ABSTRACT
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
ABSTRACT
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
Subject(s)
Biomedical Research , Geriatric Assessment , Hematologic Neoplasms/epidemiology , Veterans Health , Veterans , Age Factors , Aged , Aged, 80 and over , Biomedical Research/statistics & numerical data , Clinical Trials as Topic , Disease Management , Female , Hematologic Neoplasms/diagnosis , Hematologic Neoplasms/therapy , Humans , Male , United States/epidemiology , Veterans Health/statistics & numerical dataABSTRACT
Cancer care navigation teams can address patient needs and break down barriers to care in veteran patients with cancer.
ABSTRACT
BACKGROUND: Serologic studies indicate that herpes simplex virus (HSV)-1 and HSV-2 infections are highly prevalent among people infected with HIV. As an ulcerative genital disease, HSV may be important to HIV transmission and HIV-comorbidity. Routine clinical care of HSV in this population has not been described. METHODS: Data were abstracted from medical records of HIV-infected individuals by the Adult/Adolescent Spectrum of HIV Disease Project. Clinician-documented HSV diagnosis and HSV treatment, defined as any prescription for acyclovir, valacyclovir, or famciclovir, were the outcomes of interest. We present descriptive statistics and trends in HSV diagnosis and treatment. RESULTS: Between 1989 and 2004, 61,299 people were followed in this study. HSV was diagnosed in 20% of the population, and 32% of the population received HSV antiviral prescriptions. Prescriptions for episodic treatment were given to 28% of patients, and 11% received prescriptions for suppressive therapy. The average annual rate of HSV diagnosis declined by 31% during the course of the study. CONCLUSIONS: Clinically recognized HSV infections were frequent despite declining rates of diagnosis. Providers should have a high index of suspicion for HSV and consider routine screening and suppressive therapy for patients at risk of clinical disease.
