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CIPN: A Guide for Prevention & Management

CIPN: A Guide for Prevention & Management

Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related adverse effect that can significantly affect long-term quality of life and interfere with cancer treatments. The pain can lead to reductions in chemotherapy doses and early discontinuation of the therapy. Studies estimate that about 38% of patients who are treated with multiple agents will develop CIPN, but this rate varies depending on the types of chemotherapy regimens used, duration of exposure to these agents, and how patients are assessed. “CIPN is an important issue, especially within the context of the most commonly used chemotherapy regimens,” says Dawn L. Hershman, MD, MS. “Many of the drugs that have been evaluated for treating and preventing CIPN are agents that have documented efficacy for other common neuropathies. CIPN, however, is more difficult to manage than other neuropathies because there is greater variability in its pathophysiology and associated symptoms.” A New Guideline In 2014, the American Society of Clinical Oncology (ASCO) released a systematic review and evidence-based guideline on the management of CIPN in adult cancer survivors. The ASCO writing panel that developed the guideline systematically reviewed randomized controlled trials (RCTs) from the literature on managing CIPN, compared outcomes among trials, and provided guidance on the effectiveness of prevention and treatment options for CIPN in adults with a history of cancer. Primary outcomes included incidence and severity of neuropathy as measured by neurophysiologic changes, patient-reported outcomes, and quality of life. For the analysis, 48 RCTs met the eligibility criteria and comprised the evidentiary basis for the recommendations. “We studied many agents that have been used for CIPN, but few actually worked,” explains Dr. Hershman, who...
Who Broke The American Healthcare System?

Who Broke The American Healthcare System?

Healthcare is a hot topic in the media these days. Yet, few people are satisfied with the way it is working. Many claim that the American healthcare system is broken. Patients are increasingly frustrated with finding a doctor, getting tests and medications they need, and paying for out-of-pocket expenses. Numerous doctors are disenchanted with their career choice, and burnout is a common complaint. Frequently, doctors are now looking to retire early or for alternate career paths. Treating patients has become unfulfilling for many due to administrative burdens, increasing government regulations, and overbearing insurance over-sight. Doctors fight daily to get procedures and medications covered that their patients need. Most often, the battle is with someone who is not even a doctor or has any clue about the patient. These daily battles become wearing. Additionally, doctors now have to fight on a more abundant basis to get paid for services they provided. Their incomes are stagnant or shrinking while overhead costs are soaring. Increasingly, doctors are selling out their practices and joining large groups and hospitals. “When I go in the exam room and close the door, I face my patient and am again reminded of why I became a doctor: to alleviate suffering.”   Many people look to put blame on doctors for the broken healthcare system. Yet, it has been years since doctors truly had any control over it. More often these days, doctors are treated like pawns and servants, our independence and integrity being worn away and questioned. But, who really is to blame for the broken healthcare system? 1. Commercial insurance companies who have no oversight and...
A Look at Opioid Use During Pregnancy

A Look at Opioid Use During Pregnancy

According to NIH data, prescriptions for opioids have increased dramatically in the general population, rising by more than 200 million between 1991 and 2009. In 2014, the American Society of Anesthesiologists distributed a list as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign to help physicians and patients engage in conversations about treatments or medications that are commonly prescribed in pain medicine but are not always necessary. The list noted that opioid analgesics should not be prescribed as first-line therapy to treat chronic non-cancer pain. Little is known, however, about the use of opioids during pregnancy. Assessing Prevalence & Patterns of Opioid Use In a study by Brian T. Bateman, MD, MSc, and colleagues, researchers sought to define the prevalence and patterns of opioid use in a large cohort of pregnant women. Published in Anesthesiology, the study looked at data from more than 530,000 pregnant women enrolled in commercial insurance plans who delivered babies between 2005 and 2011. “We found that 14.4% of pregnant women were prescribed opioids at some point in their pregnancy,” says Dr. Bateman. “Most opioid exposures were for short courses, typically lasting less than a week.” The study also found that 5.7% of women were given an opioid in the first and second trimester, and 6.5% were given one in the third trimester. Overall, 2.2% were dispensed opioids three or more times during their pregnancy. Back pain was the most common condition for which opioids were prescribed. Other conditions included abdominal pain, migraine, joint pain, and fibromyalgia. Rates of opioid use also varied throughout the United States, with the highest occurring...
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