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Recognizing & Treating Caregiver Burden

Recognizing & Treating Caregiver Burden

Research has shown that unpaid family or informal caregivers provide as much as 90% of the in-home long-term care that is needed by adults. A 2009 study estimated that 65.7 million people in the United States served as unpaid family caregivers to an adult or child, two-thirds of whom provided care for an adult aged 50 or older. “The burden of caring for others is increasing because of our aging population, an increase in the number of people living with chronic disease, and a lack of formal support for caregivers,” says Ronald D. Adelman, MD. In addition to providing assistance with basic and instrumental activities of daily living and medical support, caregivers also provide emotional support and comfort. The economic burden of informal caregiving is substantial, with a recent study estimating that the cost of informal dementia caregiving was $56,290 annually per patient. Furthermore, many caregivers have little choice in taking on a caregiving role, and many report feeling ill prepared to take on these responsibilities. “Many caregivers are unaware of the toll that caregiving takes on them, making them more vulnerable to other serious health problems,” Dr. Adelman says. “In addition, caregivers often receive inadequate support from health professionals and frequently feel abandoned and unrecognized by the healthcare system.” Diagnosis & Assessment of Caregiver Burden In a recent issue of JAMA, Dr. Adelman and colleagues reviewed cohort studies and other analyses to provide strategies to diagnose, assess, and intervene for caregiver burden. Several risk factors for caregiver burden were identified, including female sex, low educational attainment, and residing with care recipients. Depression, social isolation, financial stress, a higher...
Radiation Therapy After Prostatectomy

Radiation Therapy After Prostatectomy

Radical prostatectomy (RP) is the most common primary treatment for localized prostate cancer. For most men, the surgery will cure the disease, but up to one-third of patients will present with recurrent prostate cancer within 10 years of RP. The risk of prostate cancer recurrence after RP is greater among men with adverse pathology. “In high-risk patients, clini­cians and patients must determine if adjuvant therapy is a consideration to prevent future recurrence,” explains Ian Murchie Thompson, Jr., MD. “In post-surgical patients who later present with detectable PSA levels, appropriate salvage therapies may be considered.” In 2013, the American Society for Radiation Oncology (ASTRO) and the American Urological Association (AUA) published a joint guideline for using adjuvant and salvage radiation therapy after RP in patients with and without evidence of prostate cancer recurrence. The guideline represents an intensive collaboration among experts in radiation oncology and urology. Informing Patients According to Dr. Thompson, who co-chaired the ASTRO/AUA writing group, educating patients is of the utmost importance. “Patients need to be informed of the potential for adverse pathologic findings that raise their risk of disease recurrence,” he says. “If adverse pathologic findings emerge, patients should understand that adjuvant radiation therapy can help reduce the risk of biochemical recurrence, local recurrence, and clinical disease progression.” The effectiveness of radiation therapy for disease recurrence is greatest when given at lower PSA levels, says Dr. Thompson. “Patients should be informed that PSA recurrence after surgery correlates with a higher risk of metastatic prostate cancer or death from the disease. They also need to know about the possible short- and long-term urinary, bowel, and sexual side...
Developing a Cardiology-Oncology Partnership

Developing a Cardiology-Oncology Partnership

Cardiovascular disease (CVD) and cancer are the most prevalent diseases in the current era, and the rates of these diseases continue to rise. More than 2 million breast cancer survivors in the United States are at risk for cardiotoxicity. Pediatric cancer survivors are two to five times more likely than the general population to develop heart disease. Treatment for cancer has become more effective, but cardiac disease in these patients has in turn become increasingly common. CVD can affect their quality of life as well as the course of cancer treatment. Preventing CVD in Cancer Patients Preventing CVD in cancer patients is important because aggressive cancer therapies are being used in older patients who may have cardiac problems or cardiovascular risk factors. Furthermore, researchers are identifying cardiac toxicities with new cancer therapies. Cardiotoxicity from cancer treatments include heart failure, hypertension, hypotension, arrhythmias, pericarditis, and myocardial ischemia. Radiation to the chest, leukemias, and chest tumors can lead to pericarditis, myocarditis, valve disease, and coronary artery disease.   Diagnosing cardiotoxicity during cancer treatment can be challenging. Symptoms like fatigue, shortness of breath, and edema are common to cardiac problems but are also adverse effects of cancer therapy. When patients present with these symptoms, they should be referred to cardio-oncology programs for further evaluation. Collaborative Care Among Cardiologists & Oncologists At the University of Michigan, cardiologists are collaborating with oncologists to tailor cardiac and cancer therapy to minimize cardiotoxicity. We stratify risk in patients with cardiac disease or CVD risk factors in an effort to optimize these conditions prior to cancer treatment. Cardio-oncology programs: • Provide prevention and early detection of cardiac complications....
Considerations for Dosing of Oral Therapies in Metastatic RCC

Considerations for Dosing of Oral Therapies in Metastatic RCC

For patients with meta­static renal cell carcinoma (mRCC), oral therapy has improved out­comes and has become a standard of care. When selecting oral therapies for mRCC, an important consideration is how well patients can tolerate optimal dosing of a particular agent.2 As Robert A. Figlin, MD, FACP, noted in an article published in the August 2013 issue of Physician’s Weekly—Oncology Edition, a key goal when initiating oral therapy in mRCC patients is to maintain the starting dose throughout the treatment course when possible. Outside of a clinical trial setting, the application of oral therapies may present some challenges when treating mRCC patients with unique needs.1 For example, some patients may be more prone than others to experience potential drug interactions or to have comorbidities that can affect how patients are managed with oral therapy. Prior to initiating oral therapy, clinicians should educate patients about the potential treatment-related adverse reactions (ARs). Patients should be made aware that some ARs, but not all, may be manageable during their treatment. Oral therapies have been shown to have serious life-threatening side effects, in addition to low-grade ARs.   Dosing regimens of oral therapy for mRCC might need to be adjusted based on individual safety and tolerability.1 When to Consider Dose Modifications or Interruptions Currently, there are no data that directly compare the relative safety and tolerability of oral therapies for mRCC.2 As a result, clinicians must rely on data provided from published studies of randomized controlled trials involving available agents, dosing recommendations in the package insert information, and their own clinical experience.1 In some patients, dose modifications or interruptions may be considered when managing treatment-related...

Metastatic Renal Cell Carcinoma Therapy: Supporting Patients

Data from the American Cancer Society estimate that 65,150 new cases of kidney cancer, including renal cell carcinoma (RCC), renal pelvis carcinoma, and Wilms tumor, are expected to be diagnosed in the United States in 2013.1 Kidney cancer is among the 10 most common cancers in both men and women. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors.2 From 2005 to 2009, kidney cancer incidence rates increased by 3.1% per year, primarily because of an increase in the detection of early stage disease. Most people with kidney and renal pelvis cancer are older when they are diagnosed (Figure),3 with the median age at diagnosis being about 65.2 An estimated 13,680 deaths from kidney cancer are expected to occur in 2013. Overall, the mortality rate for kidney cancer decreased by an average of 0.5% per year from 2005 to 2009.1 Recent estimates suggest that 20% to 30% of RCC patients present with metastatic disease.4 About 70% of RCC patients develop metastases during the course of their disease. The 5-year survival rate for patients with metastatic RCC (mRCC) is 11.6%, which is significantly lower than that of localized or regional RCC (Table).2 Treatment According to Robert A. Figlin, MD, FACP, interleukin-2 (IL-2) was the previous standard of care for mRCC in the 1990s. “While response rates were low, about half of mRCC patients who responded to IL-2 demonstrated long-term disease-free survival, and some of these patients were completely cured. However, the side effects associated with IL-2 were severe.” As clinician researchers have gained an improved understanding of the biology of kidney cancer, several targeted...
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