Cancer patient monitoring

Braun, S., Hepp, E., Kentenich, C. R., Janni, W., Pantel, K., Riethmuller, G., Willgeroth, E., and Sommer, H.L. (1999) Monoclonal antibody therapy with edrecolomab in breast cancer patients monitoring of elimination of disseminated cytokeratin-positive tumor cells in bone marrow, Clin Cancer Res 5, 3999-4004. 

Patients contribute to their own care at every stage through provision of diagnostic information, participation in treatment decisions, choice of provider, the management and treatment of disease and the monitoring of adverse events and other ways (Box 15.2) (Vincent and Coulter, 2002 Coulter and Filins, 2007). Patients also need to actively intervene to protect themselves from errors or to avoid delays for instance, patients frequently provide repeat histories to compensate for missing notes, relay information between clinicians, remind nurses of tests that should be done and chase test results. Unruh and Pratt (2007) nicely describe this as the invisible work that patients do in a healthcare system and provide some apposite examples of the ways in which cancer patients monitor and actively intervene to ensure they receive the correct treatments (Box 15.3). 

While receiving treatment for prostate cancer, patients should be monitored for efficacy and toxicity. 

Ultrasensitive assays for PSA contribute to the earlier detection of prostate cancer relapse and (or) residual disease in prostatectomized patients as well as the more timely evaluation of response to current therapies. PSA determinations can be useful in detecting metastatic or persistent disease in patients following surgical or medical treatment of prostate cancer. Persistent elevation of PSA following treatment, or an increase in the pretreatment PSA concentrations, is indicative of recurrent or residual disease. Hence, PSA is widely accepted as an aid in the management of prostate cancer patients, and serum levels are most useful when sequential values are obtained and monitored over time. After complete removal of the prostate gland (radical prostatectomy), PSA levels should become very low or undetectable. A rise of the serum PSA level in prostatectomy patients indicates residual prostate tissue, recurrence, or metastasis of the disease (13, 16, 24, 36). 

Intensive therapeutic monitoring is required for all lung cancer patients to avoid drug-related and radiotherapy-related toxicities. These patients frequently have numerous concurrent medical problems requiring close attention. 

Joerger, M., Schellens, J.H.M., and Beijnen, J.H. 2004. Therapeutic drug monitoring of non-anticancer drugs in cancer patients. Meth Find Exp Clin Pharmacol. 26 531. 

Cancer patients on chemotherapy Treatment of patients with grossly elevated serum erythropoietin levels (eg, greater than 200 milliunits/mL) is not recommended. Monitor hemoglobin on a weekly basis in patients receiving epoetin alfa therapy until... 

Albumin (human) Epoetin alfa contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. No cases of transmission of viral diseases or Creutzfeldt-Jakob disease have ever been identified for albumin. Anemia Not intended for CRF patients who require correction of severe anemia epoetin alfa may obviate the need for maintenance transfusions but is not a substitute for emergency transfusion. Not indicated for treatment of anemia in HIV-infected patients or cancer patients due to other factors such as iron or folate deficiencies, hemolysis, or Gl bleeding, which should be managed appropriately. Hypertension Up to 80% of patients with CRF have a history of hypertension. Do not treat patients with uncontrolled hypertension monitor blood pressure adequately before initiation of therapy. Hypertensive encephalopathy and seizures have occurred in patients with CRF treated with epoetin. 

Myocardial toxicity, manifested in its most severe form by potentially fatal CHF, may occur either during therapy with mitoxantrone or months to years after termination of therapy. Mitoxantrone use has been associated with cardiotoxicity this risk increases with cumulative dose. In cancer patients, the risk of symptomatic CHF was estimated to be 2.6% for patients receiving up to a cumulative dose of 140 mg/m. For this reason, monitor patients for evidence of cardiac toxicity and question them about symptoms of heart failure prior to initiation of treatment. Monitor patients with multiple sclerosis (MS) who reach a cumulative dose of 100 mg/m for evidence of cardiac toxicity prior to each subsequent dose. Ordinarily, patients with MS should not receive a cumulative dose greater than 140 mg/m. Active or dormant cardiovascular disease, prior or concomitant radiotherapy to the mediastinal/pericardial area, previous therapy with other anthracyclines or anthracenediones, or concomitant use of other cardiotoxic drugs may increase the risk of cardiac toxicity. Cardiac toxicity with mitoxantrone may occur at lower cumulative doses whether or not cardiac risk factors are present (see Warnings and Administration.and.Dosage). 

Brigden M and McKenzie M. Treating cancer patients. Practical monitoring and management of therapy-related complications. Can Earn Physician 2000 46 2258-2268. 

Malinovszky KM, Cameron D, Douglas S, Love C, Leonard T, Dixon JM, Hopwood P, Leonard RC. Breast cancer patients experiences on endocrine therapy monitoring with a checklist for patients on endocrine therapy (C-PET). Breast 2004 13(5) 363-8. 

In Tables 5-8, we summarize published data on the analysis of kallikrein genes and proteins in tumor tissue extracts and serum of cancer patients for the purpose of disease diagnosis, monitoring, and prognosis. As discussed below, some kallikreins are very promising new cancer biomarkers. 

However, whether the monitoring of endoxifen plasma concentrations in breast cancer patients would constitute a valid approach to optimize individual dosage and improve treatment effectiveness remains to be demonstrated. So far, only one study... 

Whether the monitoring of endoxifen plasma concentrations in breast cancer patients would constitute a valid approach to optimize individual dosage and improve treatment efficacy is under scrutiny and remains to be demonstrated. In that purpose large prospective studies relating endoxifen plasma levels to clinical outcomes are as yet needed. In this perspective, it is critical to settle analytical and selectivity discrepancies between methods and laboratories and to ensure reproducible quantification results between laboratories. These concerted harmonization efforts can be carried out within the frame of an international external quality control program, which as yet, remains to be organized. 

Esteve-Romero J et al (2010) Tamoxifen monitoring studies in breast cancer patients by micellar liquid chromatography. Anal Bioanal Chem 397 1557-1561... 

In addition to the cellular expression on malignant blast cells in AML, elevated levels of suPAR were found in plasma from leukemia patients [18]. In a longitudinal study, in which patients receiving chemotherapy were monitored, it was demonstrated that the suPAR level in plasma from patients with AML correlated with the number of circulating tumor cells and that these were reduced after chemotherapy. In plasma from AML patients, suPAR(II III) was detected in addition to intact suPAR. This is in contrast to findings in plasma from healthy individuals and from the ovarian cancer patients described above [144]. suPAR(II III) was also present in plasma made from bone marrow aspirates. The other cleaved form, uPAR(I), was only identified in urine. Lysates of the leukemic cells contained both intact uPAR and uPAR(II-III). The amounts of suPAR(II III) in plasma and uPAR(I) in urine were decreased following chemotherapy. In healthy controls, intact uPAR was detected in lysates from mononuclear cells in blood and suPAR(I-III) in plasma and bone marrow aspirates, while suPAR(II-III) was detected in urine [18]. 

Hagen NA, Wasylenko E. Methadone outpatient titration and monitoring strategies in cancer patients. J Pain Symptom Manage 1999 18(5) 369—75. 

NMR imaging. Such studies provide anatomical information in an animal model or human patient. This includes, for example, monitoring the size of plaques or tumors in the brains of Alzheimer s or cancer patients, respectively, during drug therapy. 

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