Current opinion in oncology
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Editorial Review
Should the indications for the use of myeloid growth factors for the prevention of febrile neutropenia in cancer patients be extended?
Prevention of infectious complications of chemotherapy-induced granulocytopenia is a major issue in preventive medicine, as febrile neutropenia is still associated with an overall 10% mortality and extensive morbidity and cost. ⋯ It is likely that the consideration of these newly recognized risk factors and the availability of more affordable granulocyte colony-stimulating factors will lead, in the near future, to an extension of the presently recognized indications for the prescription of granulocyte colony-stimulating factors.
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In the 1990s, cancer patients were described as poor candidates for ICU admission on the basis of high mortality rates and management costs. Over the last decade, however, advances in the management of malignancies and organ failures have led to substantial increases in survival. This review discusses current outcomes of critically ill cancer patients and recent insights into prognostic factors. Persistent areas of uncertainty are emphasized. ⋯ ICU admission of selected cancer patients leads to meaningful survival. The optimal time of ICU admission needs to be determined, and patient selection criteria by both hemato-oncologists and intensivists should be improved. Long-term studies of overall survival, disease-free survival, and quality of life are needed.
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Erectile dysfunction has a major impact on quality of life. Treating sexual dysfunction after cancer treatment requires special concern because of specific medical, psychological and social factors. This article presents the relevant experimental and clinical recent literature on rehabilitation of erectile function after surgery, external beam radiotherapy, brachytherapy or hormonal deprivation therapy for prostate cancer as it is the most studied model for erectile dysfunction management. ⋯ Erectile dysfunction postcancer treatment requires multimodal management with early administration of PDE5-Is, combined therapy to maintain erectile tissue oxygenation if necessary with PDE5-Is, intracavernosal injection and transurethral alprostadil or even vacuum erect device, psychological counseling considering erectile dysfunction as a couple's issue. The best modality to optimize postcancer erectile dysfunction management has not yet been standardized and is still challenging.