The impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center

BACKGROUND AND OBJECTIVES: Anemia in cancer patients is common, but often under-recognized and under-treated. Erythropoiesis stimulating agents (ESAs) are widely used to prevent and treat cancer and chemotherapy-related anemia, but recent studies suggest a negative impact on disease progression and survival associated with their use. this retrospective study describes the prevalence of anemia in cancer patients and recent trends in its management given the negative studies. PATIENTS AND METHODS: All consecutive adult cancer patients (n=959) admitted to regular medical units over one year were reviewed. Patients with a hemoglobin (Hb) value <12 g/dL on admission were considered anemic. Information on the primary tumor, main reasons for admission and treatment given were collected. RESULTS: At the time of enrollment, anemia was detected in 755 (78.7%) patients. The mean hb value for anemic patients was 9.5 g/dL prevalence and severity of anemia varied according to tumor type and reason for admission. the majority (68.6%) of the anemic patients were not offered treatment. The mean Hb value at which treatment was started was 8.0 g/dL Anemia treatment was related to its severity; treatment rates were 94.4%, 32.9%, and 5.0% in patients with severe, moderate and mild anemia, respectively (P<.0001). blood transfusion was used the most while ESAS were rarely used. length of hospital stay was affected by the presence of anemia (7.2 days in anemic patients vs. 4.85 days in nonanemic patients) (P<.001). CONCLUSIONS: Blood transfusion was used the most for cancer-related anemia, while ESAs were rarely used. The majority of patients with moderate anemia were not treated, including patients on active chemotherapy. better guidelines addressing anemia management in this subgroup of patients are highly needed

Eight primary malignancies: case report and review of literature

The incidence of multiple primary malignancies has increased over the past years secondary to the long-term survival of cancer patients due to improvements in the early detection and adequate treatment of cancer. We present a patient with eight primary malignant tumors and review the relevant literature. Our patient was a 59-year-old female with Crohn disease with an otherwise non-contributory medical history. Risk factors for multiple primary tumors were not detected in our patient. At a follow-up of 108 months from the time of diagnosis of the first malignancy, our patient was still alive. Similar long-term survival has been reported in the literature. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients

Periodontal Inflammation and the Risk of Cardiovascular Disease

Purpose of Review: The role of oral bacteremia and periodontal inflammation driving atherosclerosis is still under investigation. This review article highlights the role of periodontal inflammation and oral microorganisms in the development and progression of atherosclerosis and cardiovascular diseases. Recent Findings: Association between periodontal and cardiovascular diseases has been well characterized, but causal correlation is yet to be established. For instance, untreated gingivitis can progress to periodontitis. Periodontal disease has been associated with several systemic diseases one of which is atherosclerosis. One possible association that was documented in literature is that poor oral hygiene leads to bacteremia, which in turn can cause bacterial growth over atherosclerotic coronary artery plaques and possibly worsen coronary artery disease. Summary: It is crucial that clinicians understand the association between periodontal and cardiovascular disease. A comprehensive treatment for periodontitis and re-establishment of a healthy periodontium can help in reduction of overall inflammation in the body. This may play an important role in prevention of cardiovascular disease, though future research is needed to establish this