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Thanks for hosting Trish! These articles were very informative. I was not aware that Loratidine was recommended for 7 days after pegfilgrastim dosing. I will definitely tell my patients that are having several doses of Neupogen to montior for bone pain and try it.
Michelle, I wonder why brand name Claritin is more effective than generic. Also, it seems like many clinics already recommend the use of it for PIBP. I feel like that information does not trickle down to infusion areas so we can educate our patients better.
Hi, I am Jennifer Clark, I work in the CTU.
1. What was the knowledge gained from the article?
I was interested in reading the theories laid out in the Lambertini et al article of the etiology of the bone pain post pegfilgrastim treatment; expansion of the marrow, acceleration of the inflammatory process, nerve stimulation and increased osteoblast/osteoclast production. It makes sense that a patient would experience bone pain during therapy. I also find it very interesting that it seems like the recommendation of using Claritin has come from anecdotal posts on online blogs and forums and not really from EBP and literature review.2. Will the research/information in this article change or influence your practice? If so how?
I knew that bone pain was a possibility but I was unaware of the incidence of it in patients. In the different studies cited, it ranges from 20% to 71%. One of our previous Multiple Myeloma physicians always recommended the use of Claritin but I never knew the reasoning behind it. Some CTU patients have their treatment held for low counts and they are prescribed a round of Neupogen so I will definitely tell them to try Claritin (after checking with their provider, of course).3. What other questions does the article raise about current practice?
I feel more studies need done in this area due to the incidence of patient’s experiencing PIBP. I feel that they are educated that it may happen so they feel like they need to just deal with it because it is expected. Both articles mention that both acetaminophen and NSAIDs are effective as well, but both are discouraged in the oncology population due to the adverse effects of both. Other histamine blockers that are better tolerated should also be studied so patient’s have better options.4. Do you agree/disagree with the conclusions of the author, why?
I do agree that more studies need done with larger sample sizes, different combinations of drugs, etc. to find better treatments for PIBP. We have limited information on something so prevalent.Mindy, I agree that a cancer diagnosis is not enough to persuade a person to stop smoking. We have done clinical trials with thoracic patients and it is frustrating that they continue to smoke, especially when they leave the unit on a long treatment today to go outside somewhere and smoke. I do realize that it is also a way to deal with stressors and having cancer is a BIG stressor but I wish it wasn’t so addictive, and that they were able to quit.
Jeff, I also agree that having options to smoking physical cigarettes is good, but the “safer” ones like nicotine gum are not very effective. I will admit that I am very biased against e-cigs and vape pens because my two step-daughters were non-smokers and both use e-cigs all day, every day. The youngest started when she was about 16, when the marketing for them was sneakily aimed at adolescents. I am very concerned about the implications for their health in the future. I feel that the e-cigarette industry has spawned a whole new generation of non-smoking, nicotine addicts.
Hi, I am Jennifer Clark and I work in the Clinical Treatment Unit.
Thanks for choosing such interesting articles Lindsay.
What was the knowledge gained from the article? Both articles state that tobacco use/smoking is the leading preventable cause of death in the United States as well as worldwide. This surprises me because of the rules and policies regarding smoking in public places and the anti-smoking campaigns that I see, I thought less people were actually smoking cigarettes. Also, learning about how little information and research there is on the effects of e-cigarettes is alarming. There is little regulation on the chemicals in e-cigs and the nicotine doses are not standardized.Will the research/information in this article change or influence your practice? It probably won’t impact my practice much. I occasionally add smoking cessation education to a patient’s AVS but not frequently. However, I now know to not suggest an e-cigarette/vape as an alternative to cut back or stop smoking physical cigarettes.
What other questions does the article raise about current practice? Both articles raise many questions about ENDS; are there any long term research studies ongoing gathering data about the prevalence of developing COPD or other illness in people who have a history of smoking cigarettes vs. people who have only used e-cigarettes? Are there any groups lobbying for regulating the chemicals contained in the ENDS, and for educating the public about the risks of such exposure?
Do you agree/disagree with the conclusions of the author, why? I do agree with both articles that more research needs done regarding ENDS (maybe some preliminary results need publicized so the public is more aware of the risks) and the industry needs more regulation in the manufacture, marketing and distribution of the products.
Trish, I agree that we need to improve our efforts to prevent and treat mucositis more successfully. I wonder if other large cancer centers are using Morphine suspension for pain relief.
Jeff, it is difficult to understand why effective treatments like benzydamine and keratinocyte growth factor-1 are not available for use in the United States. I know the one trial we did for mucositis was so complex that it would not be appropriate for administration in an infusion center. There are not alot of options for our patients.
Hi, my name is Jennifer Clark, I am a nurse in the Clinical Treatment Unit. We do Phase I clinical trials here at The James.
1. What was the knowledge gained from the article?
Both articles were interesting. I was not aware that targeted therapies and immunotherapies cause a pathobiologically different type of oral mucositis. Developing trends in treatment are moving away from standard chemotherapies and towards these targeted therapies and immunotherapies so I feel like more emphasis needs placed on developing new treatments for oral mucositis. I have been in the CTU for the last 10 years and we have done several clinical trials for an oral mucositis treatment for the Head & Neck oncology population that were done in conjunction with radiation therapy. We have not participated in any clinical trials for the stem cell population, for whom the incidence of mucositis can be as high as 80%, or patients who receive targeted/immunotherapies. I believe the CTU is going to be opening another oral mucositis trial soon for Head & Neck oncology patients.2. Will the research/information in this article change or influence your practice?
I am the Lead RN on a trial that is opening soon for colorectal cancer patients that consists of an oral targeted therapy given in conjunction with SOC FOLFOX or FOLFIRI and includes a 5FU bolus. I will educate my patients to use oral cryotherapy during their treatment to hopefully lessen their incidence of mucositis.3. Do you agree or disagree with the conclusions of the author?
I do agree that interventions for oral mucositis are limited and new treatments need to be developed, especially as we are moving towards developing more immunotherapies.
