Original Research

Children diagnosed with cancer undergo changes in body weight secondary to illness and treatment. With progression to malnutrition come a number of significant complications.
Most patients with cancer have multiple comorbidities and are at high risk of polypharmacy. In addition, reviews have shown that up to 33% of ambulatory patients with cancer are at risk of drug–drug interactions.
Although medical oncology has furthered effective cancer treatment for many decades, finding effective treatment for patients with advanced cancer is challenging. Millions of dollars support publicly funded cancer research every year, and patients expect that the latest cancer research will bring us one step closer to discovering a cure.
Venous thromboembolism (VTE) is a common comorbidity among patients with cancer. It is often one of the initial signs for the presence of malignancy, and its presence increases the complexity of patient care within this patient population. Studies have shown that 15% to 20% of all acute VTE cases are associated with malignancy, 2% to 5% of cases are diagnosed concurrently with cancer, and 5% to 10% of cases are diagnosed during a cancer follow-up visit.1 Therefore, VTE is a significant complication affecting quality of life and patient prognosis. In fact, VTE is known to represent one of the leading causes of death in this patient population,2 and it is discovered at autopsy in at least 50% of patients with cancer.3,4 This percentage is thought to be underestimated; therefore, it is imperative to recognize this medical problem and to appropriately deploy effective treatment to reduce morbidity and mortality.

Background: The incidence of tumor lysis syndrome (TLS) has been reported in 42% of adults with hematologic malignancies and can result in serious laboratory findings and clinical manifestations. The clinical manifestations may be severe, leading to dialysis therapy and/or death. The exact incidence of these severe outcomes has not been determined; however, strategies to determine the risk for these complications have been proposed.

Carboplatin is a platinum chemotherapeutic agent introduced in 1981 as an alternative to cisplatin.

Background: Ifosfamide is a frequently used nitrogen mustard chemotherapeutic alkylating agent that is available commercially in either an aqueous or powder formulation. Documented toxicities related to ifosfamide include a unique neurotoxicity that has been associated with hypoalbuminemia, previous or concurrent administration of other neurotoxic agents, and renal dysfunction. Although data regarding ifosfamide neurotoxicity are available in adult medical oncology literature, studies regarding pediatric neurotoxicity are limited.

Background: Serum creatinine–based formulas are used to estimate glomerular filtration rate when calculating carboplatin dosage with the Calvert formula. In overweight and obese patients, body weight applied to serum creatinine–based formulas may overestimate glomerular filtration rate. Overestimation may result in divergent carboplatin dosages that correlate with dose-limiting thrombocytopenia, treatment delays, and dose reductions.

Background: Ifosfamide-based chemotherapy is the standard of care for treatment of softtissue sarcomas. Previous studies have shown an increased risk for ifosfamide neurotoxicity among patients with low albumin levels, but the association between aprepitant use and the risk of neurotoxicity in patients receiving ifosfamide-based chemotherapy is still unknown and controversial.

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