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Wiernik P.H.,Continuum Cancer Centers of New York | Wiernik P.H.,Beth Israel Deaconess Medical Center
Current Treatment Options in Oncology | Year: 2011

Much new information about ALL in adults has recently been learned from major clinical and laboratory studies. However, much of the recently reported improved management of this leukemia pertains only to younger patients. Elderly patients do not fair very well with modern therapy, including intensified treatment approaches. The question arises whether current treatmentmay be unnecessarily intensive, not only for elderly patients but formost patients. There are no prospective, randomized studies that clearly demonstrate that anthracyclines, cyclophosphamide or cytarabine are required for optimal results in this leukemia. Eliminating drugs of marginal value but with the potential for considerable toxicity may allow us to intensify treatment with drugs that are most effective at a cost of even less toxicity than usually expected. © Springer Science+Business Media, LLC 2011. Source

Kligler B.,Beth Israel Deaconess Medical Center | Homel P.,Beth Israel Deaconess Medical Center | Harrison L.B.,Continuum Cancer Centers of New York | Levenson H.D.,Beth Israel Deaconess Medical Center | And 2 more authors.
American Journal of Managed Care | Year: 2011

Objectives: To evaluate the cost impact of an integrative medicine intervention on an inpatient oncology service. Study Design: This study used nonrandomized, nonequivalent groups. A baseline sample of inpatient oncology patients at Beth Israel Medical Center admitted to the medical oncology unit before implementation of the Urban Zen Initiative were compared with patients admitted after the Urban Zen Initiative was in place. Methods: The Urban Zen Initiative incorporated yoga therapy, holistic nursing techniques, and a "healing environment" into routine inpatient oncology care. Length of stay and medication use data were extracted from Beth Israel's decision support electronic database. We compared length of stay, total medication costs, and costs of as-needed medications for both groups: the baseline sample of inpatient oncology patients and patients exposed to the Urban Zen healing environment initiative. Results: We had complete cost data on 85 patients in our baseline group and 72 in our intervention group. We found no difference in length of stay between the 2 groups. We found a significant decrease in use of antiemetic, anxiolytic, and hypnotic medication costs as well as a decrease in total medication costs in the Urban Zen sample compared with the baseline group. Conclusions: An integrative medicine approach including yoga therapy, holistic nursing, and a healing environment in the inpatient setting can decrease use of medications, resulting in substantial cost savings for hospitals in the care of oncology patients. Source

Dutcher J.P.,Continuum Cancer Centers of New York
Oncology (Williston Park, N.Y.) | Year: 2012

Three emerging trends have occurred recently in renal cell carcinoma (RCC). First, over the last several decades there has been a marked increase in the diagnosis of RCC, with a corresponding decrease in the typical tumor size, resulting in an increased interest in less invasive approaches to primary tumor treatment. Second, while conventional radiotherapy plays a limited palliative role due to the relative radio-resistance of RCC, advances in immobilization and image guidance have led several investigators to consider stereotactic radiotherapy techniques (SRT) to overcome this resistance, with impressive results in the metastatic setting. In addition, preliminary use of SRT to treat the primary RCC tumor is underway. Thirdly, although RCC is resistant to conventional chemotherapy agents, exciting recent advances have emerged in the treatment of clear cell RCC, with the development of targeted agents in addition to immunotherapy-based treatments. In the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the two modalities. Finally, we discuss the role of the new systemic agents in non-clear cell RCC. Source

Smith E.M.L.,University of Michigan | Pang H.,Alliance Statistics and Data Center | Pang H.,Duke University | Cirrincione C.,Alliance Statistics and Data Center | And 7 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

Importance: There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy. Objective: To determine the effect of duloxetine, 60 mg daily, on average pain severity. Design, Setting, and Patients: Randomized, double-blind, placebo-controlled cross-over trial at 8 National Cancer Institute (NCI)-funded cooperative research networks that enrolled 231 patients who were 25 years or older being treated at community and academic settings between April 2008 and March 2011. Study follow-up was completed July 2012. Stratified by chemotherapeutic drug and comorbid pain risk, patients were randomized to receive either duloxetine followed by placebo or placebo followed by duloxetine. Eligibility required that patients have grade 1 or higher sensory neuropathy according to the NCI Common Terminology Criteria for Adverse Events and at least 4 on a scale of 0 to 10, representing average chemotherapy-induced pain, after paclitaxel, other taxane, or oxaliplatin treatment. Interventions: The initial treatment consisted of taking 1 capsule daily of either 30 mg of duloxetine or placebo for the first week and 2 capsules of either 30 mg of duloxetine or placebo daily for 4 additional weeks. Main Outcome Measures: The primary hypothesis was that duloxetine would be more effective than placebo in decreasing chemotherapy-induced peripheral neuropathic pain. Pain severity was assessed using the Brief Pain Inventory-Short Form "average pain" item with 0 representing no pain and 10 representing as bad as can be imagined. Results: Individuals receiving duloxetine as their initial 5-week treatment reported a mean decrease in average pain of 1.06 (95% CI, 0.72-1.40) vs 0.34 (95% CI, 0.01-0.66) among those who received placebo (P=.003; effect size, 0.513). The observed mean difference in the average pain score between duloxetine and placebo was 0.73 (95% CI, 0.26-1.20). Fifty-nine percent of those initially receiving duloxetine vs 38% of those initially receiving placebo reported decreased pain of any amount. Conclusion and Relevance: Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain. Trial Registration: clinicaltrials.gov Identifier: NCT00489411. ©2013 American Medical Association. All rights reserved. Source

Wiernik P.H.,Continuum Cancer Centers of New York
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Lenalidomide, a thalidomide analog, is representative of a new class of antineoplastic drugs which has been especially effective in certain hematologic malignancies such as myeloma and myelodysplasia. Lenalidomide has anti-inflammatory, anti-angiogenic and immunomodulatory properties, and targets tumor cells by direct cytotoxicity and, indirectly by interfering with several components of the tumor microenvironment [1]. Lenalidomide retains antitumor activity equal to or greater than the parent compound, thalidomide, but with less toxicity [2]. Areas covered: This paper summarizes what is known about the mechanisms of action of lenalidomide, and recent clinical results in lymphoma and chronic lymphocytic leukemia. A literature review was accomplished by searching the PubMed database for papers in English. Publications from 2000 through November 2012 were analyzed. Search terms used were lenalidomide, lymphoma, chronic lymphocytic leukemia, and Hodgkin's lymphoma. A manual search of conference proceedings from the previous 5 years of the American Society of Clinical Oncology, American Society of Hematology, America Association of Cancer Research, and the European Hematology Association was also conducted. Relevant references in chosen papers were also considered. Expert opinion: The data suggest that lenalidomide will play a major role in the management of certain lymphoid neoplasms such as B-cell lymphoma, chronic lymphocytic leukemia and, perhaps, T-cell lymphoma. © 2013 Informa UK, Ltd. Source

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