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Clarkson P.M.,University of Massachusetts Amherst | Kaufman S.A.,Baystate Regional Cancer Program
Medical Hypotheses | Year: 2010

Epidemiological evidence has pointed to the benefits of physical activity in reducing breast cancer risk, which in turn has prompted the American Cancer Society (ACS) to make specific recommendations for adopting a life style of physical activity as a guideline for cancer protection. There is also evidence for benefits of physical activity during and after cancer treatments of chemotherapy and radiation therapy. The ACS recommendations for exercise as prevention and for exercise during/after cancer treatment are the same: " that adults engage in at least 30. min of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45-60. min of intentional physical activity are preferable." These recommendations suggest participation in aerobic types of physical activity (e.g. brisk walking, biking). Effects of resistance exercise were not addressed specifically by the ACS but have been found to increase lean body mass in patients undergoing cancer treatment. Also, many women preferred resistance exercise over aerobic exercise during breast cancer treatment. In response to strenuous resistance exercise, however, muscle satellite (progenitor) cells are activated to reenter the cell cycle and proliferate. Satellite cells can then contribute their nuclear material into the fiber to facilitate muscle repair, regeneration, and hypertrophy. Cancer therapy damages rapidly dividing cells and thus has the potential to target satellite cells that enter into the cell cycle. Although satellite cells are self-renewing, they are not completely replenished over the lifespan so losses in this progenitor population via resistance exercise and cancer therapy may impair the maintenance of muscle mass with aging. Before recommending resistance training during breast cancer treatment, we must have more information about cancer treatment effects on activated satellite cells in human studies. © 2010 Elsevier Ltd.


Emmons G.S.,Baystate Regional Cancer Program | Steingart R.H.,Baystate Regional Cancer Program | Steingart R.H.,Tufts University | Stewart J.A.,Baystate Regional Cancer Program | And 3 more authors.
Journal of Medical Case Reports | Year: 2012

Introduction. In the relapsed setting, arsenic trioxide remains the backbone of treatment. Scant literature exists regarding treatment of relapsed acute promyelocytic leukemia in patients with renal failure. To the best of our knowledge we are the first to report a safe and effective means of treatment for relapsed acute promyelocytic leukemia in the setting of advanced renal failure, employing titration of arsenic trioxide based on clinical parameters rather than arsenic trioxide levels. Case presentation. A 33-year-old Caucasian man with a history of acute promyelocytic leukemia in remission for 3 years, as well as dialysis-dependent chronic renal failure secondary to a solitary kidney and focal segmental glomerulosclerosis and human immunodeficiency virus infection, receiving highly active antiretroviral therapy presented to our hospital with bone marrow biopsy-confirmed relapsed acute promyelocytic leukemia. Arsenic trioxide was begun at a low dose with dose escalation based only on side effect profile monitoring and not laboratory testing for induction as well as maintenance without undue toxicity. Our patient achieved and remains in complete hematologic and molecular remission as of this writing. Conclusion: Arsenic trioxide can be used safely and effectively to treat acute promyelocytic leukemia in patients with advanced renal failure using careful monitoring of side effects rather than blood levels of arsenic to guide therapeutic dosing. © 2012 Emmons et al.; licensee BioMed Central Ltd.


PubMed | Baystate Regional Cancer Program
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

20566 Background: Children receiving cancer therapy and those with aplastic anemia often require indwelling central venous catheters (CVC) and commonly develop fever. Clinical observations led to the hypothesis that emesis was associated with bacteremia in these patients. Although previous studies have identified clinical and laboratory features at presentation of fever that help predict who is likely to have bacteremia, none have included vomiting as a predictor.Retrospective chart review of children admitted to Baystate Childrens Hospital between Jan 1, 2006 and Sept 30, 2007 with a diagnosis of cancer or aplastic anemia, a CVC, and fever. Vomiting was considered present if noted in the admission history, review-of-systems, or within 24 hr of admission and absent if the history/ review-of- systems documented its absence. Data were collected on culture results, type of CVC (subcutaneous port vs. tunneled external), and absolute neutrophil count (ANC) at presentation (less than or greater than 500 cells/mm3).There were 122 admissions for fever; 121 had complete data for analysis. Emesis was present in 31, absent in 90. 34 (28%) had culture-proven bacteremia. Bacteremia was present in 17 (55%) of the emesis group and 17 (19%) of the no-emesis group (p=.0003). The RR of bacteremia with emesis was 2.90 (95% CI, 1.70 - 4.95), positive predictive value 55%, negative predictive value 81%. Gram negative organisms were more common in the emesis group (13 of 17) than in the no-emesis group (6 of 17), (p=.038). The emesis and no-emesis groups had no significant differences in frequency of ANC <500 or type of CVC. Frequency of ANC <500 was not significantly different between culture positive and negative groups.Immunocompromised children with CVC and fever presenting with emesis are significantly more likely to have bacteremia, especially Gram negative bacteremia, than those without emesis. This sign could be an important additional factor in deciding if a child is at high or low risk of serious bacterial illness, location of treatment (in vs. outpatient) and in choosing initial empiric antibiotics. Further studies may incorporate these findings into risk stratification and management algorithms. No significant financial relationships to disclose.


PubMed | Baystate Regional Cancer Program
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

8159 Background: While studies have evaluated genetic/nurse counseling and risk perception, few have assessed oncologist counselors.High-risk clinic patients consented prior to consultation and completed the Brief Symptom Inventory-18 (BSI) and 5-year/lifetime risk perceptions immediately before (PRE) and after (POST) counseling. Gail model estimates were shared during counseling.61 patients were enrolled. Mean PRE perceptions were much greater than Gail estimates (5-year: 32.2% vs. 3.0%, p<.0001; lifetime: 46.2% vs. 24.1%, p<.0001). POST perceptions decreased significantly (5-year mean: 10.9%, p<.0005; lifetime 13.6%, p<.0003) but still exceeded Gail estimates (5-year: p<.0001; lifetime: p=.02). No correlations were found between PRE/POST perceptions and Gail estimates. Perception change differed between physicians (range of means: 5-year -1.1 to -29.4%, p=.002; lifetime -9.4 to -32.6%, p=.05) as did POST perception and Gail estimate differences. PRE BSI T-scores were greater for anxiety (ANX; p=.03) than standardized norms; all POST indices demonstrated declines (p<.0001). Increasing PRE 5-year perception was associated in a stepwise multivariate model with increasing PRE ANX (p=.006), number of 1PRE 5-year risk perceptions are associated with PRE ANX and predict POST perceptions which remain several-fold greater than Gail estimates. Even in a prospective trial of perception modification, oncologists were only partially successful. Individual counselor effectiveness varied considerably; this factor requires attention in future studies. No significant financial relationships to disclose.


PubMed | Baystate Regional Cancer Program
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

6040 Background: While published data suggest low chemotherapy error rates, the rate of chemotherapy ordering process defects and who detects them remains uncertain.Outpatient treatment plans/orders were prospectively evaluated by pharmacy prior to preparation, then by nursing prior to administration. Data collected included the nature of defects, how detected, utility of regimen-specific care sets (facilitating antineoplastic dose calculation and adjunct agent selection), and patient impact.Pharmacy recognized problems with 36% of orders (comprising 1,082 cycles/4,600 drugs), with 34% incomplete (absent orders 17%; missing cycle number 12.5%; other items 4%). Pharmacy identified incorrect orders in 6% (dose calculation 2%; cycle number 1.5%; other items 2.5%). Incomplete orders were more likely to have incorrect items (11.6% v. 3.5% if complete, p < .001). Care set use (76% of cycles) was associated with fewer overall problems and incomplete orders (both p < .001), with reduced absent orders and missing antiemetics, but not antineoplastics. Care set orders exhibited a trend for fewer incorrect items (p=.06). Nursing recognized problems with 14.6% of orders, again most commonly incomplete orders (10%; absent orders 7%; missing antiemetic or antineoplastic drug 4.6%); fewer missing items resulted from care set use (p < .001). Nursing detected fewer orders with problems and missing items but more instances of missing antineoplastic and antiemetic agents (all p < .001) despite prior pharmacy review. Nursing identified incorrect orders in 5% (wrong dosage 3.4%; wrong drug 2.5%) and classified 4% of cycles as having an error (near miss 3.3%; more serious error reaching the patient 0.6%).Defects in chemotherapy orders are common despite the relatively low error rate. The predominant defects-incomplete orders-are associated with incorrect items. Both care sets and pharmacy review reduce but do not eliminate incomplete orders; the effect on incorrect orders is smaller. Even with CPOE, sequential pharmacy and nursing review remain critical to reducing order defects; additional software enhancements are needed to further reduce defects. No significant financial relationships to disclose.


PubMed | Baystate Regional Cancer Program
Type: | Journal: Journal of medical case reports | Year: 2012

In the relapsed setting, arsenic trioxide remains the backbone of treatment. Scant literature exists regarding treatment of relapsed acute promyelocytic leukemia in patients with renal failure. To the best of our knowledge we are the first to report a safe and effective means of treatment for relapsed acute promyelocytic leukemia in the setting of advanced renal failure, employing titration of arsenic trioxide based on clinical parameters rather than arsenic trioxide levels.A 33-year-old Caucasian man with a history of acute promyelocytic leukemia in remission for 3 years, as well as dialysis-dependent chronic renal failure secondary to a solitary kidney and focal segmental glomerulosclerosis and human immunodeficiency virus infection, receiving highly active antiretroviral therapy presented to our hospital with bone marrow biopsy-confirmed relapsed acute promyelocytic leukemia. Arsenic trioxide was begun at a low dose with dose escalation based only on side effect profile monitoring and not laboratory testing for induction as well as maintenance without undue toxicity. Our patient achieved and remains in complete hematologic and molecular remission as of this writing.Arsenic trioxide can be used safely and effectively to treat acute promyelocytic leukemia in patients with advanced renal failure using careful monitoring of side effects rather than blood levels of arsenic to guide therapeutic dosing.

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