Physician practice in the discontinuation of statins among patients with advanced lung cancer.

BACKGROUND: Statins are effective in reducing events from coronary heart disease and can prolong survival. However, this benefit is controversial when other concurrent serious health problems greatly limit the patient's longevity. METHODS: We conducted a retrospective chart review of patients with advanced lung cancer who were receiving statins and had lived for at least one month since diagnosis. FINDINGS: Forty-seven patients with median age of 71 years were included. Discontinuation of statins occurred in 25 patients (53.2%) before the date of death. Median survival was 370 days. Statins were discontinued at a median of 244 days after cancer diagnosis. Discontinuations were more prevalent in patients who received chemotherapy or had a history of cerebrovascular diseases. Lipid monitoring was observed in 25 patients (53.2%). INTERPRETATION: About half of patients with advanced lung cancer who were prescribed statins did not have this drug discontinued until the time of death. Lipid monitoring was suboptimal and, when it occurred, indicated the lipid goal was rarely achieved.

Simple scoring system for early management of heparin-induced thrombocytopenia.

This study was performed to develop a simple scoring system to aid in the early clinical management of patients suspected of heparin-induced thrombocytopenia (HIT) with regard to decisions for continued heparin therapy. The system was designed to arrive at low (0) or possible (1) probability scores without knowledge of laboratory test results (except platelet counts) to avoid delays. As the safest clinical approach is to discontinue heparin, intermediate and high scores were combined. Critically ill VA hospital patients (n = 100) with a ≥30% fall in platelet count were assessed by platelet aggregation (PA), (14)C-serotonin release assay ((14)C-SRA), and GTI ELISA. In this population, 53% were scored 1 and of these 43% were positive by laboratory test. Emphasizing the decision to discontinue heparin, the clinical signs of HIT were paramount for the immediate determination of a diagnosis of HIT without dependence on a positive laboratory test.

Severity, risk factors, and physician practices in the management of anemia during concurrent chemoradiation for head and neck carcinoma.

BACKGROUND: Anemia is a well-recognized complication of concurrent chemoradiation therapy for head and neck carcinoma. It impairs quality of life and many studies also have reported an association between anemia and increased tumor recurrence and decreased long-term survival. In the current study, the authors attempted to identify the severity, risk factors, and physician practices in the management of anemia. METHODS: Medical records of those patients receiving concurrent chemoradiation for head and neck carcinoma between 1999-2003 were reviewed. The average weekly nadir hemoglobin level (AWNH) was defined as the mean value of the lowest hemoglobin concentration in each week. Independent predictors for an AWNH < 11 g/dL were identified using multivariable logistic regression analyses. RESULTS: Seventy-two patients were included in the current study, 66.7% of whom had unresectable disease. The overall median survival was 402 days. At baseline, 76.4% (95% confidence interval [95% CI], 66.3-86.4%) of patients already had a hemoglobin level < 13.5 g/dL. The hemoglobin level dropped 2.5 +/- 1.9 g/dL during concurrent chemoradiation, resulting in 95.8% of patients having a hemoglobin level < 13.5 g/dL at the end of the observation period. Blood was transfused to 24 patients (33.3%); erythropoietin or darbepoietin was administered to 2 patients (2.7%). The mean lowest hemoglobin threshold of transfusion was 7.3 +/- 1.0 g/dL. The cumulative percentage of patients who received a transfusion reached 50% when the mean nadir hemoglobin level was 7.4 g/dL. Independent predictors of an AWNH < 11.0 g/dL were low baseline hemoglobin and receiving multiple concurrent chemotherapeutic agents, with relative risks of 13.6 and 1.8, respectively (95% CI,1.9-93.9 and 1.1-3.1, respectively). CONCLUSIONS: Anemia is prevalent in patients undergoing treatment for head and neck carcinoma and can be severe with concurrent chemoradiation therapy. However, the intensity of anemia management is low. A low baseline hemoglobin level and the reception of multiple concurrent chemotherapeutic agents are considered to be the main risk factors of anemia. Cancer 2006.

Hypocalcemia and azotemia associated with zoledronic acid and interferon alfa.

OBJECTIVE: To describe severe hypocalcemia and acute renal failure associated with zoledronic acid and interferon alfa in a patient with metastatic carcinoid tumors. CASE SUMMARY: A 39-year-old white man with metastatic carcinoid tumor tolerated treatment with subcutaneous long-acting octreotide monthly and interferon alfa 6 million units 3 times weekly for 6 months. Due to multiple bony metastases, zoledronic acid was prescribed as a monthly 4-mg intravenous infusion over 30 minutes to prevent skeletal-related events. Although the first infusion went well, the patient developed severe hypocalcemia and acute renal failure after the second zoledronic infusion. DISCUSSION: Bisphosphonates may infrequently cause symptomatic hypocalcemia, especially among patients who have vitamin D deficiency or hypoparathyroidism or receive treatment with an aminoglycoside. Our literature review suggests that zoledronic acid and interferon alfa may exert additive effects on the inhibition of osteoclasts, thus potentially precipitating hypocalcemia. Renal dysfunction may not be a direct consequence of interferon alfa. However, altered mental function due to hypocalcemia may lead to dehydration and further exacerbate renal dysfunction, a known adverse effect of zoledronic acid. Since therapeutic indications of both interferon alfa and zoledronic acid continue to expand, clinicians should be aware of these serious adverse reactions and potential interaction. Supportive treatment with hydration, calcium supplement, and oral calcitriol resulted in resolution of hypocalcemia, but only partial improvement of azotemia. CONCLUSIONS: In our patient with metastatic carcinoid tumor, treatment with zoledronic acid and interferon alfa was associated with symptomatic hypocalcemia and acute renal failure.