Cancer care for adolescents and young adults in Jordan

Background: Adolescents and young adults with cancer have special characteristics and needs.

Aims: This study highlighted psychosocial challenges, fertility issues and secondary diseases encountered in adolescents and young adults with cancer. This work is meant to be a platform for future interventions for cancer in this demographic.

Methods: We investigated the latest edition of the Jordan Cancer Registry [JCR] and our more comprehensive institutional database during 2000–2012. Smoking, obesity and fertility preservation were addressed briefly as important issues among AYA patients.

Results: Cancer among adolescents and young adults represents 16.3% of all new cancer cases and has increased by 25% over the past 12 years. Women are more likely to be involved [female: male ratio of 1.44: 1] because of thyroid and breast cancers. Five-year survival rate for the AYA group was 72.4%, which was significantly better than for adults aged . 40 years [59.8%] but worse than for paediatric patients aged < 15 years [79.2%] [P < 0.0001].

Conclusions: Cancer in adolescents and young adults represents a substantial and growing proportion of oncological diagnoses. Due to their special needs and treatment complications, a dedicated service is urgently needed.

Cancer care in Jordan

Cancer is the second leading cause of death in Jordan after cardiovascular diseases. Due to increase in life expectancy and prolonged exposure to risk factors, cancer mortality and morbidity are expected to increase as the young population ages. This increase will constitute a challenging burden on healthcare systems in Jordan and many other neighboring countries. Planning is key to managing the expected rise in the demand for cancer care, and this will require public health initiatives to guarantee access to quality cancer care. Over the past decade, cancer care in Jordan has witnessed remarkable improvement through access to advanced diagnostics and therapeutics. In this review, we address the history of cancer care in Jordan, including cancer statistics, infrastructure, workforce as well as cancer care outcomes. We also discuss many of the challenges that we face and offer suggestions for the improvement of cancer management in Jordan and the region

Inferior vena cava filters in patients with advanced-stage cancer

Cancer and its treatment are recognized risk factors for venous thromboembolism [VTE]. Inferior vena cava [IVC] filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism [PE] or to avoid bleeding from systemic anticoagulation. A retrospective analysis of 107 cancer patients who had IVC filters inserted and followed up at our institution was performed. All patients had active cancer; a majority [> 90%] had advanced-stage disease, whereas only five patients [5.8%] had stages I or II disease. Eighty six patients [80.3%] had their IVC filter placed through a jugular approach. Filter insertion was not without complications; recurrent deep vein thrombosis [DVT] was reported in 10 [9.3%], PE in three [2.8%] and filter thrombosis in one patient. The value of IVC filter in patients with advanced stage disease was very limited: among 59 patients with stage IV disease for whom survival data was available, the median survival was only 1.31 months [0.92-2.20] with 23 patients [39.0%] surviving less than a month, and 40 [67.8%] surviving less than three months. Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or PE is high, IVC filters can be utilized. However, the placement of such filters should take into consideration the stage of disease and life expectancy of such patients. Patients with advanced-stage disease may gain little benefit from IVC filter insertion

Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve

Venous thromboembolism [VTE], comprising life-threatening pulmonary embolism [PE] and its precursor deep-vein thrombosis [DVT], is commonly encountered problem. Although most patients survive DVT, they often develop serious and costly long-term complications. Both unfractionated heparin and low molecular weight heparins significantly reduce the incidence of VTE and its associated complications. Despite the evidence demonstrating significant benefit of VTE prophylaxis in acutely ill medical patients, several registries have shown significant underutilization. This underutilization indicates the need for educational and audit programs in order to increase the number of medical patients receiving appropriate prophylaxis. Many health advocacy groups and policy makers are paying more attention to VTE prophylaxis; the National Quality Forum and the Joint Commission recently endorsed strict VTE risk assessment evaluation for each patient upon admission and regularly thereafter. In the article, all major studies addressing this issue in medical patients have been reviewed from the PubMed. The current status of VTE prophylaxis in hospitalized medical patients is addressed and some improvement strategies are discussed

impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center

Anemia in cancer patients is common, but often under-recognized and under-treated. Erythropoiesis stimulating agents [ESAs] are widely used to prevent and treat cancer and chemotherapy-related anemia, but recent studies suggest a negative impact on disease progression and survival associated with their use. This retrospective study describes the prevalence of anemia in cancer patients and recent trends in its management given the negative studies. All consecutive adult cancer patients [n=959] admitted to regular medical units over one year were reviewed. Patients with a hemoglobin [Hb] value<12 g/dL on admission were considered anemic. Information on the primary tumor, main reasons for admission and treatment given were collected. At the time of enrollment, anemia was detected in 755 [78.7%] patients. The mean Hb value for anemic patients was 9.5 g/dL. Prevalence and severity of anemia varied according to tumor type and reason for admission. The majority [68.6%] of the anemic patients were not offered treatment. The mean Hb value at which treatment was started was 8.0 g/dL. Anemia treatment was related to its severity; treatment rates were 94.4%, 32.9%, and 5.0% in patients with severe, moderate and mild anemia, respectively [P<.0001]. Blood transfusion was used the most while ESAs were rarely used. Length of hospital stay was affected by the presence of anemia [7.2 days in anemic patients vs. 4.85 days in nonanemic patients] [P<.001]. Blood transfusion was used the most for cancer-related anemia, while ESAs were rarely used. The majority of patients with moderate anemia were not treated, including patients on active chemotherapy. Better guidelines addressing anemia management in this subgroup of patients are highly needed

Pentasaccharides: the new anticoagulants

Venous thromboembolism VTE remains a common but preventable disease. The last decade has witnessed major advances in VTE treatment and prophylaxis. Low molecular weight heparins LMWH became the agents of choice in the treatment of deep venous thrombosis DVT and are increasingly used in the treatment of stable pulmonary embolism PE. Increasing focus on simplicity and efficacy has led to the discovery of the synthetic pentasaccharides, substances that specifically inhibit factor Xa activity, producing an antithrombotic effect without affecting other coagulation factors or platelets. Fondaparinux, the first pentasaccharide introduced into the market, was first tried as a prophylactic agent against VTE in patients undergoing major orthopedic procedures, such as hip fracture, total hip and knee replacements, such approach appeared to be more effective than LMWH. Fondaparinux was also used, with promising results, in prophylaxis in patients undergoing major abdominal surgery and high risk medical patients. Pentasaccharides were recently tried in the treatment of both DVT and PE. The largest clinical investigation program ever undertaken in this therapeutic area, has shown that pentasaccharides are as safe and as effective as either unfractionated heparin UFH or LMWH, with the added convenience of once daily injection, no need for monitoring the anticoagulant effect and no major side effects such as thrombocytopenia. Therefore, the efficacy, the safety profile and the added convenience for both patients and physicians alike, will probably keep pentasaccharides as the front runner among new anticoagulants of the future. This article focuses on the use of fondaparinux as a prophylactic agent against VTE in patients undergoing major orthopedic and abdominal surgery along with high risk medical patients; it will also discuss the recent promising data on its use to treat active DVT and PE