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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.
32 Episodes
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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   
  David Cella, PhD, of Northwestern University in Chicago, joins Blood & Cancer as the guest host for a conversation on patient-reported outcomes and how to apply them in oncology clinical practice with Ethan Basch, MD, of the University of North Carolina, Chapel Hill. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about invisible illness and what it’s like for a patient to be dying but appear outwardly healthy. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  Patients understand how they are doing better than clinicians do. Subjective patient outcomes (pain, fatigue, myalgias) are difficult for clinicians to classify and are often discordant with patient reports. In routine practice and clinical trials, the clinician reporting of adverse events/patient symptomatic side effects is inconsistent and incomplete. Physicians may not know about symptoms and side effects of patients undergoing treatment because: Patients are scared their dose will be reduced or discontinued. Patients don’t want to let their doctors down. Patients think feeling ill after chemo is “normal.” Questionnaires produce more accurate reports of patient symptoms than conversations with providers. CTCAE = Common Terminology Criteria for Adverse Events (provider version). PRO-CTCAE = Patient-reported outcomes version of the Common Terminology Criteria for Adverse Events. It is a library of individual items asking patients directly about symptomatic events. It is used in many clinical trials to monitor patient-reported adverse events. Monitoring patient-reported outcomes (PROs) systematically during visits decreases rates of emergency department visits and hospitalizations. Nurses and patient advocates often alert providers to PROs.   Resources: CTCAE PRO-CTCAE Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) consortium    For more MDedge Podcasts go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc
James C. Reynolds, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss the ins and outs of constipation among cancer patients: how to recognize it, how to treat it, and why you need to ask about it. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about those tough phone calls. You can interact with the show on Twitter: @DavidHenryMd @IlanaYurkiewicz @MDedgeHemOnc Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  Stool dysmotility is defined by a both objective imaging and the Bristol stool scale. Narcotics, mechanical issues (anastomoses), nausea, lack of exercise, and low-liquid or low-fiber diet contribute to constipation. There is a placebo effect of up to 40% for drugs given for constipation. Reglan (metoclopramide) in low doses, used sporadically, is relatively safe. However, it has been associated with Parkinsonian-type movement disorders and depression. Gastric emptying tests (and stomach function) are influenced by stress, mood, nausea, side effects, and hormones. They are not efficacious to evaluate gastric motility in the inpatient setting. Anal pain and fecal incontinence can occur during acute therapy (including radiation proctitis). It is important for clinicians to ask patients about constipation as it may be paradoxical and manifest as diarrhea. Fecal incontinence and sphincter dysfunction following therapy is multifactorial. Flat plate, proctosigmoidoscopy, and anal manometry can give a detailed description of anal function and compliance. It is important for clinicians to ask patients about constipation and fecal incontinence. Further reading: Managing constipation in adults with cancer (J Adv Pract Oncol. 2017 Mar;8[2]:149-61). Bristol Stool Chart   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc
In this bonus edition, MDedge Postcasts voice Nick Andrews brings an interview from our sister show, the Postcall Podcast with Ilana Yurkiewicz, MD.  You can learn more about the Postcall Podcast by clicking here. Ilana Yurkiewicz, MD, is a hem/onc fellow at Stanford. She writes the Hard Questions Column for MDedge Hematology/Oncology and writes/records/produces the Clinical Correlation segment of Blood & Cancer, the official podcast of MDedge Hematology/Oncology.   Dr. Yurkiewicz's 's articles: Doctor will you please lie to me? Should doctors disclose primary results?   A complete list of Dr. Yurkiewicz's column, Hard Questions is available here, and you can check out Blood & Cancer here. Links from the interview: Ted Chiang Story of Your Life Exhalation Arrival  
Cancer-related fatigue

Cancer-related fatigue

2019-05-3000:33:40

  David Cella, PhD, and Lisa Wu, PhD, both of Northwestern University in Chicago, discuss fatigue and sleep disturbance related to cancer – its prevalence and possible treatments -- in this episode of Blood & Cancer.   In Clinical Correlation (29:45), Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares a case that highlights the resilience that patients show in the face of cancer, and asks: Can a positive attitude improve outcomes?   Show notes By Hitomi Hosoya, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  Cancer-related fatigue is prevalent in cancer patients and cancer survivors. Sleep disturbance also is prevalent in this population and can be related to fatigue. In breast cancer patients, for instance, fatigue during treatment can be as high as 80%. Even after 7-9 years of treatment, more than 50% of breast cancer patients reported sleep disturbances, according to one study. Cancer-related fatigue is different from usual daily fatigue; it is more severe, more distressing, and not relieved by rest. Cancer-related fatigue and sleep disturbance are thought to be related to pro-inflammatory cytokines, endocrine dysfunction, and possibly to circadian rhythm. Cancer-related fatigue should be evaluated from treatment regimen perspectives, metabolic perspectives, or other underlying medical problems. If the above conditions are ruled out, psychosocial therapy (exercise, cognitive behavioral therapy) should be considered. Recently, light therapy using broad-spectrum bright light to correct circadian rhythm has been studied. The gold standard treatment for sleep issues in cancer is cognitive behavioral therapy for insomnia.  
Hazard ratio? P value?

Hazard ratio? P value?

2019-05-2300:27:05

Episode 17: 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 talk hazard ratios and P values as they examine the clinical relevance of findings from a phase 3 trial.   In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about how to balance family versus patient preferences.   Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  A phase 3 trial is a randomized, controlled trial testing a new intervention against placebo or treatment as usual. Randomization maximizes the chances that the groups are equivalent but does not guarantee it. With randomization, you also are accounting for variables that are unknown and/or cannot be controlled for.  Phase 3 trial discussed by Dr. Henry and Dr. Streiner: AURELIA trial: Bevacizumab plus chemotherapy vs. chemotherapy alone for platinum-resistant ovarian cancer. Inclusion criteria: Ovarian cancer that has progressed on a platinum-based therapy. Randomization: 361 patients randomized 1:1 to receive bevacizumab plus chemotherapy versus chemotherapy alone. Primary endpoint: Progression-free survival (PFS). Main outcome: PFS had a hazard ratio 0.48 (95% confidence interval, 0.38-0.60). A hazard ratio of 0.48 means that patients in the experimental group had half the risk of experiencing a bad outcome (progression) than patients in the comparison group did. The hazard ratio includes a confidence interval (CI) at the end of the value because it is an estimate. The CI represents where the true hazard will fall 95% of the time. If 1.0 is included in the range, then the result is not statistically significant, and the events could have happened by chance. An ad hoc analysis is conducted at the end of the study. It is not a prespecified statistical idea. It is thought provoking and hypothesis generating but not conclusive. Reference: AURELIA trial: J Clin Oncol. 2014;32(13):1302-8.
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