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Risk Calculator for Ischemic Heart Disease and Stroke in Childhood Cancer Survivors
Cardiovascular disease is a leading contributor to early morbidity and mortality in survivors of childhood cancer. In a review of 13,060 participants in the Childhood Cancer Survivor Study who were diagnosed and treated for cancer prior to age 21 and observed through the age of 50, the cumulative incidence of ischemic heart disease and stroke was 2 percent each condition. A risk prediction model was developed incorporating sex, age at cancer diagnosis, and chemotherapy and/or radiotherapy regimen used, to identify low-, intermediate-, and high-risk groups for both outcomes. The cardiovascular risk calculator is available online.
Health Risks of Consistent Low-Level Smoking
Although cigarette smoking is widely recognized as having adverse effects on health, patients sometimes feel that if they don't smoke very much, they will be safe from health risks. However, a prospective cohort study found higher all-cause mortality and cancer incidence among people aged 59 to 82 who consistently smoked 10 or fewer cigarettes a day than among never-smokers. Even smoking less than one cigarette daily was associated with higher mortality and cancer rates. Quitting smoking lowered the risks; the younger the age at quitting, the lower the risks. Sharing such data with patients may help to encourage quitting smoking.
Caution Advised for Active Surveillance for Intermediate-Risk Prostate Cancer
Active surveillance (observation rather than immediate therapy, with curative-intent treatment deferred until evidence of increased risk for progression) is a management option for appropriately selected men with prostate cancer. A retrospective study found that men with low-volume intermediate-risk disease who underwent immediate radical prostatectomy were at increased risk for adverse pathologic findings compared with those with low-risk or very low-risk prostate cancer. While major guidelines consider active surveillance a potential option for men with favorable intermediate-risk disease, particular caution should be exercised if active surveillance is being considered in men in this group.
Alternating Electric Field Therapy in Newly Diagnosed Glioblastoma
Low-intensity alternating electric field therapy (TTFields) is a novel treatment strategy for glioblastoma, delivered continuously by transducers applied to a shaved scalp. In an open-label randomized trial of 695 adults with newly diagnosed glioblastoma, median survival was improved in patients assigned to wear the device during the adjuvant temozolomide phase of standard chemoradiation compared with those assigned to standard chemoradiation alone (21 versus 16 months). Given the magnitude of potential benefit, we discuss the option of TTFields in patients with newly diagnosed glioblastoma. Use of the device is encouraged in interested patients, although the requirement to carry a device and maintain a shaved scalp for the duration of treatment presents a potential burden that is not acceptable to all patients.
Hypersensitivity Reactions With Rolapitant
Rolapitant is a neurokinin-1 receptor antagonist used, in combination with other antiemetic agents, to prevent delayed nausea and vomiting associated with cancer chemotherapy. Postmarketing reports have surfaced about anaphylaxis, anaphylactic shock, and other serious hypersensitivity reactions in patients receiving intravenous rolapitant emulsion, which is in soybean oil, occurring during or soon after drug infusion. Clinicians are advised to watch for signs of hypersensitivity or anaphylaxis during and following administration of rolapitant, and to ask patients prior to the first dose if they are allergic to legumes. Patients with known allergies to soybeans, legumes, or other related allergens (including peanuts) should be monitored especially closely. If any serious reaction occurs, rolapitant should be immediately and permanently discontinued.
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