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Blood & Cancer

Author: MDedge Hematology & Oncology

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Interview-style hematology/oncology podcast from MDedge Hematology-Oncology. The show is hosted by Dr. David Henry with Pearls from Dr. Ilana Yurkiewicz for clinical hematology and oncology health care professionals. The information in this podcast is provided for informational and educational purposes only.
37 Episodes
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Geriatric oncology

Geriatric oncology

2019-08-1500:34:52

  David Cella, PhD, of Northwestern University in Chicago, joins Blood & Cancer as the guest host for a conversation with Supriya Mohile, MD, MS, of the University of Rochester in N.Y., on geriatric oncology and the best tools to assess the fitness of older patients with cancer. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about social support and what happens when there isn’t a supportive family member at the bedside. Show notes What is “geriatric oncology?” The geriatrics population is traditionally defined as people aged 65 years and older. Geriatric medicine focuses on patient function and interventions that improve resilience, such as mobility, physical functional status, cognitive function, aging-related issues, and polypharmacy. Geriatric oncology integrates these principles into cancer treatment for the elderly. Clinical trials tend to exclude older, more frail patients in their study population, making it harder to apply the outcomes of trials to the geriatric population. Choosing an appropriate regimen and dose is harder for older patients since toxicity and dosage data are obtained from a more fit population. The general rule is to “start low and go slow” for elderly patients. In frail patients, oncologists should reconsider treatment altogether because of the implications on functional status. Assessment tools for elderly patients Geriatric assessment: A validated series of tests based on a survey that assesses categories such as function and quality of life, as well as objective findings, such as cognition and physical performance. It is a better way to determine health status for elderly patients than are the standard ECOG ratings. ASCO Guidelines in Geriatric Assessment Cancer and Aging Research Group: A community of researchers who are working collaboratively to design and implement clinical trials to improve cancer care in older adults. Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
The pitfalls of P values

The pitfalls of P values

2019-08-0800:31:14

David L. Streiner, PhD, of McMaster University, Hamilton, Ont., and the University of Toronto, joins Blood & Cancer host David Henry, MD, of Pennsylvania Hospital, Philadelphia, to explain what P values actually measure and how they both help and hinder the interpretation of clinical research findings. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, explores how quickly cancer can turn into bankruptcy. Show notes In statistics, P value is null hypothesis significance testing. The P value assesses the following: If the null hypothesis (i.e., there is no difference) is true, what is the probability that we could get data that is extreme? What are researchers doing when they test this way? Given the null hypothesis (i.e., we are assuming data is from chance alone), what is the probability that the data are actually true? What do researchers actually want to be able to do? Given the data, what is the probability of the null hypothesis (i.e., random chance alone is responsible for the difference)? The P value is affected by sample size; a smaller sample is more easily influenced by variable data and can result in outcomes that are not statistically significant. Large sample sizes are affected less by variables. It is important to differentiate what is statistically significant from what is clinically significant. Remember, P less than .05 is an arbitrary number. Do not let a P value deter use of a therapy that may show clinical benefit. Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Edward S. Kim, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., chats with David H. Henry, MD, host of Blood & Cancer, about how to perform clinical trials in the community oncology setting. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses a byproduct of our fragmented health care system – patients having to hear the same bad news repeated over and over. Show notes  Only 3%-4% of adult oncology patients are enrolled in clinical trials. Most patients diagnosed with cancer are seen in community settings (as opposed to academic centers). Oncologists in the community setting face significant obstacles to enrolling their patients in clinical trials: Communication between academic and community centers often is lacking, especially in more rural areas of the country. Community-based oncologists usually are not compensated for time spent on research or academic work. Treatment pathways used by many oncologists may not offer any information regarding clinical trials. The traditional infrastructure of a community practice may not have the necessary experts to facilitate clinical trial participation. Community oncologists may not feel comfortable talking to their patients about a novel drug of which they have little knowledge. How can community oncologists facilitate participation in clinical trials? There must be a cultural change, starting with the organization’s leadership. A study coordinator is crucial. Data, finance, and regulatory individuals are likely required. Coordination with pharmacy and pathology usually is necessary. Electronically Accessible Pathways (EAPathways) is a tool developed by Dr. Kim’s team. It is available and allows any oncologist to input a patient’s information to determine if there is an appropriate clinical trial available. Show notes by Sugandha Landy, MD, a resident in the department of internal medicine, University of Pennsylvania, Philadelphia Dr. Kim can be reached at Edward.Kim@atriumhealth.org   Additional reading Patronik KE and ES Kim. A novel clinical pathways approach to delivering regional-based clinical trials and patient care in a hybrid academic- community-based system. J Clin Pathways. 2018 May;4(4):52-5. Ersek JL et al. Implementing precision medicine programs and clinical trials in the community-based oncology practice: Barriers and best practices. Am Soc Clin Oncol Educ Book. 2018 May 23:38:188-96.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  
Ginah Nightingale, PharmD, of the Jefferson College of Pharmacy at Thomas Jefferson University in Philadelphia chats with David H. Henry, MD, host of Blood & Cancer, about the definition of polypharmacy and the challenges it poses in treating older cancer patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the waiting that cancer patients face. Show notes Older adults comprise about 15% of the total population but account for more than 33% of prescription drug use. Polypharmacy can be defined as taking five or more medications (prescription and nonprescription), as well as being on medications that have adverse effects in older adults. Older adults are at increased risk for adverse effects from polypharmacy for multiple reasons, including multiple comorbidities and altered drug metabolism. In a study by Nightingale et al., 61% of patients already had a major drug-drug interaction on their medication list prior to initiation of cancer therapy. In a study by Sharma et al., 22% of patients were taking proton pump inhibitors concurrently with tyrosine kinase inhibitors, an interaction that was associated with increased risk of death at 90 days and 1 year. Patients who receive medications from multiple pharmacies, such as a specialty pharmacy for oncologic drugs, are at increased risk of polypharmacy errors. Tools to screen for polypharmacy include: Beers criteria by American Geriatrics Society STOPP/START criteria (commonly used in Europe) Medication appropriateness index Considerations such as patient’s life expectancy and quality-of-life goals should be taken into account when deciding which medications are necessary and what may be deprescribed. Clinicians should encourage patients to bring in all medications to every doctor’s visit, and certainly at the time of initiation of cancer treatment. Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   Additional reading American Geriatrics Society 2019 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019 Apr;67(4):674-94. O'Mahony Denis et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing. 2015 Mar;44(2):213-8. Nightingale G et al. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol. 2015 May 1;33(13):1453-9. Sharma M et al. The concomitant use of tyrosine kinase inhibitors and proton pump inhibitors: Prevalence, predictors, and impact on survival and discontinuation of therapy in older adults with cancer. Cancer. 2019 Apr 1;125(7):1155-62.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Pancreatic cancer and clinical trials   David H. Henry, MD, host of Blood & Cancer, is on location at the 2019 annual meeting of the American Society of Clinical Oncology during this podcast, speaking with Davendra Sohal, MD, of the Cleveland Clinic. Dr. Sohal presented preliminary results from SWOG S1505, a phase 2 study on neoadjuvant chemotherapy for resectable pancreatic adenocarcinoma. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when a cancer patient wants to act against medical advice. Show Notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia SWOG S1505 trial: Neoadjuvant chemotherapy experience with mFOLFIRINOX vs. gemcitabine/nab-paclitaxel for resectable pancreatic adenocarcinoma.  Patients with resectable pancreatic adenocarcinoma typically have surgery prior to chemotherapy. Many patients with pancreatic adenocarcinoma recur after surgery. Randomized phase 2 trial of resectable pancreatic adenocarcinoma Patients were given chemotherapy for 3 months. If there was no progression, patients underwent surgery, followed by more chemotherapy. About one-third of these patients were found to have nonresectable disease. Additional data will be published in 2020. Neoadjuvant chemotherapy may be easier to tolerate since it is given prior to surgery. Venous thromboembolism is a common among patients with metastatic pancreatic cancer.   Resources  SWOG S1505 trial: NCT02562716 ASCO 2019, Abstract 4137   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  
David H. Henry, MD, host of Blood & Cancer, is joined by two experts on the financial toxicity of cancer. Melissa Monak and Kimberly Bell, both of the Cleveland Clinic, presented research at the 2019 annual meeting of the American Society of Clinical Oncology on the implementation of a financial navigation program at the Cleveland Clinic’s Taussig Cancer Center. In this podcast, they discuss the findings of their research and how just educating patients about their insurance benefits can improve access and patient satisfaction. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, revisits the “illusion of options” and what happens when this false hope originates with the treatment team. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia   Prior authorizations, high deductibles, and out-of-pocket expenses often delay cancer treatment. Financial navigators connect with patients diagnosed with a malignancy who have not yet started treatment. These navigators identify insurance benefits, estimate out-of-pocket costs, and find copayment assistance programs or other charitable options.   Resources Development of a financial navigation program to ease the burden of financial toxicity. J Clin Oncol 37. 2019 May 26. ASCO 2019, Abstract 6565. Patient financial burden: Considerations for oncology care and access – One organization’s approach to addressing financial toxicity (Cleveland Cancer Institute white paper).   For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc
Emergency Oncology: ICYMI

Emergency Oncology: ICYMI

2019-07-0500:26:14

Episode 26:  ICYMI: Immunotherapy side effects in the ED In this special edition podcast, Blood & Cancer revisits an interview on the complications of immunotherapy, particularly how cancer patients present in the emergency department. David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, interviews emergency department physician Maura Sammon, MD, of Temple University, Philadelphia, about what happens when cancer patients come to the ED with side effects of their immunotherapy treatment, but they think they are being treated with chemotherapy. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd  
Episode 24:   David H. Henry, MD, host of Blood & Cancer, is on location at the 2019 annual meeting of the American Society of Clinical Oncology in this podcast. Dr. Henry speaks with one of his own residents, Ronak Mistry, DO, about recent research among “bloodless medicine” patients, iron deficiency, and the ASCO experience. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when patients do their own literature search for treatment options.   Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  “Bloodless medicine” patients demonstrated superior outcomes following cardiovascular surgery when their hemoglobin was optimized to a higher level. Iron deficiency is defined as transferrin saturation less than 20 with concurrent ferritin 100-300 or ferritin less than 100. Intravenous iron repletion is superior to oral iron repletion among patients with heart failure. Iron repletion in heart failure correlates with improved functional status. Iron deficiency anemia in heart failure goes underrecognized and undertreated.   Additional reading Iron supplementation, response in iron-deficiency anemia: Analysis of five trials. Am J Med. 2017 Aug;130(8):991.e1-991.e8. Risk-adjusted clinical outcomes in patients enrolled in a bloodless program. Transfusion. 2014 Oct;54(10 Pt 2):2668-77.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz            
ASCO 2019 Special

ASCO 2019 Special

2019-06-2200:39:05

Alan P. Lyss, MD, a medical oncologist in community practice at Missouri Baptist Medical Center in St. Louis, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, to break down the most interesting and practice-changing studies at the recent 2019 annual meeting of the American Society of Clinical Oncology. Complete show notes by Ronak H. Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia, are available online here. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc David Henry on Twitter: @DavidHenryMD     Relevant links: Big Data Abstract LBA1 Abstract LBA5563 Abstract 110 CancerLinQ Database Colorectal Cancer Abstract 3500 Abstract 3501 Pancreatic Cancer Abstract 4000 Abstract LBA4 Prostate Cancer Abstract LBA2 Lung Cancer Abstract 8504 Breast Cancer Abstract 500 Abstract 502 TAILORx Abstract 503 Health Informatics Abstract 6509 Abstract 6510 Multiple Myeloma Multiple Myeloma Abstracts Smoldering Myeloma Abstract 8000 Myeloma Abstract 8002 Abstract 8007  
Episode 22: David Scadden, MD, of Harvard University Medical School, Boston, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, for a conversation about his book, “Cancerland: A Medical Memoir,” as well as immunotherapy and the challenge of patient care in the EHR age. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about enrolling patients in clinical trials and the tension between their needs and the goals of research. Read more about Dr. Scadden’s research: http://www.scaddenlab.com/ Read more about Cancerland: https://us.macmillan.com/books/9781250092755 For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz   
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