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Original Research

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy.1 Current survival rates for pediatric ALL are approaching 90% in the United States.1,2 This has been accomplished by dose intensification, risk stratification, extended treatment duration, and central nervous system prophylaxis.1,2
Granulocyte colony-stimulating factor (G-CSF) is often used after a hematopoietic stem-cell transplant (HSCT) to expedite neutrophil recovery after high-dose chemotherapy. Prolonged neutropenia after HSCT increases the risk for infectious complications and can contribute significantly to morbidity and mortality.1-3

In the United States, colorectal cancer (CRC) is the third most common cancer type and the second most common cause of cancer mortality.1,2 The lethal nature of CRC is attributable to being largely asymptomatic until advanced stages and the lack of curative treatment options for patients with advanced-stage disease.3 CRC screening in the average-risk population has clear, early detection and mortality benefits.1-3 Recently, not being up to date with screening for CRC was associated with an approximate 3-fold risk for CRC-related mortality.4

The National Comprehensive Cancer Network (NCCN) is comprised of 27 leading cancer centers in the United States that focus on creating patient and prescriber guidelines for the diagnosis of, treatment of, and supportive care for patients affected by cancer. Since 1995, the NCCN has aimed to aid oncology prescribers by providing evidence-based clinical recommendations. Although those guidelines often focus on treatment, they also provide a large amount of supportive care recommendations, including guidelines for antiemesis. The NCCN antiemesis guidelines are based on the following criteria—emetic risk of the chemotherapy agents administered, previous use of antiemetic medications, and the patient’s risk factors.1
The oncology patient population is at an elevated risk for severe infections associated with increased mortality. The early recognition of fever is critical in patients with febrile neutropenia, because a fever may be the only sign of infection.1 According to the 2010 Infectious Diseases Society of America (IDSA) guidelines, febrile neutropenia is defined as an absolute neutrophil count (ANC) of ≤500 cells/mm3, with a single oral temperature of ≥101°F or a temperature of ≥100.4°F sustained over a 1-hour period.2
Venous thromboembolism (VTE) is a major complication of hematologic malignancies and is associated with significant morbidity and mortality. Patients with multiple myeloma are especially at risk for VTEs based on the underlying disease pathophysiology and the treatments used for this patient population, specifically immunomodulatory drugs (IMiDs). The risk for VTE among patients ranges from 26% to 67% for those with newly diagnosed multiple myeloma, and from 11% to 15% for patients with relapsed or refractory multiple myeloma. The use of IMiDs further increases the risk for thromboembolic complications, particularly within the first 6 months of therapy, although this risk decreases over time.
Cisplatin is a platinum-based antineoplastic drug that is widely prescribed alone or in combination for the treatment of patients with solid-organ tumors.
Myelosuppression is a dose-limiting complication of systemic chemotherapy that can result in serious and life-threatening infections.
Tumor lysis syndrome (TLS) is a life-threatening complication of hematologic malignancies and some solid tumors. This syndrome occurs after tumor cells break down spontaneously or after exposure to radiation or chemotherapy. Lysis of tumor cells will release intracellular contents into the bloodstream, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
The use of a closed-system transfer device (CSTD) has been accepted as a standard of practice to minimize exposure to harmful materials when compounding hazardous medications. Several reports indicate that CSTDs also preserve the sterility of unpreserved (ie, single-use) medication vials for up to 1 week. Taking advantage of prolonged sterility of nonpreserved vials with an appropriate CSTD attached offers the possibility of significant cost-savings through reduced drug waste.
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