Management of lung cancer-associated anaemia: the Spanish Lung Cancer Anaemia Survey (SLCAS)

BACKGROUND: The purpose of the Spanish Lung Cancer Anaemia Survey (SLCAS) was to thoroughly investigate lung cancer-associated anaemia management, and describe the profile of lung cancer patients in relation to anaemia incidence and tumour type in Spain. PATIENTS AND METHODS: This survey collected data from 1089 randomly recruited patients gathered by 50 Spanish physicians at 38 sites. In addition, a qualitative assay was performed through 16 one-to-one and 2 one-to-two interviews, and a discussion group of 4 cancer specialists participating in the survey. RESULTS: Lung cancer patients undergoing chemotherapy treatment had haemoglobin (Hb) levels <12.0 g/dl in 58.0% of the cases, in contrast to 39.0% of patients receiving no chemotherapy. Anaemia was treated in 53.0% of patients with Hb<12 g/dl (45.0% epoetin, 3.9% transfusion, 4.1% iron). Mean Hb level trigger was 9.7 g/dl for administration of epoetin and 8.2 g/dl for blood transfusion. CONCLUSIONS: SLCAS reveals a significant change in the management of anaemia and clinical practice pattern in the use of erythropoiesis-stimulating agents (45.0% vs. 18.0%) and much less use of blood transfusions (3.9% vs. 15.0%) since the European Cancer Anaemia Survey performed five years ago (AU)

Professional burnout among Spanish medical oncologists.

INTRODUCTION: Studies on physician burnout in Spain show a significant presence of the syndrome among our professionals. Some studies highlight the speciality of medical oncology as one of the most affected. The objective of this study was to evaluate the incidence of burnout syndrome among the group of medical oncologists affiliated to the Spanish Society of Medical Oncology (SEOM), as well as to assess the weight of sociodemographic variables, background and consequences involved in the process. MATERIALS AND METHODS: An anonymous protocol was posted to medical oncologist members of the SEOM (n=795). This protocol comprised a scale of sociodemographic variables and three scales of the Medical Professional Burnout Questionnaire. In response we received 200 complete protocols and statistical analyses were conducted with the programme SPSS, version 14.0. RESULTS: The sample showed high burnout levels in the areas of exhaustion and loss of expectations, with perception of time pressure to conduct work and social deterioration perceived in the profession as the two background elements with the greatest weight to explain the syndrome. The health consequences (physical and emotional) for the phy - sician are clear. Initial results show that conducting research and lecturing tasks could be a protective factor against developing the syndrome. CONCLUSIONS: The results suggest the importance of developing prevention and intervention lines for medical oncology burnout. In this sense, issues such as work time management and motivational aspects related to research tasks could be worth considering.

Ifosfamide in advanced epidermoid head and neck cancer.

A total of 37 men with epidermoid head and neck cancer whose disease had recurred following primary treatment (surgery and/or radiotherapy) received first-line chemotherapy with ifosfamide at i.v. doses of 3 g/m2 given daily on 3 consecutive days in combination with mesna (600 mg/m2 x 3 oral daily doses on days 1-3) every 3 weeks. In all, 7 patients showed a partial response and 2 patients achieved a complete response, for an overall objective response rate of 26% (9 of 35 eligible patients; 95% confidence interval, 12.5%-43%). Excluding the 5 early nontoxic deaths observed during the first 3 weeks of therapy, the objective response rate was 30% (9 of 30 patients; 95% confidence interval, 15%-49.5%). Responses were seen in lung metastases (2 patients), lymph nodes (2 patients), skin (3 patients), and cases of local recurrence (5 patients). The median duration of responses was 3 months (range, 2-5 months). The main side effects of ifosfamide were alopecia (83% of patients), emesis (80%), granulocytopenia (23%), and mild mucositis (20%). Two poor-risk patients suffered severe CNS complications that were probably related to treatment. Three patients died due to chemotherapy-related complications (2 patients with CNS toxicity and 1 patient with granulocytopenic sepsis). In conclusion, ifosfamide appears to be an active drug in epidermoid head and neck cancer and merits further evaluation in this disease.

Intravenous and oral magnesium supplementations in the prophylaxis of cisplatin-induced hypomagnesemia. Results of a controlled trial.

The effects of oral and intravenous magnesium supplementation on cisplatin (CDDP)-induced hypomagnesemia were investigated in 41 patients treated with 100 mg/m2 CDDP. Patients were randomly allocated to receive no magnesium supplementation, intravenous magnesium supplementation (magnesium sulphate, 3 g before each CDDD administration) or oral magnesium supplementation (magnesium pidolate, 2 g orally every 8 hours on days 2 to 21 of each CDDP course) during the first 4 courses of CDDP treatment. Patients in both supplementation arms showed significantly higher magnesium levels than control patients from the second course on (oral magnesium arm) or from the third course on (intravenous magnesium arm). Three of the 9 patients (33%) in the intravenous magnesium arm and 4 of the 9 (44%) in the oral magnesium arm developed hypomagnesemia after the fourth course of CDDP, compared with 9 of the 10 (90%) unsupplemented patients. There were no magnesium-related side effects in patients on intravenous magnesium supplementation. Two patients treated with oral magnesium developed mild gastrointestinal symptoms (emesis and diarrhea), probably from magnesium therapy. Our study showed that both intravenous and oral magnesium supplementations appear to be safe and efficacious in the prevention of CDDP-induced hypomagnesemia. Since patients were not completely protected, and since the analysis was limited to the first four courses of chemotherapy, additional studies are needed to determine the best schedule of magnesium supplementation, especially in patients who receive more than four courses of CDDP chemotherapy.

[Superior vena cava syndrome in microcytic carcinoma of the lung: incidence, treatment response and prognostic importance]. / Síndrome de la vena cava superior en el carcinoma microcítico de pulmón: incidencia, respuesta al tratamiento e importancia pronóstica.

The incidence, response to chemotherapy treatment and prognostic value in the prediction of the Superior Cave vein syndrome (SVCS) surveillance were retrospectively studied in a group of 125 patients presenting microcytic pulmonary carcinoma. We found SVCS in 20 cases (16% of the total group of patients), there were no statistically significant differences between the limited or diseminated stages. All patients were initially treated with polychemotherapy. The efficacy of this treatment to eliminate the symptoms of SVCS could be evaluated in 17 cases while in the other 3 cases that was not possible give the early or toxic death of the patients. Fourteen out of the 17 patients with evaluable SVCS (82%) achieved a complete remission of the syndrome with chemotherapy which parallel with the achievement of a partial or complete response of the primary tumor and its metastasis. The SVCS only reappeared in one case at the moment of tumor recurrence. The remission of symptoms was quickly initiated after treatment and was completed in most cases one week after treatment was started. An statistically significant difference was not observed between the surveillance of patients who presented SVCS at time of diagnosis and those who did not. Given that both groups were balanced with regard to the rest of the prognostic factors (the disease stage, Karnofsky's index, sex, or treatment) the SVCS does not constitute a pejorative prognostic factor in the prediction of surveillance in microcytic pulmonary carcinoma.

The natural course of emesis after carboplatin treatment.

Twenty-eight patients receiving their first cycle of carboplatin treatment (300-400 mg/m2) entered a prospective study in which the natural course and intensity of postchemotherapy emesis was evaluated. Twenty-five patients (89%) experienced nausea at some time after carboplatin treatment and twenty-three patients (82%) vomited. The median number of emetic episodes was 13.5. In the 23 patients who experienced vomiting, the mean period of latency of vomiting (time from start of carboplatin administration to onset of vomiting) was 6.25 h. The period of maximum incidence of vomiting was between 8 and 12 h (71% of patients with vomiting). Between 6 and 14 h after the start of carboplatin treatment, more than 50% of patients were continuously vomiting. Vomiting declined significantly after 24 h. According to these data, carboplatin is a severely emetic drug. Prospective antiemetic trials are necessary in order to obtain antiemetic schedules which are able to increase the tolerance to carboplatin treatment.

Lethal cardiac toxicity after cisplatin and 5-fluorouracil chemotherapy. Report of a case with necropsy study.

This article presents a patient affected with epidermoid carcinoma of the soft palate who developed a dilated myocardiopathy with aortic embolism and fatal left cardiac failure after treatment with cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1 g/m2/day i.v. days 2-6). The postmortem necropsy study showed diffuse interstitial edema and intracytoplasmic vacuolization of myocytes, without inflammatory changes. These findings were interpreted as acute toxic myocardiopathy, probably due to 5-fluorouracil treatment. Although the patient also received cisplatin, metoclopramide, allopurinol, thiethylperazine, and amitriptyline, before the onset of clinical symptoms, these drugs were not considered to play an important role in the production of this cardiopathy because of the dosage, necropsy findings, and lack of previous report.

[Cardiotoxicity induced by 5-fluorouracil. Review of the literature]. / Cardiotoxicidad inducida por 5-fluorouracilo. Revisión de la literatura.

5-fluorouracil is potentially cardiotoxic to man. To date, 47 patients have been reported with undesired heart disorders after the administration of this cytotoxic drug. The incidence of cardiotoxicity due to 5-FU is 1.6%. Angina-type precordial pain with electrocardiographic changes suggesting myocardial ischemia is the common clinical feature. Generally it disappears spontaneously or after the use of coronary vasodilators. Acute left ventricular failure, pericarditis and rythm disorders are not often found. The pathogenesis is unknown however, cardiac spasm as well as the direct or indirect effect of the drug on myocardium, are possible responsible mechanisms.