017 Sep 7; doi: 10.1056/NEJMoa1703309).
In that study, Cristina V. Cardemil, MD, of the CDC, and her colleagues looked at college students who received a 3rd MMR dose during an outbreak of at the University of Iowa in Iowa City. Almost a quarter of students (4,783 of 20,496) enrolled in the 2015-2016 academic year received a 3rd dose. Compared with two doses of MMR, students receiving three total doses had a 78% lower risk of mumps at 28 days after vaccination, investigators reported.
“These findings suggest that the campaign to administer a 3rd dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak,” Dr. Cardemil and her colleagues wrote.
The vote in favor of a 3rd dose was unanimous among 15 voting members of ACIP. The committee’s recommendations must be approved by the CDC director before they are considered official recommendations.
The Advisory Committee on Immunization Practices voted Oct. 25 to recommend a 3rd dose of measles, mumps, and rubella (MMR) vaccine for individuals at mumps risk from an outbreak.
The recommendation applies to individuals who already have been vaccinated with the usual two doses of MMR “who are identified by public health as at increased risk for mumps because of an outbreak,” according to draft text of the recommendation. This practice would “improve protection against mumps disease and related complications.”
Young adults are at highest risk, she said.
Key evidence supporting the ACIP’s recommendation includes one recent study suggesting a 3rd dose of MMR is effective for mumps outbreak control (N Engl J Med. 2017 Sep 7; doi: 10.1056/NEJMoa1703309).
In that study, Cristina V. Cardemil, MD, of the CDC, and her colleagues looked at college students who received a 3rd MMR dose during an outbreak of at the University of Iowa in Iowa City. Almost a quarter of students (4,783 of 20,496) enrolled in the 2015-2016 academic year received a 3rd dose. Compared with two doses of MMR, students receiving three total doses had a 78% lower risk of mumps at 28 days after vaccination, investigators reported.
“These findings suggest that the campaign to administer a 3rd dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak,” Dr. Cardemil and her colleagues wrote.
The vote in favor of a 3rd dose was unanimous among 15 voting members of ACIP. The committee’s recommendations must be approved by the CDC director before they are considered official recommendations.
The Advisory Committee on Immunization Practices voted Oct. 25 to recommend a 3rd dose of measles, mumps, and rubella (MMR) vaccine for individuals at mumps risk from an outbreak.
The recommendation applies to individuals who already have been vaccinated with the usual two doses of MMR “who are identified by public health as at increased risk for mumps because of an outbreak,” according to draft text of the recommendation. This practice would “improve protection against mumps disease and related complications.”
Young adults are at highest risk, she said.
Key evidence supporting the ACIP’s recommendation includes one recent study suggesting a 3rd dose of MMR is effective for mumps outbreak control (N Engl J Med. 2017 Sep 7; doi: 10.1056/NEJMoa1703309).
In that study, Cristina V. Cardemil, MD, of the CDC, and her colleagues looked at college students who received a 3rd MMR dose during an outbreak of at the University of Iowa in Iowa City. Almost a quarter of students (4,783 of 20,496) enrolled in the 2015-2016 academic year received a 3rd dose. Compared with two doses of MMR, students receiving three total doses had a 78% lower risk of mumps at 28 days after vaccination, investigators reported.
“These findings suggest that the campaign to administer a 3rd dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak,” Dr. Cardemil and her colleagues wrote.
The vote in favor of a 3rd dose was unanimous among 15 voting members of ACIP. The committee’s recommendations must be approved by the CDC director before they are considered official recommendations.
AT AN ACIP MEETING
In close vote, advisory panel prefers Shingrix over Zostavax
Herpes zoster subunit vaccine (Shingrix) was preferentially recommended over zoster vaccine live (Zostavax) for preventing herpes zoster and related complications Oct. 25 at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Eight committee members voted for the recommendation, and seven voted against it.
In discussions leading up to the vote, some committee members cited potential supply issues, as well as the need for longer-term safety data, among other issues.
“I think it would be nice to see data on a larger population that is not just research-based, especially because we have very little data on ethnic minorities,” said Laura E. Riley, MD, of Harvard Medical School, Boston, who voted against the recommendation.
The vote comes several days after GlaxoSmithKline announced the Food and Drug Administration approval of Shingrix for the prevention of herpes zoster (shingles) in adults aged 50 years or older. In pooled clinical trial results, the vaccine demonstrated greater than 90% efficacy in all age groups, according to a company statement.
Shingrix is a non-live, recombinant subunit vaccine that is given in two doses, intramuscularly. Zostavax, also indicated in individuals aged 50 years or older, is a live attenuated virus vaccine.
In a related decision, ACIP voted 14-1 to recommend Shingrix for prevention of herpes zoster and related complications for immunocompetent adults aged 50 years and older.
They also voted 12-3 to recommend Shingrix to prevent herpes zoster and its complications for immunocompetent adults who previously received Zostavax.
Herpes zoster subunit vaccine (Shingrix) was preferentially recommended over zoster vaccine live (Zostavax) for preventing herpes zoster and related complications Oct. 25 at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Eight committee members voted for the recommendation, and seven voted against it.
In discussions leading up to the vote, some committee members cited potential supply issues, as well as the need for longer-term safety data, among other issues.
“I think it would be nice to see data on a larger population that is not just research-based, especially because we have very little data on ethnic minorities,” said Laura E. Riley, MD, of Harvard Medical School, Boston, who voted against the recommendation.
The vote comes several days after GlaxoSmithKline announced the Food and Drug Administration approval of Shingrix for the prevention of herpes zoster (shingles) in adults aged 50 years or older. In pooled clinical trial results, the vaccine demonstrated greater than 90% efficacy in all age groups, according to a company statement.
Shingrix is a non-live, recombinant subunit vaccine that is given in two doses, intramuscularly. Zostavax, also indicated in individuals aged 50 years or older, is a live attenuated virus vaccine.
In a related decision, ACIP voted 14-1 to recommend Shingrix for prevention of herpes zoster and related complications for immunocompetent adults aged 50 years and older.
They also voted 12-3 to recommend Shingrix to prevent herpes zoster and its complications for immunocompetent adults who previously received Zostavax.
Herpes zoster subunit vaccine (Shingrix) was preferentially recommended over zoster vaccine live (Zostavax) for preventing herpes zoster and related complications Oct. 25 at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Eight committee members voted for the recommendation, and seven voted against it.
In discussions leading up to the vote, some committee members cited potential supply issues, as well as the need for longer-term safety data, among other issues.
“I think it would be nice to see data on a larger population that is not just research-based, especially because we have very little data on ethnic minorities,” said Laura E. Riley, MD, of Harvard Medical School, Boston, who voted against the recommendation.
The vote comes several days after GlaxoSmithKline announced the Food and Drug Administration approval of Shingrix for the prevention of herpes zoster (shingles) in adults aged 50 years or older. In pooled clinical trial results, the vaccine demonstrated greater than 90% efficacy in all age groups, according to a company statement.
Shingrix is a non-live, recombinant subunit vaccine that is given in two doses, intramuscularly. Zostavax, also indicated in individuals aged 50 years or older, is a live attenuated virus vaccine.
In a related decision, ACIP voted 14-1 to recommend Shingrix for prevention of herpes zoster and related complications for immunocompetent adults aged 50 years and older.
They also voted 12-3 to recommend Shingrix to prevent herpes zoster and its complications for immunocompetent adults who previously received Zostavax.
FROM AN ACIP MEETING
Yoga benefits lung cancer patients and caregivers alike
Yoga provides physical and mental benefits for both lung cancer patients and their caregivers, according to results of a randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
“Overall, we are encouraged by the findings,” said lead study author, Kathrin Milbury, PhD, of University of Texas MD Anderson Cancer Center, Houston.
This study provides preliminary evidence that a yoga program can provide a “buffer” and improve physical function for patients, as well as self-reported improved quality of life for both patients and their caregivers, she added.
All patients in the study had non–small cell lung cancer and were undergoing thoracic radiation therapy, which can cause respiratory toxicities that negatively affect quality of life and physical activity, according to Dr. Milbury and her coinvestigators.
A total of 32 patient-caregiver dyads were randomized to participate in 15 yoga sessions or to be in a “wait-list” control group, and 26 dyads completed all assessments.
Patients who practiced yoga had significantly better scores on a 6-minute walking test (478 vs. 402 for wait-list enrollees; P less than .05), plus better stamina and mental health. Caregivers had improved fatigue and better stamina at work.
Almost all patients (96%) rated the program as “very useful,” investigators reported at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
This study provides additional evidence that yoga and other nonpharmacologic supportive therapies “can be integrated into not only the care of cancer patients, but also the family caregivers who support them,” according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York.
Next, the researchers plan to conduct a larger, randomized, controlled trial with a more stringent comparison group, according to Dr. Milbury.
This is an interesting study further supporting the benefits of yoga and meditation when dealing with a chronic illness such as lung cancer. The benefits included reducing stress and improving quality of life, not only for the patient but also the caregiver.
This is an interesting study further supporting the benefits of yoga and meditation when dealing with a chronic illness such as lung cancer. The benefits included reducing stress and improving quality of life, not only for the patient but also the caregiver.
This is an interesting study further supporting the benefits of yoga and meditation when dealing with a chronic illness such as lung cancer. The benefits included reducing stress and improving quality of life, not only for the patient but also the caregiver.
Yoga provides physical and mental benefits for both lung cancer patients and their caregivers, according to results of a randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
“Overall, we are encouraged by the findings,” said lead study author, Kathrin Milbury, PhD, of University of Texas MD Anderson Cancer Center, Houston.
This study provides preliminary evidence that a yoga program can provide a “buffer” and improve physical function for patients, as well as self-reported improved quality of life for both patients and their caregivers, she added.
All patients in the study had non–small cell lung cancer and were undergoing thoracic radiation therapy, which can cause respiratory toxicities that negatively affect quality of life and physical activity, according to Dr. Milbury and her coinvestigators.
A total of 32 patient-caregiver dyads were randomized to participate in 15 yoga sessions or to be in a “wait-list” control group, and 26 dyads completed all assessments.
Patients who practiced yoga had significantly better scores on a 6-minute walking test (478 vs. 402 for wait-list enrollees; P less than .05), plus better stamina and mental health. Caregivers had improved fatigue and better stamina at work.
Almost all patients (96%) rated the program as “very useful,” investigators reported at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
This study provides additional evidence that yoga and other nonpharmacologic supportive therapies “can be integrated into not only the care of cancer patients, but also the family caregivers who support them,” according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York.
Next, the researchers plan to conduct a larger, randomized, controlled trial with a more stringent comparison group, according to Dr. Milbury.
Yoga provides physical and mental benefits for both lung cancer patients and their caregivers, according to results of a randomized study presented at the Palliative and Supportive Care in Oncology Symposium.
“Overall, we are encouraged by the findings,” said lead study author, Kathrin Milbury, PhD, of University of Texas MD Anderson Cancer Center, Houston.
This study provides preliminary evidence that a yoga program can provide a “buffer” and improve physical function for patients, as well as self-reported improved quality of life for both patients and their caregivers, she added.
All patients in the study had non–small cell lung cancer and were undergoing thoracic radiation therapy, which can cause respiratory toxicities that negatively affect quality of life and physical activity, according to Dr. Milbury and her coinvestigators.
A total of 32 patient-caregiver dyads were randomized to participate in 15 yoga sessions or to be in a “wait-list” control group, and 26 dyads completed all assessments.
Patients who practiced yoga had significantly better scores on a 6-minute walking test (478 vs. 402 for wait-list enrollees; P less than .05), plus better stamina and mental health. Caregivers had improved fatigue and better stamina at work.
Almost all patients (96%) rated the program as “very useful,” investigators reported at the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
This study provides additional evidence that yoga and other nonpharmacologic supportive therapies “can be integrated into not only the care of cancer patients, but also the family caregivers who support them,” according to Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York.
Next, the researchers plan to conduct a larger, randomized, controlled trial with a more stringent comparison group, according to Dr. Milbury.
FROM PALLONC 2017
Key clinical point: Yoga provides both physical and mental benefits for lung cancer patients undergoing radiotherapy and their caregivers.
Major finding: Patients who practiced yoga had significantly better scores on a 6-minute walking test (478 vs. 402 for wait-list enrollees; P less than .05), plus better stamina and mental health. Caregivers had improved fatigue and better stamina at work.
Data source: Randomized study including 47 patient-caregiver dyads, of which 32 consented and 26 completed all assessments.
Disclosures: Funding for this study came from the National Institutes of Health. Lead author Kathrin Milbury, PhD, reported no potential conflicts of interest.
AML patients overestimate treatment risk and chance of cure
Older patients with acute myeloid leukemia (AML) tend to overestimate not only the risks of treatment, but also their likelihood of cure, according to the results of a 100-patient longitudinal study presented at the Palliative and Supportive Care in Oncology Symposium.
Compared with what their oncologists thought, patients were significantly more likely to believe they would die from treatment, said senior study author Areej El-Jawahri, MD, of Massachusetts General Hospital in Boston.
Yet when surveyed again 1 month later, they were significantly more likely to overestimate the chances of being cured, versus the chances of cure given by their oncologists.
“We really need interventions to facilitate communication and ensure accurate prognostic understanding in this patient population, where understanding the treatment risk and prognosis can have a significant effect on their treatment choices and treatment decisions,” Dr. El-Jawahri said in a press conference from the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Patients were first surveyed within 72 hours of starting chemotherapy.
At that point, 91% of patients said it was somewhat likely (63%) or extremely likely (28%) they would die as a result of their treatment, but among their oncologists, only 22% said death due to treatment was somewhat likely, and none thought it was very likely, according to the presented data.
A much different picture emerged 1 month later, when 90% of patients said they were somewhat or very likely to be cured of their leukemia, while only 26% of physicians said it was somewhat likely for the patient to be cured.
For both the question on treatment risk and the question on cure potential, the differences between patient responses and physician responses was significant (P less than .001), according to Dr. El-Jawahri.
Of note, half of the patients (n = 50) received intensive chemotherapy, while the other half received nonintensive (that is, palliative) chemotherapy. Patients receiving palliative therapy were even more likely to overestimate their chances of cure, Dr. El-Jawahi said.
This study highlights how stress and anxiety might shape a patient’s perception of treatment and prognosis, and provides new evidence that “accurate knowledge” can lead to “efficiencies on both sides of this [doctor-patient] interface,” said Andrew S. Epstein, MD, of Memorial Sloan-Kettering Cancer Center, New York.
A shared understanding of prognosis and treatment risk between clinician and patient is “crucial in informed consent” and can help patients make better-informed decisions with their doctor, said Dr. Epstein, who was not involved with the study.
This study was funded by a grant from the National Cancer Institute. Dr. El-Jawahri, the senior author, reported no relevant financial disclosures.
Older patients with acute myeloid leukemia (AML) tend to overestimate not only the risks of treatment, but also their likelihood of cure, according to the results of a 100-patient longitudinal study presented at the Palliative and Supportive Care in Oncology Symposium.
Compared with what their oncologists thought, patients were significantly more likely to believe they would die from treatment, said senior study author Areej El-Jawahri, MD, of Massachusetts General Hospital in Boston.
Yet when surveyed again 1 month later, they were significantly more likely to overestimate the chances of being cured, versus the chances of cure given by their oncologists.
“We really need interventions to facilitate communication and ensure accurate prognostic understanding in this patient population, where understanding the treatment risk and prognosis can have a significant effect on their treatment choices and treatment decisions,” Dr. El-Jawahri said in a press conference from the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Patients were first surveyed within 72 hours of starting chemotherapy.
At that point, 91% of patients said it was somewhat likely (63%) or extremely likely (28%) they would die as a result of their treatment, but among their oncologists, only 22% said death due to treatment was somewhat likely, and none thought it was very likely, according to the presented data.
A much different picture emerged 1 month later, when 90% of patients said they were somewhat or very likely to be cured of their leukemia, while only 26% of physicians said it was somewhat likely for the patient to be cured.
For both the question on treatment risk and the question on cure potential, the differences between patient responses and physician responses was significant (P less than .001), according to Dr. El-Jawahri.
Of note, half of the patients (n = 50) received intensive chemotherapy, while the other half received nonintensive (that is, palliative) chemotherapy. Patients receiving palliative therapy were even more likely to overestimate their chances of cure, Dr. El-Jawahi said.
This study highlights how stress and anxiety might shape a patient’s perception of treatment and prognosis, and provides new evidence that “accurate knowledge” can lead to “efficiencies on both sides of this [doctor-patient] interface,” said Andrew S. Epstein, MD, of Memorial Sloan-Kettering Cancer Center, New York.
A shared understanding of prognosis and treatment risk between clinician and patient is “crucial in informed consent” and can help patients make better-informed decisions with their doctor, said Dr. Epstein, who was not involved with the study.
This study was funded by a grant from the National Cancer Institute. Dr. El-Jawahri, the senior author, reported no relevant financial disclosures.
Older patients with acute myeloid leukemia (AML) tend to overestimate not only the risks of treatment, but also their likelihood of cure, according to the results of a 100-patient longitudinal study presented at the Palliative and Supportive Care in Oncology Symposium.
Compared with what their oncologists thought, patients were significantly more likely to believe they would die from treatment, said senior study author Areej El-Jawahri, MD, of Massachusetts General Hospital in Boston.
Yet when surveyed again 1 month later, they were significantly more likely to overestimate the chances of being cured, versus the chances of cure given by their oncologists.
“We really need interventions to facilitate communication and ensure accurate prognostic understanding in this patient population, where understanding the treatment risk and prognosis can have a significant effect on their treatment choices and treatment decisions,” Dr. El-Jawahri said in a press conference from the symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Patients were first surveyed within 72 hours of starting chemotherapy.
At that point, 91% of patients said it was somewhat likely (63%) or extremely likely (28%) they would die as a result of their treatment, but among their oncologists, only 22% said death due to treatment was somewhat likely, and none thought it was very likely, according to the presented data.
A much different picture emerged 1 month later, when 90% of patients said they were somewhat or very likely to be cured of their leukemia, while only 26% of physicians said it was somewhat likely for the patient to be cured.
For both the question on treatment risk and the question on cure potential, the differences between patient responses and physician responses was significant (P less than .001), according to Dr. El-Jawahri.
Of note, half of the patients (n = 50) received intensive chemotherapy, while the other half received nonintensive (that is, palliative) chemotherapy. Patients receiving palliative therapy were even more likely to overestimate their chances of cure, Dr. El-Jawahi said.
This study highlights how stress and anxiety might shape a patient’s perception of treatment and prognosis, and provides new evidence that “accurate knowledge” can lead to “efficiencies on both sides of this [doctor-patient] interface,” said Andrew S. Epstein, MD, of Memorial Sloan-Kettering Cancer Center, New York.
A shared understanding of prognosis and treatment risk between clinician and patient is “crucial in informed consent” and can help patients make better-informed decisions with their doctor, said Dr. Epstein, who was not involved with the study.
This study was funded by a grant from the National Cancer Institute. Dr. El-Jawahri, the senior author, reported no relevant financial disclosures.
FROM PALLONC 2017
Key clinical point: Acute myeloid leukemia (AML) patients overestimated both the risks of treatment and the chances of cure, compared with estimates from their own oncologists.
Major finding: Ninety-one percent of patients thought it was somewhat or extremely likely they would die from the treatment, while only 22% of oncologists said it was somewhat likely. A month later, 90% of patients thought it was somewhat or very likely they would be cured of their AML, but only 26% of oncologists said cure was somewhat likely.
Data source: A longitudinal study including 100 patients with newly diagnosed AML treated at one of two tertiary hospitals.
Disclosures: This study was funded by a grant from the National Cancer Institute. Dr. El-Jawahri, the senior author, reported no relevant financial disclosures.
Cancer patients prefer no computer at physician visit
Patients with cancer perceived physicians who did not use a computer as more compassionate, more professional, and better at communication, according to results of a randomized, video-based study presented at the Palliative and Supportive Care in Oncology Symposium.
In addition, the majority of patients said they would prefer having a doctor who communicated face to face (in other words, without aid of a computer) to be their provider, said Ali Haider, MD, of the University of Texas MD Anderson Cancer Center, Houston.
This is one of the few, if not only, studies to evaluate how the presence of a computer affects exam room interactions between physicians and patients, Dr. Haider said in a press conference held during the meeting.
To test the impact of the computer in the exam room, Dr. Haider and his colleagues created four different 3-minute video vignettes featuring two different actors playing physicians in an encounter with a patient. Each actor created one video in which he used a computer and one in which he did not. To minimize potential bias, the videos had identical scripts, and actors were careful to use the same gestures, expressions, and nonverbal communication in each video.
A total of 120 cancer patients were randomized to view two of the videos and fill out validated questionnaires rating their perception of the physician’s compassion, communication skills, and professionalism.
The face-to-face clinical encounter videos were associated with a median compassion score of 9 on a scale of 0-50 where 0 is best and 50 is worst; by comparison, the encounters with computers scored worse, at a median of 20 out of 50 (P = .0003). Likewise, the patients rated the face-to-face encounter videos significantly higher on communication skills (P = .0001) and professionalism (P = .013).
After watching both videos, the patients were asked which encounter they would personally prefer, and 86 (72%) said they liked the face-to-face communication video better.
Actors and patients were all blinded to the purpose of the study, according to the researchers.
Further research is required to confirm these findings in other clinical settings and populations, according to Dr. Haider.
“We believe these results may be different if we choose a younger population, or patients with high computer literacy,” he explained.
While more research may be needed, “face-to-face communication seems quite possibly the preferred route, despite the pressures clinicians have to search and document in the medical record,” said medical oncologist Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York, who was not involved with the study.
“In an age of ubiquitous technology, this study is an important reminder of the need to address the potential for technology to interfere with the patient-physician interface,” said Dr. Epstein, who moderated the press conference from the palliative care symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Patients with cancer perceived physicians who did not use a computer as more compassionate, more professional, and better at communication, according to results of a randomized, video-based study presented at the Palliative and Supportive Care in Oncology Symposium.
In addition, the majority of patients said they would prefer having a doctor who communicated face to face (in other words, without aid of a computer) to be their provider, said Ali Haider, MD, of the University of Texas MD Anderson Cancer Center, Houston.
This is one of the few, if not only, studies to evaluate how the presence of a computer affects exam room interactions between physicians and patients, Dr. Haider said in a press conference held during the meeting.
To test the impact of the computer in the exam room, Dr. Haider and his colleagues created four different 3-minute video vignettes featuring two different actors playing physicians in an encounter with a patient. Each actor created one video in which he used a computer and one in which he did not. To minimize potential bias, the videos had identical scripts, and actors were careful to use the same gestures, expressions, and nonverbal communication in each video.
A total of 120 cancer patients were randomized to view two of the videos and fill out validated questionnaires rating their perception of the physician’s compassion, communication skills, and professionalism.
The face-to-face clinical encounter videos were associated with a median compassion score of 9 on a scale of 0-50 where 0 is best and 50 is worst; by comparison, the encounters with computers scored worse, at a median of 20 out of 50 (P = .0003). Likewise, the patients rated the face-to-face encounter videos significantly higher on communication skills (P = .0001) and professionalism (P = .013).
After watching both videos, the patients were asked which encounter they would personally prefer, and 86 (72%) said they liked the face-to-face communication video better.
Actors and patients were all blinded to the purpose of the study, according to the researchers.
Further research is required to confirm these findings in other clinical settings and populations, according to Dr. Haider.
“We believe these results may be different if we choose a younger population, or patients with high computer literacy,” he explained.
While more research may be needed, “face-to-face communication seems quite possibly the preferred route, despite the pressures clinicians have to search and document in the medical record,” said medical oncologist Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York, who was not involved with the study.
“In an age of ubiquitous technology, this study is an important reminder of the need to address the potential for technology to interfere with the patient-physician interface,” said Dr. Epstein, who moderated the press conference from the palliative care symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Patients with cancer perceived physicians who did not use a computer as more compassionate, more professional, and better at communication, according to results of a randomized, video-based study presented at the Palliative and Supportive Care in Oncology Symposium.
In addition, the majority of patients said they would prefer having a doctor who communicated face to face (in other words, without aid of a computer) to be their provider, said Ali Haider, MD, of the University of Texas MD Anderson Cancer Center, Houston.
This is one of the few, if not only, studies to evaluate how the presence of a computer affects exam room interactions between physicians and patients, Dr. Haider said in a press conference held during the meeting.
To test the impact of the computer in the exam room, Dr. Haider and his colleagues created four different 3-minute video vignettes featuring two different actors playing physicians in an encounter with a patient. Each actor created one video in which he used a computer and one in which he did not. To minimize potential bias, the videos had identical scripts, and actors were careful to use the same gestures, expressions, and nonverbal communication in each video.
A total of 120 cancer patients were randomized to view two of the videos and fill out validated questionnaires rating their perception of the physician’s compassion, communication skills, and professionalism.
The face-to-face clinical encounter videos were associated with a median compassion score of 9 on a scale of 0-50 where 0 is best and 50 is worst; by comparison, the encounters with computers scored worse, at a median of 20 out of 50 (P = .0003). Likewise, the patients rated the face-to-face encounter videos significantly higher on communication skills (P = .0001) and professionalism (P = .013).
After watching both videos, the patients were asked which encounter they would personally prefer, and 86 (72%) said they liked the face-to-face communication video better.
Actors and patients were all blinded to the purpose of the study, according to the researchers.
Further research is required to confirm these findings in other clinical settings and populations, according to Dr. Haider.
“We believe these results may be different if we choose a younger population, or patients with high computer literacy,” he explained.
While more research may be needed, “face-to-face communication seems quite possibly the preferred route, despite the pressures clinicians have to search and document in the medical record,” said medical oncologist Andrew S. Epstein, MD, of Memorial Sloan Kettering Cancer Center, New York, who was not involved with the study.
“In an age of ubiquitous technology, this study is an important reminder of the need to address the potential for technology to interfere with the patient-physician interface,” said Dr. Epstein, who moderated the press conference from the palliative care symposium, which was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
AT PALLONC 2017
Key clinical point: Patients rate physicians who communicate face to face, without using a computer, as more compassionate, more professional, and better at communication.
Major finding: A total of 72% of patients preferred videos in which physicians did not use a computer during the conversation.
Data source: Randomized study including 120 adults who watched two short video vignettes depicting two different physician-patient encounters.
Disclosures: Dr. Haider reported no disclosures. The study was funded by the University of Texas MD Anderson Cancer Center.
Rheumatoid arthritis increases risk of COPD hospitalizations
Individuals with rheumatoid arthritis (RA) had an increased risk of hospitalizations from chronic obstructive pulmonary disease (COPD) when compared with the general population in a Canadian retrospective, population-based cohort study.
The risk of COPD hospitalizations was 47% higher in individuals with RA. “This finding emphasizes the need to control inflammation in rheumatoid arthritis, not only to prevent joint damage, but also to prevent complications of systemic inflammation, including the development of comorbidities such as cardiovascular diseases and COPD,” wrote Diane Lacaille, MD, of the University of British Columbia, Vancouver, and her coauthors (Arthritis Care Res. 2017 Oct 19. doi: 10.1002/acr.23410).
Several previous studies have suggested a link between COPD and inflammation, Dr. Lacaille and her colleagues said. Accordingly, they sought to evaluate the risk of COPD hospitalizations in a cohort of 24,625 individuals with RA as compared with 25,396 general population controls randomly selected and matched based on age, sex, and index year. Most subjects in the analysis were female, and the mean age at onset of RA was 57.2 years.
The investigators reported an increased incidence of COPD in individuals with RA, compared with controls, based on an incident rate ratio (IRR) of 1.58 (95% confidence interval, 1.34-1.87) that dropped to 1.47 (95% CI, 1.24-1.74) after adjustment for potential confounders, including comorbidities and health services usage at baseline. The overall incidence rate for COPD was 2.07 per 1,000 patient-years for RA patients and 1.31 per 1,000 patient-years for controls.
When the model was stratified based on sex, COPD hospitalization risk was significantly increased in women (adjusted hazard ratio [HR], 1.61; 95% CI, 1.30-1.98), but not in men (adjusted HR, 1.25; 95% CI, 0.95-1.66), they said.
Data were not available on smoking, the main COPD risk factor, for the patients in this study; however, the increased risk of COPD hospitalizations in the RA group remained significant after modeling for smoking, according to the investigators.
Combined, these results have “notable implications for the clinical care of RA and COPD,” Dr. Lacaille and her coinvestigators said.
Both clinicians and people living with RA “should be aware of the increased risk of developing COPD and be vigilant in watching for early symptoms of COPD, so that appropriate diagnostic tests can be administered at the onset of early symptoms,” they wrote. “Early detection of COPD is essential so that effective treatments can be initiated before irreversible damage to the lungs occurs, to improve long-term outcomes.”
These findings strengthen the conclusions of two previous cross-sectional studies showing an association between RA and COPD prevalence, according to the investigators. In one study, RA patients in Israel who were receiving disease-modifying antirheumatic drugs had double the prevalence of COPD, compared with general population controls, according to authors of that study (Immunol Res. 2013;56[2-3]:261-6). Similarly, U.K. investigators compared 421 RA patients against controls and reported a twofold increase in obstructive pattern on screening spirometry in the RA group (Ann Rheum Dis. 2013;72:1517-23).
The current study from Dr. Lacaille and her coinvestigators was supported by funding from the Canadian Institute for Health Research. The authors reported that they had no financial disclosures, conflicts of interest, or benefits from commercial sources.
Individuals with rheumatoid arthritis (RA) had an increased risk of hospitalizations from chronic obstructive pulmonary disease (COPD) when compared with the general population in a Canadian retrospective, population-based cohort study.
The risk of COPD hospitalizations was 47% higher in individuals with RA. “This finding emphasizes the need to control inflammation in rheumatoid arthritis, not only to prevent joint damage, but also to prevent complications of systemic inflammation, including the development of comorbidities such as cardiovascular diseases and COPD,” wrote Diane Lacaille, MD, of the University of British Columbia, Vancouver, and her coauthors (Arthritis Care Res. 2017 Oct 19. doi: 10.1002/acr.23410).
Several previous studies have suggested a link between COPD and inflammation, Dr. Lacaille and her colleagues said. Accordingly, they sought to evaluate the risk of COPD hospitalizations in a cohort of 24,625 individuals with RA as compared with 25,396 general population controls randomly selected and matched based on age, sex, and index year. Most subjects in the analysis were female, and the mean age at onset of RA was 57.2 years.
The investigators reported an increased incidence of COPD in individuals with RA, compared with controls, based on an incident rate ratio (IRR) of 1.58 (95% confidence interval, 1.34-1.87) that dropped to 1.47 (95% CI, 1.24-1.74) after adjustment for potential confounders, including comorbidities and health services usage at baseline. The overall incidence rate for COPD was 2.07 per 1,000 patient-years for RA patients and 1.31 per 1,000 patient-years for controls.
When the model was stratified based on sex, COPD hospitalization risk was significantly increased in women (adjusted hazard ratio [HR], 1.61; 95% CI, 1.30-1.98), but not in men (adjusted HR, 1.25; 95% CI, 0.95-1.66), they said.
Data were not available on smoking, the main COPD risk factor, for the patients in this study; however, the increased risk of COPD hospitalizations in the RA group remained significant after modeling for smoking, according to the investigators.
Combined, these results have “notable implications for the clinical care of RA and COPD,” Dr. Lacaille and her coinvestigators said.
Both clinicians and people living with RA “should be aware of the increased risk of developing COPD and be vigilant in watching for early symptoms of COPD, so that appropriate diagnostic tests can be administered at the onset of early symptoms,” they wrote. “Early detection of COPD is essential so that effective treatments can be initiated before irreversible damage to the lungs occurs, to improve long-term outcomes.”
These findings strengthen the conclusions of two previous cross-sectional studies showing an association between RA and COPD prevalence, according to the investigators. In one study, RA patients in Israel who were receiving disease-modifying antirheumatic drugs had double the prevalence of COPD, compared with general population controls, according to authors of that study (Immunol Res. 2013;56[2-3]:261-6). Similarly, U.K. investigators compared 421 RA patients against controls and reported a twofold increase in obstructive pattern on screening spirometry in the RA group (Ann Rheum Dis. 2013;72:1517-23).
The current study from Dr. Lacaille and her coinvestigators was supported by funding from the Canadian Institute for Health Research. The authors reported that they had no financial disclosures, conflicts of interest, or benefits from commercial sources.
Individuals with rheumatoid arthritis (RA) had an increased risk of hospitalizations from chronic obstructive pulmonary disease (COPD) when compared with the general population in a Canadian retrospective, population-based cohort study.
The risk of COPD hospitalizations was 47% higher in individuals with RA. “This finding emphasizes the need to control inflammation in rheumatoid arthritis, not only to prevent joint damage, but also to prevent complications of systemic inflammation, including the development of comorbidities such as cardiovascular diseases and COPD,” wrote Diane Lacaille, MD, of the University of British Columbia, Vancouver, and her coauthors (Arthritis Care Res. 2017 Oct 19. doi: 10.1002/acr.23410).
Several previous studies have suggested a link between COPD and inflammation, Dr. Lacaille and her colleagues said. Accordingly, they sought to evaluate the risk of COPD hospitalizations in a cohort of 24,625 individuals with RA as compared with 25,396 general population controls randomly selected and matched based on age, sex, and index year. Most subjects in the analysis were female, and the mean age at onset of RA was 57.2 years.
The investigators reported an increased incidence of COPD in individuals with RA, compared with controls, based on an incident rate ratio (IRR) of 1.58 (95% confidence interval, 1.34-1.87) that dropped to 1.47 (95% CI, 1.24-1.74) after adjustment for potential confounders, including comorbidities and health services usage at baseline. The overall incidence rate for COPD was 2.07 per 1,000 patient-years for RA patients and 1.31 per 1,000 patient-years for controls.
When the model was stratified based on sex, COPD hospitalization risk was significantly increased in women (adjusted hazard ratio [HR], 1.61; 95% CI, 1.30-1.98), but not in men (adjusted HR, 1.25; 95% CI, 0.95-1.66), they said.
Data were not available on smoking, the main COPD risk factor, for the patients in this study; however, the increased risk of COPD hospitalizations in the RA group remained significant after modeling for smoking, according to the investigators.
Combined, these results have “notable implications for the clinical care of RA and COPD,” Dr. Lacaille and her coinvestigators said.
Both clinicians and people living with RA “should be aware of the increased risk of developing COPD and be vigilant in watching for early symptoms of COPD, so that appropriate diagnostic tests can be administered at the onset of early symptoms,” they wrote. “Early detection of COPD is essential so that effective treatments can be initiated before irreversible damage to the lungs occurs, to improve long-term outcomes.”
These findings strengthen the conclusions of two previous cross-sectional studies showing an association between RA and COPD prevalence, according to the investigators. In one study, RA patients in Israel who were receiving disease-modifying antirheumatic drugs had double the prevalence of COPD, compared with general population controls, according to authors of that study (Immunol Res. 2013;56[2-3]:261-6). Similarly, U.K. investigators compared 421 RA patients against controls and reported a twofold increase in obstructive pattern on screening spirometry in the RA group (Ann Rheum Dis. 2013;72:1517-23).
The current study from Dr. Lacaille and her coinvestigators was supported by funding from the Canadian Institute for Health Research. The authors reported that they had no financial disclosures, conflicts of interest, or benefits from commercial sources.
FROM Arthritis Care AND Research
Key clinical point:
Major finding: The risk of COPD hospitalizations was 47% higher in individuals with rheumatoid arthritis (adjusted hazard ratio, 1.47; 95% confidence interval, 1.34-1.87).
Data source: A retrospective cohort study including approximately 25,000 RA patients seen in British Columbia and a roughly equal number of controls.
Disclosures: The Canadian Institute for Health Research provided funding for the study. The authors reported that they had no financial disclosures, conflicts of interest, or benefits from commercial sources.
Rituximab improves salvage in elderly B-cell lymphoma patients
In elderly patients with aggressive B-cell lymphomas who experience treatment failure after CHOP or rituximab-CHOP (R-CHOP), the outcomes of subsequent salvage therapy were improved when rituximab was included, results of a retrospective analysis suggest.
“Survival after rituximab-containing salvage therapy was better in all patient groups, supporting the repeated administration of rituximab to all patients needing salvage therapy,” wrote investigator Bertram Glass, MD, of the department of hematology and stem cell transplantation at Helios Klinikum Berlin-Buch, Berlin, and his coauthors (Ann Oncol. 2017 Oct 6. doi: 10.1093/annonc/mdx556).
Dr. Glass and colleagues reviewed data from the randomized RICOVER-60 trial, which included 1,222 patients aged 61-80 years with aggressive B-cell lymphomas who received CHOP or R-CHOP for six or eight cycles. Based on survival outcomes, six cycles of R-CHOP every 2 weeks should be the preferred regimen, investigators wrote when the study results were published in 2008 (Lancet Oncol. 2008;9[2]:105-16. doi: 10.1016/S1470-2045(08)70002-0).
Of 1,222 patients in the RICOVER-60 trial, 301 (24.6%) had treatment failure, of whom 297 could be included in the present analysis.
Rituximab, included in salvage therapy for 57.4% of those evaluable patients, was found to improve the 2-year survival rate from 20.7% to 46.8% (P less than .001), Dr. Glass and his coinvestigators reported.
The benefit of rituximab in the salvage setting was apparent regardless of whether patients received R-CHOP or CHOP as part of their initial therapy in RICOVER-60, they added.
Among patients who had received CHOP as first-line therapy, 2-year overall survival was 49.6% for those who received rituximab in the salvage setting, compared with 19.1% for those who did not (P less than .001), according to the published data. Likewise, in the initial R-CHOP group, 2-year overall survival was 33.1% for rituximab in salvage and 22.5% for no rituximab in salvage (P = .034).
The investigators also looked for differences in prognosis according to specific patient characteristics, including presence of MYC rearrangements and MYC expression by immunohistochemistry.
In patients with MYC translocation at diagnosis, use of rituximab reduced risk of initial treatment failure from 58.8% to 26.3%, according to the investigators. After treatment failure, patients who initially received CHOP had significantly improved 2-year survival if they had MYC translocations or negative MYC immunohistochemistry, though no such association was found for patients who initially received R-CHOP, they wrote.
Dr. Glass and colleagues concluded that new treatment strategies are needed.
“Overall, the outcome of second-line treatment of elderly patients with refractory and relapsed aggressive B-cell lymphoma is disappointing and worse than in younger patients regardless of the modality chosen,” they wrote. “New drugs and treatment modalities with the potential to change the dismal outlook for elderly patients with aggressive B-cell lymphomas are eagerly awaited.”
Dr. Glass and several coauthors reported honoraria, research funding, and consultancies with Roche.
In elderly patients with aggressive B-cell lymphomas who experience treatment failure after CHOP or rituximab-CHOP (R-CHOP), the outcomes of subsequent salvage therapy were improved when rituximab was included, results of a retrospective analysis suggest.
“Survival after rituximab-containing salvage therapy was better in all patient groups, supporting the repeated administration of rituximab to all patients needing salvage therapy,” wrote investigator Bertram Glass, MD, of the department of hematology and stem cell transplantation at Helios Klinikum Berlin-Buch, Berlin, and his coauthors (Ann Oncol. 2017 Oct 6. doi: 10.1093/annonc/mdx556).
Dr. Glass and colleagues reviewed data from the randomized RICOVER-60 trial, which included 1,222 patients aged 61-80 years with aggressive B-cell lymphomas who received CHOP or R-CHOP for six or eight cycles. Based on survival outcomes, six cycles of R-CHOP every 2 weeks should be the preferred regimen, investigators wrote when the study results were published in 2008 (Lancet Oncol. 2008;9[2]:105-16. doi: 10.1016/S1470-2045(08)70002-0).
Of 1,222 patients in the RICOVER-60 trial, 301 (24.6%) had treatment failure, of whom 297 could be included in the present analysis.
Rituximab, included in salvage therapy for 57.4% of those evaluable patients, was found to improve the 2-year survival rate from 20.7% to 46.8% (P less than .001), Dr. Glass and his coinvestigators reported.
The benefit of rituximab in the salvage setting was apparent regardless of whether patients received R-CHOP or CHOP as part of their initial therapy in RICOVER-60, they added.
Among patients who had received CHOP as first-line therapy, 2-year overall survival was 49.6% for those who received rituximab in the salvage setting, compared with 19.1% for those who did not (P less than .001), according to the published data. Likewise, in the initial R-CHOP group, 2-year overall survival was 33.1% for rituximab in salvage and 22.5% for no rituximab in salvage (P = .034).
The investigators also looked for differences in prognosis according to specific patient characteristics, including presence of MYC rearrangements and MYC expression by immunohistochemistry.
In patients with MYC translocation at diagnosis, use of rituximab reduced risk of initial treatment failure from 58.8% to 26.3%, according to the investigators. After treatment failure, patients who initially received CHOP had significantly improved 2-year survival if they had MYC translocations or negative MYC immunohistochemistry, though no such association was found for patients who initially received R-CHOP, they wrote.
Dr. Glass and colleagues concluded that new treatment strategies are needed.
“Overall, the outcome of second-line treatment of elderly patients with refractory and relapsed aggressive B-cell lymphoma is disappointing and worse than in younger patients regardless of the modality chosen,” they wrote. “New drugs and treatment modalities with the potential to change the dismal outlook for elderly patients with aggressive B-cell lymphomas are eagerly awaited.”
Dr. Glass and several coauthors reported honoraria, research funding, and consultancies with Roche.
In elderly patients with aggressive B-cell lymphomas who experience treatment failure after CHOP or rituximab-CHOP (R-CHOP), the outcomes of subsequent salvage therapy were improved when rituximab was included, results of a retrospective analysis suggest.
“Survival after rituximab-containing salvage therapy was better in all patient groups, supporting the repeated administration of rituximab to all patients needing salvage therapy,” wrote investigator Bertram Glass, MD, of the department of hematology and stem cell transplantation at Helios Klinikum Berlin-Buch, Berlin, and his coauthors (Ann Oncol. 2017 Oct 6. doi: 10.1093/annonc/mdx556).
Dr. Glass and colleagues reviewed data from the randomized RICOVER-60 trial, which included 1,222 patients aged 61-80 years with aggressive B-cell lymphomas who received CHOP or R-CHOP for six or eight cycles. Based on survival outcomes, six cycles of R-CHOP every 2 weeks should be the preferred regimen, investigators wrote when the study results were published in 2008 (Lancet Oncol. 2008;9[2]:105-16. doi: 10.1016/S1470-2045(08)70002-0).
Of 1,222 patients in the RICOVER-60 trial, 301 (24.6%) had treatment failure, of whom 297 could be included in the present analysis.
Rituximab, included in salvage therapy for 57.4% of those evaluable patients, was found to improve the 2-year survival rate from 20.7% to 46.8% (P less than .001), Dr. Glass and his coinvestigators reported.
The benefit of rituximab in the salvage setting was apparent regardless of whether patients received R-CHOP or CHOP as part of their initial therapy in RICOVER-60, they added.
Among patients who had received CHOP as first-line therapy, 2-year overall survival was 49.6% for those who received rituximab in the salvage setting, compared with 19.1% for those who did not (P less than .001), according to the published data. Likewise, in the initial R-CHOP group, 2-year overall survival was 33.1% for rituximab in salvage and 22.5% for no rituximab in salvage (P = .034).
The investigators also looked for differences in prognosis according to specific patient characteristics, including presence of MYC rearrangements and MYC expression by immunohistochemistry.
In patients with MYC translocation at diagnosis, use of rituximab reduced risk of initial treatment failure from 58.8% to 26.3%, according to the investigators. After treatment failure, patients who initially received CHOP had significantly improved 2-year survival if they had MYC translocations or negative MYC immunohistochemistry, though no such association was found for patients who initially received R-CHOP, they wrote.
Dr. Glass and colleagues concluded that new treatment strategies are needed.
“Overall, the outcome of second-line treatment of elderly patients with refractory and relapsed aggressive B-cell lymphoma is disappointing and worse than in younger patients regardless of the modality chosen,” they wrote. “New drugs and treatment modalities with the potential to change the dismal outlook for elderly patients with aggressive B-cell lymphomas are eagerly awaited.”
Dr. Glass and several coauthors reported honoraria, research funding, and consultancies with Roche.
FROM ANNALS OF ONCOLOGY
Key clinical point: Rituximab improved salvage therapy for elderly patients with aggressive-B-cell lymphoma who relapsed after CHOP or R-CHOP.
Major finding: Rituximab as part of a salvage regimen improved the 2-year survival rate from 20.7% to 46.8% (P less than .001).
Data source: Retrospective analysis including 297 elderly patients in the RICOVER-60 trial who had progressive, persistent, or relapsed lymphoma.
Disclosures: Dr. Glass and several coauthors reported honoraria, research funding, and consultancies with Roche.