Patients receiving ifosfamide as part of their cancer treatment are at risk for ifosfamide-related encephalopathy (IRE), a potentially serious adverse event affecting up to 60% of patients. Symptoms range from transient altered mental status to coma and death. Consensus regarding risk factors for the development of IRE has not been reached in the literature. The purpose of this review is to identify risk factors for the development of IRE in adult cancer patients. A literature review was completed by searching PubMed and Scopus databases to identify articles published between 2008 and 2018. A total of 76 search results were reduced to a final sample of seven articles after applying inclusion and exclusion criteria. Published data suggest that Eastern Cooperative Oncology Group (ECOG) performance status of greater than or equal to 2, impaired renal function, hypoalbuminemia, and having multiple risk factors are risk factors for the development of IRE. Knowledge of which patients are at increased risk for the development of IRE could help clinicians to appropriately counsel patients and families regarding personal risk for the development of IRE. Clinicians may also more closely monitor patients with risk factors for IRE.

Purpose: The purposes of this literature review were to (1) establish the utility of supportive telehealth interventions focusing on early identification of treatment-related symptoms in adult patients with hematologic malignancies, with a secondary aim to (2) evaluate acceptability and feasibility. Methods: A literature review was conducted using PubMed, Cochrane Database of Systematic Reviews, CINAHL, Scopus, and Embase. Dates searched were from January 2007 through December 2019. Inclusion criteria included a diagnosis of hematologic malignancy, incorporation of telehealth interventions, effects on physiological outcomes, and participants ages 18 or older. Articles were excluded if they were a duplicate, had an irrelevant title, or were an incomplete study. Results: Results indicated overall utility, acceptability, and feasibility of the interventions, including improved awareness of late and long-term therapy–related sequelae in survivorship, an overall decline in the number of chemotherapy delays with decreased rates in dose reductions, a means to further manage exercise remotely, and finally, improved communication between provider and patient with real-time management of acute and chronic treatment-related side effects using supportive telemetric interventions. Conclusion: Overall, the use of telehealth interventions in adult patients with hematologic malignancies positively impacts patient health, and telehealth interventions were found to be both accepted and feasible. Future studies should be directed at the role and involvement of the advanced practitioner, and current literature calls for well-planned studies as methodologic limitations remain in the evidence.

No abstract

Scoring on ASCO and ESMO frameworks for 102 advanced oncology drugs were taken from Cherny 2018. Corresponding final appraisal documents by NICE were reviewed. Data were extracted for indication, comparators, clinical benefit assessment, toxicity, quality of life, and cost-effectiveness. NICE committee's final decision was recorded: recommended or not, with restriction in indication or with a patient access scheme (PAS) or on the cancer drugs fund (CDF). The relationship between ASCO/ESMO scores and NICE recommendation was investigated. Results: 79% of the 102 drugs included in Cherny 2018 were assessed by NICE; 45% were recommended by NICE, 22% were with PAS and 12% on the CDF. Of the recommended treatments, 82% and 93% were associated with a moderate to high clinical benefit score on ASCO (.40) and ESMO (.3), respectively. Treatments with restricted recommendation based on indication and on CDF were associated with the highest mean ASCO (54) and ESMO (4) benefit score. Cost-effectiveness was less correlated with clinical scoring, potentially suggesting that pricing does not fully reflect clinical benefit. The cost-effectiveness analysis was limited by the confidential nature of the final agreed price. Conclusions: An association was found between NICE recommendations and clinical benefit assessments by ASCO and ESMO despite the difference in performance criteria, clinical evidence, comparator choice, disease burden, and cost-effectiveness, adopted by payers and clinical frameworks.

No abstract