Cancer
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Multicenter Study
Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and neutropenia.
Traditionally, children with malignant disease who present with fever and neutropenia are hospitalized for parenteral antibiotics. More recently, outpatient strategies have been proposed for lower risk cohorts of such patients. The authors sought to identify clinical and laboratory parameters that are associated with a low risk of bacteremia in children with malignant disease who presented with febrile neutropenia. ⋯ Adverse outcomes due to bacteremia are infrequent in pediatric oncology patients who present with fever and neutropenia are treated with parental antibiotics. Patients with fever and neutropenia and an AMC value of > or = 155 cells per mm(3) have the lowest risk for bacteremia and may be potential candidates for outpatient management.
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Although technologic advances and insights into the mechanisms of cancer and cancer treatments have resulted in hope of increased survival and even cure in many cancer populations, parallel efforts to promote quality of life through a commitment to rehabilitation and aggressive palliation have lagged. Recent studies have demonstrated fatigue to be the most distressing phenomenon experienced by cancer patients. This article examines fatigue from a rehabilitation perspective. ⋯ Experience of CRFS by cancer patients, regardless of their diagnosis, stage of disease, treatment regimen, or age, influences all aspects of quality of life and aggravates the experience of other distressing symptoms such as pain, nausea, and dyspnea. Understanding the underlying mechanisms for energy loss and gain, as well as the relationship between the right amount and type of activity and sleep, can lead toward more effective and innovative rehabilitation programs. Development of research based clinical interventions in these areas holds promise for significant improvement in functioning and quality of life for cancer survivors and may constitute valuable rehabilitative techniques that can be adjunctive to standard therapies.
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Although soluble CD44 (sCD44) is considered a reliable marker of both tumor burden and disease activity, to the authors' knowledge, its predictive and prognostic value in B-cell chronic lymphocytic leukemia (CLL) has not been addressed to date. ⋯ An increased serum level of sCD44 can be considered to be a promising parameter for predicting the risk of disease progression in patients with early CLL. Furthermore, sCD44 helps to refine the prognostic stratification of patients with either nonsmoldering CLL or Rai Stage I-II disease, thus enabling the identification of different prognostic subgroups in patients with early CLL.
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People with cancer often have functional limitations resulting from fatigue, deconditioning, pain, or metastasis to the musculoskeletal or nervous system, in addition to the psychosocial aspects of dealing with their disease. Their medical caregivers often focus on treating the disease and overlook these important aspects. The Department of Physical Medicine and Rehabilitation at the Mayo Clinic developed a Cancer Rehabilitation Service in 1979 to address these needs for hospitalized patients. Some of the challenges and successes of this service are briefly discussed in this article.
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Pemetrexed disodium (Alimta [Eli Lilly and Company, Indianapolis, IN], LY231514, multitargeted antifolate) is a new multitargeted antifolate agent that inhibits multiple enzymes in the folate pathway. Phase II trials showed single-agent response rates of 16% and 23% in untreated patients with nonsmall cell lung carcinoma (NSCLC). This study was undertaken to determine the response to pemetrexed disodium given in combination with cisplatin. ⋯ The combination of pemetrexed disodium and cisplatin is active against advanced NSCLC and is a well-tolerated convenient outpatient regimen. It deserves further study to compare it with other standard regimens for NSCLC.