Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life

Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML) | Journal of Clinical Oncology

End-of-life care is particularly relevant for older adults with AML because of their poor prognosis.

We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment. Predictors of these end points were evaluated using multivariable logistic regression analyses.

In the overall cohort (N = 13,156), hospice care after AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012, but the increase was primarily driven by late hospice enrollment that occurred in the last 7 days of life. Among the 5,847 patients who enrolled in hospice, 47.4% and 28.8% started their first hospice enrollment in the last 7 and 3 days of life, respectively. Among patients who transferred in and out of hospice care, 62% received transfusions outside hospice. Additionally, the use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Patients who were male and nonwhite were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life. Conversely, older patients were less likely to receive chemotherapy or have intensive care unit admission at the end of life, and were more likely to enroll in hospice.

End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.

Full reference: Wang, R. et al. (2017) Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life. Journal of Clinical Oncology. Published online: 7th August 2017

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NICE Quality Standard: Haematological cancers

NICE has published a new quality standard Haematological cancers (QS150).

This quality standard covers diagnostic reporting and the organisation of haematological cancer services for people of all ages (including children and young people) and managing haematological cancers in adults and young people (aged 16 and over). It describes high-quality care in priority areas for improvement.

Amino acids in diet could be key to starving cancer

Cutting out certain amino acids from the diet of mice slows tumor growth and prolongs survival, according to new research | ScienceDaily

https://en.wikipedia.org/wiki/Glycine#/media/File:Glycin.jpg

SPOTzillah – Wikipedia // CC BY-SA 4.0

Image shows glycine; a white crystalline solid

Researchers at the Cancer Research UK Beatson Institute and the University of Glasgow found that removing two non-essential amino acids — serine and glycine — from the diet of mice slowed the development of lymphoma and intestinal cancer.

The researchers also found that the special diet made some cancer cells more susceptible to chemicals in cells called reactive oxygen species.

Chemotherapy and radiotherapy boost levels of these chemicals in the cells, so this research suggests a specially formulated diet could make conventional cancer treatments more effective.

Read the full commentary here

The original research abstract is available here

How big data is being mobilised in the fight against leukaemia

In a project funded by Bloodwise and the Scottish Cancer Foundation, we have created LEUKomics. This online data portal brings together a wealth of CML gene expression data from specialised laboratories across the globe | Lorna Jackson & Lisa Hopcroft for The Conversation

Leucemia mieloide cronica (LMC)

Image source: Paulo Henrique Orlandi Mourao – Wikimedia // CC BY-SA 3.0

Our intention is to eliminate the bottleneck surrounding big data analysis in CML. Each dataset is subjected to manual quality checks, and all the necessary computational processing to extract information on gene expression. This enables immediate access to and interpretation of data that previously would not have been easily accessible to academics or clinicians without training in specialised computational approaches.

Consolidating these data into a single resource also allows large-scale, computationally-intensive research efforts by bioinformaticians (specialists in the analysis of big data in biology). From a computational perspective, the fact that CML is caused by a single mutation makes it an attractive disease model for cancer stem cells. However, existing datasets tend to have small sample numbers, which can limit their potential.

Read the full blog post here

Management of Early-stage Hodgkin Lymphoma: A Practice Guideline

Herst, J. et al. Clinical Oncology. Published online: September 30 2016

Highlights

  • A clinical practice guideline for early stage Hodgkin lymphoma is proposed.
  • The recommendations, based on a systematic review, have been reviewed by an external panel.
  • Evidence quality was evaluated with the Cochrane Risk of Bias tool and we used GRADE.
  • Combined modality therapy or chemotherapy alone are options for early-stage Hodgkin lymphoma.
  • PET scanning was not considered a good tool to identify patients for whom IFRT could be omitted.

Abstract

In the past, treatment for patients with early-stage Hodgkin lymphoma consisted mainly of radiotherapy. Now, chemotherapy alone and chemoradiotherapy are treatment options. These guidelines aim to provide recommendations on the optimal management of early-stage Hodgkin lymphoma.

We conducted a systematic review searching MEDLINE, EMBASE, the Cochrane Library and other literature sources from 2003 to 2015, and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Two authors independently reviewed and selected studies, and appraised the evidence quality. The document underwent internal and external review by content, methodology experts, a patient representative and clinicians in Ontario.

We have issued recommendations for patients with classical Hodgkin lymphoma and with nodular lymphocyte predominant Hodgkin lymphoma; with favourable and unfavourable prognosis; and for the use of positron emission tomography to direct treatment. We have provided our interpretation of the evidence and considerations for implementation. Examples of recommendations are: ‘Patients with early-stage classical Hodgkin lymphoma should not be treated with radiotherapy alone’; ‘chemotherapy plus radiotherapy or chemotherapy alone are recommended treatment options for patients with early-stage non-bulky Hodgkin lymphoma’; ‘The Working Group does not recommend the use of a negative interim positron emission tomography scan alone to identify patients with early-stage Hodgkin lymphoma for whom radiotherapy can be omitted without a reduction in progression-free survival’.

Through the use of GRADE, recommendations were geared towards patient important outcomes and their strength reflected the available evidence and its interpretation from the patients’ point of view.

Read the abstract here

Two drugs set to be removed from the Cancer Drugs Fund

OnMedica | Published online: 18 August 2016

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The National Institute for Health and Care Excellence has issued draft guidance recommending that two drugs are removed from the Cancer Drugs Fund because they are not cost effective. The drugs, everolimus (Afinitor made by Novartis) for breast cancer and ibrutinib (Imbruvica, Janssen) for mantle cell lymphoma are being appraised under the new CDF system. The ultimate decision on whether the drugs will be removed will rest with NHS England

Under the new CDF system as a gateway fund for new cancer drugs, NICE recommends drugs are funded through the CDF if there is not enough information to make an immediate decision on whether they should be available on the NHS to enable patients to access the drugs while the company generates the supporting information required.

NICE rejected everolimus (in combination with the drug exemestane) for treating HER2-negative, hormone-receptor-positive advanced breast cancer in 2013 and it was then made available through the CDF.

Read the full news story here

How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic

Khan, J.M. et al. Journal of Pediatric Health Care. Published online: July 23 2016

bubble-602146_960_720In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent’s comprehension of the drug’s indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy.

We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium.

The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions. The extent of teaching often varies depending on a provider’s subjective assessment of a family’s needs. Twenty-five percent of providers suggested standardizing patient teaching.

When developing educational models, care teams should consider approaches that (a) objectively identify families in need of extensive teaching, (b) designate allotted teaching time by nursing staff during clinic visits, and (c) maintain the variation and dynamism that informs a successful provider-patient relationship.

Read the abstract here