Purpose To update the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors (CSFs). Methods The American Society of Clinical Oncology convened an Update Committee and conducted a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014. Guideline recommendations were based on the review of the evidence by the Update Committee. Results Changes to previous recommendations include the addition of tbo-filgrastim and filgrastim-sndz, moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma, and addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high–dose-intensity chemotherapy in urothelial cancer. The Update Committee did not address recommendations regarding use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults. Recommendations Prophylactic use of CSFs to reduce ...

Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update

Simple Summary Obesity has been linked to several common cancers including breast, colorectal, esophageal, kidney, gallbladder, uterine, pancreatic, and liver cancer. Obesity also increases the risk of dying from cancer and may influence the treatment choices. About 4–8% of all cancers are attributed to obesity. The underlying mechanism of obesity causing cancer is complex and is incompletely understood. Lifestyle changes that include diet, exercise, and behavior therapy are the mainstay of interventions. Drug therapy and weight reduction surgery result in a more rapid weight loss and may be used for a subgroup of cancer survivors with obesity. This review highlights the epidemiology and the risk associated with the development and recurrence of cancer in obese individuals and the management of obesity. Abstract Background: Obesity or excess body fat is a major global health challenge that has not only been associated with diabetes mellitus and cardiovascular disease but is also a major risk factor for the development of and mortality related to a subgroup of cancer. This review focuses on epidemiology, the relationship between obesity and the risk associated with the development and recurrence of cancer and the management of obesity. Methods: A literature search using PubMed and Google Scholar was performed and the keywords ‘obesity’ and cancer’ were used. The search was limited to research papers published in English prior to September 2022 and focused on studies that investigated epidemiology, the pathogenesis of cancer, cancer incidence and the risk of recurrence, and the management of obesity. Results: About 4–8% of all cancers are attributed to obesity. Obesity is a risk factor for several major cancers, including post-menopausal breast, colorectal, endometrial, kidney, esophageal, pancreatic, liver, and gallbladder cancer. Excess body fat results in an approximately 17% increased risk of cancer-specific mortality. The relationship between obesity and the risk associated with the development of cancer and its recurrence is not fully understood and involves altered fatty acid metabolism, extracellular matrix remodeling, the secretion of adipokines and anabolic and sex hormones, immune dysregulation, and chronic inflammation. Obesity may also increase treatment-related adverse effects and influence treatment decisions regarding specific types of cancer therapy. Structured exercise in combination with dietary support and behavior therapy are effective interventions. Treatment with glucagon-like peptide-1 analogues and bariatric surgery result in more rapid weight loss and can be considered in selected cancer survivors. Conclusions: Obesity increases cancer risk and mortality. Weight-reducing strategies in obesity-associated cancers are important interventions as a key component of cancer care. Future studies are warranted to further elucidate the complex relationship between obesity and cancer with the identification of targets for effective interventions.

/pdf/obesity-and-cancer-a-current-overview-of-epidemiology-rntl7u94.pdf

Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management

BACKGROUND A wide variety of myelosuppressive chemotherapy regimens are used for the treatment of cancer in clinical practice. Neutropenic complications, such as febrile neutropenia, are among the most common side effects of chemotherapy, and they often necessitate delays or reductions in doses of myelosuppressive agents. Reduced relative dose intensity (RDI) may lead to poorer disease-free and overall survival. METHODS Using the McKesson Specialty Health/US Oncology iKnowMed electronic health record database, we retrospectively identified the first course of adjuvant or neoadjuvant chemotherapy received by patients without metastases who initiated treatment between January 1, 2007, and March 31, 2011. For each regimen, we estimated the incidences of dose delays (≥7 days in any cycle of the course), dose reductions (≥ 15% in any cycle of the course), and reduced RDI (<85% over the course) relative to the corresponding standard tumor regimens described in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). RESULTS This study included 16,233 patients with 6 different tumor types who received 1 of 20 chemotherapy regimens. Chemotherapy dose delays, dose reductions, and reduced RDI were common among patients treated in community oncology practices in the United States, but RDI was highly variable across patients, regimens, and tumor types (0.486-0.935 for standard tumor regimen cohorts). Reduced RDI was more common in older patients, obese patients, and patients whose daily activities were restricted. CONCLUSIONS In this large evaluation of RDI in US clinical practice, physicians frequently administered myelosuppressive agents at dose intensities lower than those of standard regimens.

/pdf/dose-delays-dose-reductions-and-relative-dose-intensity-in-1p1l1htrfl.pdf

Dose Delays, Dose Reductions, and Relative Dose Intensity in Patients With Cancer Who Received Adjuvant or Neoadjuvant Chemotherapy in Community Oncology Practices

Neutropenic complications remain an important dose-limiting toxicity of cancer chemotherapy-associated with considerable morbidity, mortality, and cost. Risk of the initial neutropenic event is greatest during the first cycle. The purpose of this study was to better understand timing of neutropenic events in relation to delivered chemotherapy dose intensity and utilization of supportive care during cancer treatment. A prospective cohort study of adult patients with solid tumors or lymphoma initiating chemotherapy was conducted at 115 randomly selected US practice sites between 2002 and 2006. Chemotherapy-associated toxicities were captured in up to four treatment cycles including severe neutropenia, febrile neutropenia, and infection. Documented interventions included colony-stimulating factor (CSF), antibiotics use, and reductions in chemotherapy relative dose intensity (RDI). A total of 3638 patients with breast (39.7%), lung (23.7%), colorectal (13.6%), ovarian (8.3%) cancers, or lymphoma (14.7%) were eligible for this analysis. The majority of neutropenic and infection events occurred in the first cycle. A significant inverse relationship was observed between reductions in neutropenic and infectious events and increased utilization of measures to reduce these complications in subsequent cycles. More than 60% of patients with stage IV solid tumors underwent reductions in RDI. Patients with lymphoma and stage I–III solid tumors had less dose reductions while receiving more prophylactic CSFs. Approximately, 15% of patients received prophylactic antibiotics. While the risk of neutropenic complications remains greatest during the initial cycle of chemotherapy, subsequently instituted clinical measures in efforts to reduce the risk of these events vary with cancer type and stage.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/cam4.200

Patterns of chemotherapy-associated toxicity and supportive care in US oncology practice: a nationwide prospective cohort study

Receipt of full chemotherapy dose is associated with improved treatment efficacy and survival following a diagnosis of cancer. Exercise has emerged as a supportive care intervention that may improve chemotherapy completion rate by managing dose-limiting toxicities. We conducted a systematic review to evaluate the impact of exercise interventions on outcomes of chemotherapy completion rate in adult cancer patients. Relevant literature was retrieved from CINAHL, Medline (Ovid) and EMBASE based on subject headings and keywords pertaining to cancer, exercise and antineoplastic agents. Eligible articles were randomized control trials (RCTs) that prescribed aerobic or resistance exercise and included end-points relating to chemotherapy completion rate. Overall, eight RCTs were included in the final analysis. Only two RCTs (25%) that enrolled women with early-stage breast cancer reported a significant beneficial effect of exercise on chemotherapy completion rate, including higher mean relative dose intensity and fewer chemotherapy dose adjustments, relative to usual care. The remaining six studies reported no difference with exercise. Altogether, despite the growing number of exercise oncology trials to-date, information pertaining to the effect of exercise on chemotherapy completion rate is limited. Current data suggest exercise does not worsen chemotherapy tolerability. However, full interpretation of these findings is limited by the small number of trials. Future research involving rigorous study design is needed to confirm whether exercise can influence chemotherapy treatments.

Impact of exercise on chemotherapy completion rate: A systematic review of the evidence and recommendations for future exercise oncology research.

Early studies suggested a link between chemotherapy dosing and outcomes in breast cancer and aggressive non-Hodgkin's lymphoma. To help define the impact of relative dose intensity (RDI) and the role of growth factor support, we conducted a systematic literature review. Many breast cancer patients do not achieve planned RDI. Older age, obesity and febrile neutropenia are associated with reduced RDI, which leads to worse survival in several studies, particularly those including anthracyclines. G-CSF prophylaxis improved RDI in most, but not all, studies. There may be a threshold above which increasing RDI does not further improve outcomes (∼85% for CMF and anthracycline-based regimens). For lymphoma, there is strong evidence that patients benefit from full-dose chemotherapy, with RDI reductions associated with reduced survival. The definition of “full dose” is, however, unclear. Older age and higher disease stage may be associated with reduced RDI, and G-CSF improved the chances of higher RDI in most studies.

Relative dose intensity of chemotherapy and its impact on outcomes in patients with early breast cancer or aggressive lymphoma

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Relative dose intensity of chemotherapy and its impact on outcomes in patients with early breast cancer or aggressive lymphoma