Clinical characteristics and prognostic factors in multiple myeloma patients with light chain deposition disease.

Light chain deposition disease (LCDD) is characterized by monotypic immunoglobulin depositions which will eventually lead to loss of organ function if left untreated. While the kidney is almost always affected, the presence and degree of LCDD in other organs vary. Ten to thirty percent of LCDD patients have underlying Multiple Myeloma (MM), yet outcome and prognostic markers in this particular patient group are still lacking. Here, we analyzed 69 patients with MM and biopsy proven LCDD and report on renal and extra-renal involvement and its impact on prognosis as well as renal response depending on hematologic response. Coexisting light chain diseases such as AL amyloid and cast nephropathy were found in 30% of patients; those with LCDD and concurrent amyloid tended to have shorter survival. Cardiac involvement by LCDD was seen in one-third of our patients and was associated with shorter overall survival; such patients also had a significantly higher risk of treatment-related mortality (TRM) after stem cell transplant (SCT) compared to LCDD patients without cardiac involvement. This study highlights that MM patients with LCDD present with different clinical features compared to previously reported LCDD cohorts. Rapid initiation of treatment is necessary to prevent progressive renal disease and worse outcome. Coexisting light chain diseases and cardiac involvement are more common than previously reported and confer worse clinical outcome, emphasizing the need for careful patient careful patient evaluation and treatment selection.

Cancer survivorship training: a pilot study examining the educational gap in primary care medicine residency programs.

BACKGROUND: Cancer survivors need high-quality follow-up care that addresses long-term problems related to cancer and their treatment. With growing numbers of cancer patients transitioning from oncological treatment to survivorship care, primary care physicians (PCPs) will play a major role in the delivery of survivorship care. OBJECTIVE: This pilot study was undertaken to provide initial insights into internal medicine (IM) and family medicine (FM) residents' educational experience, training, and preparedness for practice as healthcare providers of adult cancer survivors (ACS). DESIGN: This study utilizes an anonymous cross-sectional, electronic survey of a sample of US IM and FM residents. PARTICIPANTS: A total of 77 residents in their PGY-3 year of training responded to the survey, including 53 IM (69%) and 24 FM (31%) residents. RESULTS: The majority (97%) of respondents performed as PCPs for ACS during their training, and 81% expected to take care of such patients in the future. However, only a minority reported feeling very comfortable in this role or very confident of identifying cancer recurrence and potential long-term effects of cancer treatment (13%, 21%, and 15%, respectively). Formal education in survivorship care was reported by 27% of residents and was modestly associated with knowledge responses. High clinical exposure (defined as having ≥10 opportunities to perform as the PCP for ACS) was significantly associated with self-reported knowledge, comfort level, and self-confidence in being able to evaluate and manage potential long-term effects of cancer treatment and their symptoms. CONCLUSIONS: Our results suggest there is a substantial disconnect between resident's educational experience, training, and self-reported preparedness for practice in cancer survivorship in both IM and FM training specialties. IMPLICATIONS FOR CANCER SURVIVORS: Inadequate training in cancer survivorship represents a barrier to providing adequate cancer follow-up. Inexperience or unawareness of essential survivorship issues could lead to mistakes which affect survivors' health and timely assessment of long-term cancer-associated morbidity. As PCPs will play a key role in the delivery of survivorship care, effective educational opportunities and achievement of competencies in adult cancer survivorship care by primary care trainees are needed.

Perfil epidemiológico y clínico de los pacientes con diagnóstico de neoplasia maligna en el servicio de Medicina Interna 11c del Hospital Nacional Edgardo Rebagliati Martins: período 2008-2009 / Epidemiological and clinical profile of patients with a diagnosis of malignancy in Internal Medicine 11c National Hospital Edgardo Rebagliati Martins: period 2008-2009

OBJETIVO: Describir las características epidemiológicas y clínicas de los pacientes internados en el Servicio de Medicina Interna 11C del Hospital Nacional Edgardo Rebagliati Martins (HNERM) en el periodo 2008 - 2009, que tuvieron como diagnostico neoplasia maligna. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo, se recolectaron datos consignados en la epicrisis de los 446 pacientes que egresaron o fallecieron con diagnóstico de Neoplasia Maligna del Servicio de Medicina Interna 11C del HNERM. RESULTADOS: La tasa de prevalencia de Neoplasia Maligna (NM) fue 19.4% (446) y la tasa de incidencia del 8.2% (188). La frecuencia de neoplasias malignas por sexo, se encontró que de los 188 casos nuevos, un 43.7% (82) fueron mujeres y un 56.3% (106) varones El promedio de edad de los pacientes internados con diagnóstico de neoplasia maligna fue de 67.19 años. Los tipos de neoplasias malignas mas frecuentes fueron neoplasias hematológicas (Leucemia/Linfoma/Mieloma Múltiple) 16%, NM de Próstata 11.7%, NM de pulmón 11.2%, NM de mama 7.4% y NM Urológicas (Riñón/vejiga) 6.9%. Durante su internamiento fallecieron 61 (13.67 %) y salieron de alta vivos 385 (86.3%). Los lugares más frecuentes de metástasis fueron: ósea 20 (10.6%), cerebro 11 (5.9%) y zonas múltiples 16 (8.5%). CONCLUSIONES: La tasa de prevalencia de neoplasias malignas en un servicio de medicina interna es significativa, especialmente en pacientes mayores de 60 años, sin predominancia significativa de sexo. Las más frecuentemente internadas fueron las neoplasias hematológicas, próstata, pulmón, mama y las urológicas, siendo los lugares más frecuentes de metástasis el tejido óseo y el cerebro. Por ello los Servicios de Medicina Interna de la Seguridad Social deben de estar preparados para diagnosticar y manejar en forma multidisciplinaria con los Oncólogos y demás especialidades los problemas médicos de los pacientes con neoplasias.