Impact of the 2014 NIH chronic graft-versus-host disease scoring criteria modifications assessed in a large cohort of severely affected patients.

In 2005, the National Institutes of Health (NIH) chronic graft-versus-host disease (cGVHD) consensus project provided diagnosis and staging criteria, based mostly on clinical experience and expert opinion. These criteria were revised in 2014, aiming to provide enhanced specificity and clarity. However, the impact of 2014 changes to the original NIH cGVHD severity scoring criteria has not been reported. In this study, 284 patients, prospectively enrolled on the National Cancer Institute's cross-sectional cGVHD natural history study, were scored using the 2005 NIH cGVHD criteria and then rescored according to the 2014 modifications. In comparing the two criteria, 2014 cGVHD global severity scoring resulted in a tendency toward being categorized as milder scores (75 vs. 72% of severe score per 2014, p = 0.0009), with a statistically significant shift in NIH liver and lung scores toward milder categories (p < 0.0001). 2005 and 2014 NIH global severity scores showed a significant association with reduced grip strength (p < 0.0001), reduced joint range of motion (p = 0.0003), and the subspecialist evaluation score (p < 0.0001). Poor survival prediction of the severe NIH lung score is also retained in the new criteria (p = 0.0012). These findings support the use of 2014 cGVHD scoring criteria in continuous efforts to develop better classification systems.

Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner.

OBJECTIVE: To examine the most common long-term and late effects of breast cancer treatment, the American Society of Clinical Oncology guidelines for surveillance, and recommendations for the primary care provider's role in delivering breast cancer survivorship care. DATA SOURCES: A comprehensive literature review was conducted using CINAHL, PubMed, Google Scholar, and hand searches using the search terms breast cancer, survivor, and long-term or late effects. STUDY SELECTION: Articles published in English from 2002 to 2012 that addressed the long-term or late effects of adults with breast cancer were included. DATA EXTRACTION: Findings are discussed categorically, including the most common late and long-term psychosocial effects from relevant studies. DATA SYNTHESIS: Topics relevant to survivors included challenges to psychosocial, emotional, and cognitive well-being; satisfaction with life; sexuality; body image; anxiety; fear of recurrence and post-traumatic stress disorder; depression; cognitive dysfunction challenges to physical well-being; adverse cardiovascular events; fatigue; lymphedema; musculoskeletal symptoms; accelerated bone loss and fractures; pain; skin changes due to radiation; disease recurrence; and new breast cancers. CONCLUSIONS: With earlier detection methods and improvements in treatment options making breast cancer a highly survivable disease, there are more survivors of breast cancer than ever. The clinicians' role in survivorship care is more important than ever to manage the potential long-term and late effects of treatment, physical and emotional well-being, and recurrent disease surveillance. However, the clinician's role in cancer follow-up care is often poorly defined leading to a lack of awareness about the needs of survivors of breast cancer, suboptimal communication between providers and survivors, and an overall deficiency in quality care.