ABSTRACT
BACKGROUND: In this cross-sectional study, the sensibility, test-retest reliability, and validity of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were assessed in patients who underwent neck dissection. METHODS: Sensibility was assessed with a questionnaire. Test-retest reliability was performed with completion of the DASH questionnaire 2 weeks after initial completion; validity, by evaluating differences in scores between patients undergoing different types of neck dissections and correlating DASH scores with Neck Dissection Impairment Index (NDII) scores. RESULTS: The DASH questionnaire met sensibility criteria. For test-retest reliability analysis, the intraclass coefficient was 0.91. The DASH questionnaire showed differences between patients who underwent accessory nerve-sacrifice and nerve-sparing neck dissection. DASH questionnaire scores strongly correlated with NDII scores (r = -0.86). CONCLUSION: Although this study provides preliminary data on some psychometric properties of the DASH questionnaire in patients who have undergone a neck dissection, further assessment of responsiveness and other properties are required.
Subject(s)
Disability Evaluation , Head and Neck Neoplasms/pathology , Neck Dissection , Accessory Nerve/surgery , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neck Dissection/methods , Organ Sparing Treatments , Reproducibility of ResultsABSTRACT
BACKGROUND: Dermatologic toxicities from targeted agents such as panitumumab can interfere with cancer treatment. OBJECTIVE: We sought to evaluate the rash assessment and management in a consecutive patient cohort who received panitumumab for colorectal cancer treatment. METHODS: This was a retrospective chart review. RESULTS: Skin toxicity, consisting of papulopustular rash, was experienced by 32 of 34 patients. The majority (85%) developed the rash by the end of the second infusion cycle. Patients presented with a mild (41%), moderate (38%), and severe (21%) rash, and progressed to an extensive rash without appropriate treatment. A grading system was used for 65% of patients to document severity. LIMITATIONS: Small sample size limited power in analysis. Rash severity had to be inferred based on rash description and management in 11 of the patients. CONCLUSION: Dermatologic toxicities related to panitumumab are common; however, the way they are reported and managed varies among physicians. To prevent progression, toxicities must be assessed and treated early and aggressively, according to severity grading. Dermatologists could aid oncologists in choosing the best management strategies.
Subject(s)
Antibodies, Monoclonal/adverse effects , Colorectal Neoplasms/drug therapy , Drug Eruptions/etiology , Exanthema/chemically induced , Exanthema/drug therapy , Acneiform Eruptions/chemically induced , Acneiform Eruptions/drug therapy , Adult , Aged , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Chemotherapy, Adjuvant , Cohort Studies , Colorectal Neoplasms/surgery , Dermatologic Agents/therapeutic use , Drug Eruptions/drug therapy , Drug Eruptions/epidemiology , Exanthema/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Ontario , Panitumumab , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Graft-versus-host disease (GVHD) has no therapeutic benefit after hematopoietic cell transplantation (HCT) for patients with acquired aplastic anemia (AA), and its prevention is highly desirable. We designed a conditioning regimen using an intermediate dose of alemtuzumab (50 to 60 mg) and describe our institutional experience of 41 patients who underwent HCT for AA. The median age at HCT was 37 years (range, 17 to 59). The conditioning regimen was high-dose cyclophosphamide (n = 9) or fludarabine based (n = 32). Additional GVHD prophylaxis was with cyclosporine. With a median follow-up of 3.6 years, overall survival at 3 years was 85%. Survival in patients <40 years and ≥40 years was 96% and 67%, respectively (P = .04). Graft failure occurred in 4 (10%) patients; 2 primary and 2 secondary. The cumulative incidences of acute (grades 1 to 2) and chronic GVHD were 27% and 15%, respectively. No patients developed grade 3 to 4 acute GVHD or severe chronic GVHD. The following viral complications were frequent: cytomegalovirus reactivation (79%), herpes simplex (18%), varicella zoster (25%), and BK virus hemorrhagic cystitis (8%). The majority of patients had no significant long-term health issues. This intermediate-dose alemtuzumab-based conditioning regimen results in excellent survival with a favorable impact on GVHD and long-term health outcomes, but close monitoring for viral complications is important.