A modified filgrastim regimen does not reduce pain burden compared to pegfilgrastim in women receiving chemotherapy for non-metastatic breast cancer.

PURPOSE: The short half-life of filgrastim allows for modification in the dose or duration of prophylaxis to limit inconvenience, adverse effects, and cost. The objectives of this study were to characterize and compare pain and neutropenic events between filgrastim and pegfilgrastim. METHODS: A prospective, observational study was performed. Eligible patients had non-metastatic breast cancer and were to receive adjuvant or neo-adjuvant chemotherapy with prophylaxis for febrile neutropenia. The prophylaxis used was a fixed-dose regimen of filgrastim 300 µg subcutaneously once daily for 7 days or pegfilgrastim 6 mg subcutaneously for 1 day. Participants completed a pain diary once a day for 14 days commencing the evening of the patient's first chemotherapy. Telephone interviews occurred at two instances within 2 weeks after their first treatment. The primary endpoints of this study were the difference in pain and incidences of neutropenia. Muscle pain, pain burden, and potential risk factors for pain were also explored. RESULTS: A total of 142 women were enrolled, 94 with pegfilgrastim and 48 with filgrastim. Filgrastim was associated with worse joint and muscle pain compared to pegfilgrastim. Joint pain was present in 38 and 26 % of diary entries for filgrastim and pegfilgrastim, respectively (p = 0.009). The mean AUC for joint pain score across 14 days, normalized to 100, were 6.0 for pegfilgrastim and 8.6 for filgrastim in patients receiving non-docetaxel chemotherapy and 14.6 for pegfilgrastim and 21.5 for filgrastim in patients receiving docetaxel-based chemotherapy (p = 0.037). Muscle pain patterns and frequencies were similar to joint pain. There were no statistical differences in febrile neutropenia and neutropenic events. CONCLUSIONS: Both filgrastim and pegfilgrastim caused significant pain burden. A fixed-dose regimen of filgrastim may be effective, but offers no advantage to minimize muscle or joint pain and, in fact, appears to cause greater and more frequent pain.

An Unusual Presentation of a Patient With Low-Dose Methotrexate Causing Colitis and Pancytopenia.

This paper summarizes the case of a patient admitted to the hospital due to methotrexate-induced colitis in the setting of pancytopenia. Although methotrexate is commonly used for a variety of diseases, this medication can precipitate side effects in a subset of patients. This is an atypical case of chronic low-dose methotrexate use leading to colitis and pancytopenia. It is of utmost significance to monitor patients on methotrexate through routine laboratory checks such as complete blood counts and liver function tests to ensure safety and reduce mortality.

Efficacy of Daratumumab-Based Regimens Compared to Standard of Care in Transplant-Eligible Multiple Myeloma: A Meta-Analysis.

Daratumumab (dara) belongs to a class of monoclonal antibodies that target CD38 receptors expressed on multiple myeloma (MM) cells. It was first approved for MM treatment in 2015. The efficacy and safety of dara have been reported in many studies. In this analysis, we assessed the outcome of dara addition to standard of care for transplant-eligible newly diagnosed (ND) MM. We conducted a comprehensive search using PubMed, ClinicalTrial.gov, and Embase. Out of 435 articles, we included two randomized clinical trials. We computed the odds ratio (OR) of response rates and risk ratio (RR) of adverse effects using Cochrane RevMan version 5.4. A total of 1,292 patients were enrolled in both trials. The patients were randomized into the control group and the dara group. The dara group included 647 patients and the control group included 645 patients. The CASSIOPEIA trial reported the outcomes using dara, bortezomib (V), thalidomide (T), and dexamethasone (d) versus VTd. The GRIFFIN trial underlined the efficacy of dara, lenalidomide (R), and Vd in the dara group versus RVd in the control group. A pooled analysis of included studies showed an increased overall response rate (OR: 1.60; 95% CI: 1.06-2.41; p = 0.02; I 2 = 65%), stringent complete response (OR: 1.59; 95% CI: 1.24-2.05; p = 0.03; I 2 = 0%), and negative status for minimal residual disease (OR: 2.47; 95% CI: 1.97-3.10; p < 0.01; I 2 = 66%) in the dara group as compared to the control group. However, an increased risk of neutropenia (RR: 1.80; 95% CI: 1.60-2.03; p < 0.01) and decreased risk of peripheral neuropathy (RR: 0.92; 95% CI: 0.86-0.99; p = 0.02; I 2 = 52%) were observed in the dara group. Dara addition to the standard of care regimen for transplant-eligible NDMM has promising outcomes with increased efficacy and safety profile and manageable toxicity.

Association of Gastrointestinal System With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis.

At present, the novel coronavirus disease (COVID-19) is causing a major pandemic. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In COVID-19, the patient usually presents with fever, dry cough, and respiratory manifestations. However, the involvement of other systems has also been reported in the literature. Abdominal pain, diarrhea, vomiting, and nausea are the predominant gastrointestinal (GI) manifestations underlined in the literature. We conducted a literature search using four databases (PubMed, Web of Science, Google Scholar, and Clinicaltrials.gov). Our search strategy included Medical Subject Headings (MeSH) terms and keywords for COVID-19, SARS-CoV-2, and GI system from inception to October 2020. After excluding duplicates, review articles, and non-relevant articles, we included 20 studies out of 842 articles reporting GI manifestations in COVID-19 patients. Using Cochrane RevMan version 5.4 (Cochrane, London, UK), a compute pooled analysis using a random-effect model was performed. Our study included 6,022 patients with a median age of 49.5 years. Pooled analysis via random effect model revealed an increased risk of severe COVID-19 in patients manifesting GI symptoms with an odds ratio (OR) of 2.07 (95% Confidence Interval [CI]: 1.34-3.18) with I2=41%). Odds of mortality in COVID-19 with GI manifestation and hepatic abnormalities included 0.92 (95% CI: 0.50-1.69) (I2=57%) and 1.26 (95% CI: 0.67-2.37) (I2=0%), respectively. Severe COVID-19 may have a strong association with GI manifestations and have a significant impact on GI practice. Holistic knowledge of the spectrum of the GI consequences in COVID-19 is crucial to get a hold of virus spread. In this article, we have summarized the association of GI manifestations in severe COVID-19 patients.

The Association of Acute Kidney Injury With Disease Severity and Mortality in COVID-19: A Systematic Review and Meta-Analysis.

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has become a global healthcare emergency. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has a wide range of clinical manifestations ranging from subclinical infection to multi-organ failure. In addition to the respiratory system, COVID-19 also adversely affects the kidneys. In this study, we aimed to measure the prevalence of acute kidney injury (AKI) in COVID-19 and its association with the disease severity and mortality in COVID-19 patients. Materials and methods We conducted our study by following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A comprehensive literature search using four databases (PubMed, EMBASE, Google Scholar, and clinicaltrial.gov) was performed. Our initial search returned 2,771 articles. After excluding review articles, duplicates, and non-relevant studies, we included 20 articles that reported an association between COVID-19 and AKI. We subsequently performed a random effect analysis to find the pooled prevalence, pooled odds ratio (OR) estimates, and 95% confidence intervals for severe COVID-19 and mortality outcomes in AKI using Cochrane RevMan (version 5.4) and R programming language (version 4.16-2). Results A total of 14,415 patients from various countries were included. Among the 20 cohorts, the median age was 55.8 ±8.39 years (range: 43-72 years), and 43.78% of the subjects were female. Out of a total of 14,415 patients, 3,820 developed AKI with a pooled prevalence of 11% (95% CI: 0.07-0.15; p<0.01; I2=98%). AKI was found to have a significant association with severe COVID-19 disease, with a pooled OR of 8.45 (95% CI: 5.56-12.56; p<0.00001; I2=0%). AKI was associated with significantly higher mortality in patients with COVID-19 with an OR of 13.52 (95% CI: 5.43-33.67; p<0.00001; I2=88%). Conclusion AKI manifests as a common COVID-19 complication, and COVID-19 patients with AKI generally have poor outcomes in terms of disease severity and mortality.

Impact of Chronic Kidney Disease on Severity and Mortality in COVID-19 Patients: A Systematic Review and Meta-analysis.

Coronavirus disease 19 (COVID-19) has affected over 180 countries, resulting in global mass death. It has been reported that patients with underlying disease are more likely to contract the disease and become critically ill. The impact of chronic kidney disease (CKD) on the severity of COVID-19 has been underlined in the literature. In this analysis, we have provided evidence of an association between CKD and COVID-19. We followed the PRISMA protocol and conducted a literature search using Google Scholar, EMBASE, PubMed, and Clinical trail.gov. The initial search yielded 2102 articles. We included 20 cohorts based on inclusion criteria reporting an association between CKD and COVID-19 after excluding irrelevant articles, including review articles and duplicates. We conducted pooled prevalence of CKD and meta-analysis to estimate the odds ratio (OR), 95% confidence interval (CI) using Cochrane RevMan (version 5.4, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration), and R programming language version 4.16-2 (University of Auckland, New Zealand). Our study involved 4350 patients from different countries, and 212 (4.9%) patients had CKD. Among 20 cohorts, 57.27% were male with a median age of 55.5 years. Eight hundred sixty-six patients developed severe COVID-19, and out of which, 39 (4.5%) were CKD patients. CKD patients had a significantly increased risk of severe disease as compared to non-CKD patients with a pooled OR of 2.15 (95% CI 1.16-4.01) (I2=41; p=0.02). Out of 443 COIVD-19 patients who died, 85 patients had CKD, with a prevalence of 19.18%. CKD patients had an increased risk of death as compared to non-CKD patients with a pooled OR of 5.58 (95% CI 3.27-9.54) (I2=0; p<0.00001). CKD is manifested as a common underlying disease in COVID-19 patients who had a worse prognosis, including mortality.

Perceptions of Radiation Therapists about Providing Psychosocial and Supportive Care to Patients at Peel Regional Cancer Center.

BACKGROUND: Many patients with cancer undergoing radiation treatment have unmet psychosocial and supportive care (PSOSC) needs. Radiation therapists (RTs) have a unique opportunity to provide PSOSC, but the published literature is limited regarding their perceptions and beliefs about delivering such care. A survey was designed to evaluate these aspects. METHODS: A one-time, cross-sectional survey was distributed to 52 RTs at the Peel Regional Cancer Centre, Mississauga, Ontario, Canada. This survey contained six baseline questions and 34 item statements. The 34 statements spanned three themes: (1) convictions and motivations, (2) preparedness and execution, and (3) resources and facilitators. Participants were asked to rank statements on an eight-point scale, from "strongly disagree" to "strongly agree." RESULTS: Eighty-three percent of the RTs responded. Respondents reported they were engaged for 6.2 hours per week in supporting patients with PSOSC. This was despite a technical focus of organizing and delivering a course of radiotherapy for each patient, a relatively fixed schedule, and short-duration time slots booked per patient. Overall, respondents reported a moderately strong level of convictions and motivations for including PSOSC in practice. They perceived that they were not using all of their existing PSOSC skills and knowledge on the job and that supporting professional (eg, training and scheduling) and environmental (eg, screening tools, physical environment, and policies) infrastructures for PSOSC were not optimized. CONCLUSIONS: A majority of the respondents believed PSOSC to be an integral part of providing quality care to radiation oncology patients. Findings showed that staff members were highly motivated to provide this care and perceived that, with additional support, their capacity to provide such care in a way that is meaningful to patients would increase.