Ageing-related considerations for medication used in supportive care in cancer.

Both randomized controlled trials (RCTs) and retrospective studies have shown that a comprehensive geriatric assessment (CGA) prior to a patient commencing systemic anti-cancer therapy (SACT) results in improved quality of life outcomes and is associated with a decreased risk of grade 3-5 toxicity; however, data are lacking in relation to adverse drug events (ADE) associated with supportive care medications. Supportive care medications are prescribed as prophylactic agents in a SACT regimen, for management of treatment related toxicity and for symptoms caused by the disease itself. While necessary, the commencement of SACT and supportive medications may cause, or exacerbate, a significant drug burden in older patients, some of whom may have existing comorbidities. For many medications, older adults are underrepresented in pharmacokinetic and pharmacodynamic modelling studies. In this article we will review ageing-related changes in pharmacokinetics and pharmacodynamics, as well as how these changes may impact supportive care medications. Additional considerations for prescribing these medications in older adults with cancer, such as polypharmacy, potentially inappropriate medications, drug-drug interactions, and anticholinergic burden, as well as ageing-related considerations and recommendations for supportive care medications commonly used in older adults with cancer are also reviewed.

The Effect of Childhood Eye Disorders on Social Relationships during School Years and Psychological Functioning as Young Adults.

AIMS: To determine (1) whether having a visible eye condition and/or treatment with glasses and/or occlusion in childhood has any impact on psychological and/or social outcomes during childhood and young adulthood and (2) whether there is an effect of age at treatment. METHODS: A cohort of 160 participants was asked to take part in an online study. The cohort had previously taken part in a research study at Royal Preston Hospital from 1999-2006 when they were 3-8 years old (Buckley and Perkins 2010). Participants were divided into treatment and no-defect (control) groups and were invited to take part in the current study when they had reached age 18-21. Thirty-five (35) participants (22.5% of the total cohort) were recruited and completed a series of online questionnaires assessing recalled victimisation at school, current generalised anxiety, current depressive symptoms, current loneliness, current friendship quality, and adjustment to university/work. Questionnaire scores between treated patients and controls were compared. RESULTS: Findings showed that young adults who received treatment during their pre-school years, compared to their peers who did not need treatment, reported higher current generalised anxiety and more victimisation when in school.Those who received treatment in reception class were no different on psycho-social functioning compared to their peers; with both groups reporting higher victimisation than average compared to previous studies, and mild rates of anxiety. CONCLUSIONS: It appears that having a visible eye condition or treatment with glasses and/or occlusion commencing at pre-school has long term psychological implications, with scores on victimisation and current anxiety levels being higher for the pre-school treatment group compared to the pre-school no defect (control) group. Treatment plans and advice to parents should consider psycho-social outcomes of proposed treatment.

Interfraction and respiratory organ motion during conformal radiotherapy in gastric cancer.

PURPOSE: To quantify the interfraction and breathing organ motion during adjuvant radiotherapy for gastric cancer and assess organ stability in different breathing states. METHODS AND MATERIALS: A planning computed tomography (CT) scan and serial study CT scans in free breathing, voluntary inhale and exhale were performed in weeks 1, 3, and 5 of radiotherapy for 22 resected gastric patients. All data sets were fused to register the vertebral bodies. The regions of interest (kidneys, stomach, liver, pancreas, celiac axis, and porta hepatis) or points of interest (POIs; left dome of diaphragm, splenic hilum) were identified. For each region of interest, a POI was automatically placed at the center of mass. The interfraction displacement and breathing amplitude were assessed in the craniocaudal (CC), anteroposterior (AP), and right-left (RL) directions. RESULTS: Comparison of the serial free-breathing CT scans with the planning CT scan showed a median displacement of all POIs of 5.6, 2.2, and 1.8 mm in the CC, AP, and RL directions, respectively. Comparison of the serial inhale scans with the first inhale scan showed a displacement of 4.9, 2.6, and 1.8 mm in the CC, AP, and RL directions, respectively. The comparable values for the exhale scans were 5.1, 2.0, and 1.8 mm. The displacements of the organs were similar in the free breathing, inhale, and exhale states. The median respiratory amplitude in the CC, AP, and RL direction was 14, 4.8, and 1.7 mm, respectively. CONCLUSION: The median interfraction displacement of the POIs relative to the vertebral bodies was about 6 mm in the CC direction and 2 mm in the other directions. The planning target volume margins need to account for these shifts. Individual assessment of respiratory motion is recommended to identify patients with unusually large respiratory amplitude.

Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy.

Although ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy is infrequently associated with premature amenorrhea, little is known about the success rate of women attempting pregnancy following ABVD. In the present study females treated for HL with ABVD chemotherapy without pelvic radiation therapy (RT) and who were alive without relapse > or =3 years after treatment were identified from a clinical database and screened for inclusion. Using a standardized questionnaire, we determined the pregnancy rate (i.e. time-to-pregnancy, TTP) among survivors who had become pregnant, tried to become pregnant, or who had been sexually active for over 2 months without using contraception at any time following ABVD. The cumulative incidence of pregnancy was calculated using the Kaplan-Meier method. Cox proportional hazards models were constructed to compare the pregnancy rate among HL survivors to that reported by friend or sibling controls. Thirty-six female HL survivors, who had attempted pregnancy after ABVD treatment, and 29 controls, completed the survey. Eighteen patients (50%) received 2-4 cycles of ABVD, 16 (44%) received 4-6 cycles, and 2 (6%) received >6 cycles. The median TTP among both HL survivors and controls was 2.0 months. The 12-month pregnancy rates were 70% and 75%, respectively. The fertility ratio (FR) for HL survivors versus controls was 0.94 (95%CI = 0.53-1.66; p = 0.84) after adjusting for age and frequency of intercourse (where FR < 1 indicates subfertility). Age at treatment and the number of cycles of chemotherapy were not associated with pregnancy rate among HL survivors. Female HL patients who had survived without recurrence > or =3 years and who had attempted pregnancy after ABVD did not experience significant sub-fertility.

Tuberculosis in elephants: antibody responses to defined antigens of Mycobacterium tuberculosis, potential for early diagnosis, and monitoring of treatment.

Tuberculosis (TB) in elephants is a re-emerging zoonotic disease caused primarily by Mycobacterium tuberculosis. Current diagnosis relies on trunk wash culture, the only officially recognized test, which has serious limitations. Innovative and efficient diagnostic methods are urgently needed. Rapid identification of infected animals is a crucial prerequisite for more effective control of TB, as early diagnosis allows timely initiation of chemotherapy. Serology has diagnostic potential, although key antigens have not been identified and optimal immunoassay formats are not established. To characterize the humoral responses in elephant TB, we tested 143 serum samples collected from 15 elephants over time. These included 48 samples from five culture-confirmed TB cases, of which four were in Asian elephants infected with M. tuberculosis and one was in an African elephant with Mycobacterium bovis. Multiantigen print immunoassay (MAPIA) employing a panel of 12 defined antigens was used to identify serologic correlates of active disease. ESAT-6 was the immunodominant antigen recognized in elephant TB. Serum immunoglobulin G antibodies to ESAT-6 and other proteins were detected up to 3.5 years prior to culture of M. tuberculosis from trunk washes. Antibody levels to certain antigens gradually decreased in response to antitubercular therapy, suggesting the possibility of treatment monitoring. In addition to MAPIA, serum samples were evaluated with a recently developed rapid test (RT) based on lateral flow technology (ElephantTB STAT-PAK). Similarly to MAPIA, infected elephants were identified using the RT up to 4 years prior to positive culture. These findings demonstrate the potential for TB surveillance and treatment monitoring using the RT and MAPIA, respectively.

Comparison of selenium determination in liver samples by atomic absorption spectroscopy and inductively coupled plasma-mass spectrometry.

Selenium (Se) is an essential trace element that is often deficient in the natural diets of domestic animal species. The measurement of Se in whole blood or liver is the most accurate way to assess Se status for diagnostic purposes. This study was conducted to compare hydride generation atomic absorption spectroscopy (HG-AAS) with inductively coupled plasma-mass spectrometry (ICP-MS) for the detection and quantification of Se in liver samples. Sample digestion was accomplished with magnesium nitrate and nitric acid for HG-AAS and ICP-MS, respectively. The ICP-MS detection was optimized for 82Se with yttrium used as the internal standard and resulted in a method detection limit of 0.12 microg/g. Selenium was quantified by both methods in 310 samples from a variety of species that were submitted to the Toxicology Laboratory at New Bolton Center (Kennett Square, PA) for routine diagnostic testing. Paired measurements for each sample were evaluated by a mean difference plot method. Limits of agreement were used to describe the maximum differences likely to occur between the 2 methods. Results suggest that under the specified conditions ICP-MS can be reliably used in place of AAS for quantitation of tissue Se at or below 2 microg/g to differentiate between adequate and deficient liver Se concentrations.

Detection of nonesterified (free) fatty acids in bovine serum: comparative evaluation of two methods.

A method comparison study for the determination and quantitation of nonesterified fatty acids (NEFAs) in serum, using the commercial "NEFA C" enzymatic test kit, was performed using the spectrophotometric method recommended by the manufacturer and a modified procedure optimized for the use of a microplate reader, a 96-well microtiter plate, and small sample volumes (10 microl). Linearity, sensitivity, and precision using the test kit were determined for each method of detection. The assay was linear from 0 to 1.97 mEq/liter for both procedures, and the limits of detection were determined to be 0.22 (+/- 0.074) and 0.05 (+/- 0.002) mEq/liter for the spectrophotometer and microplate reader, respectively. Pairs of measurements for bovine serum samples were compared and evaluated by a mean difference plot method and not regression analysis, a method that has been shown to be inappropriate for method comparison studies. The difference plot was used to evaluate the systematic bias between the 2 methods. Random error is reported on the basis of SD differences, and "limits of agreement" are used to describe the maximum differences likely to occur between the 2 methods. Results suggest that the microplate reader method can be used reliably in place of the recommended spectrophotometric method. The microplate reader method is preferred because of its high throughput capabilities, simultaneous analysis of all the standards and samples, use of small sample and reagent volumes, and reduction in labor requirements and costs.