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Symptom Management

This section provides a quick update of symptomatic conditions in oncology and their management. Readers are invited to submit brief updates following the guidelines at www.JHOPonline.com.
Targeting and inhibiting the vascular endothelial growth factor (VEGF)-signaling pathway has become an integral modality in the treatment of a variety of malignancies, including renal-cell carcinoma (RCC); glioblastoma; hepatocellular carcinoma; gastrointestinal stromal tumors; and colorectal, lung, gastric, and ovarian cancers.

For patients diagnosed with cancer, the annual incidence of VTE is approximately 20%, and the risk for VTE in this patient population is estimated to be 7 times higher than in the general population.

This symptom management article describes the approach to rasburicase-induced hemolytic anemia in patients with glucose-6-phosphate dehydrogenase deficiency, which may occur intravascularly in this patient population.

Anthracyclines, such as doxorubicin or epirubicin, have been used for decades for the treatment of a variety of cancers, including breast cancer, sarcoma, lymphoma, and leukemia.
A paradigm shift in the management of relapsed or refractory B-cell chronic lymphocytic leukemia (CLL) and low-grade non-Hodgkin lymphoma (NHL) has evolved in recent years. With increased use of targeted therapies, ibrutinib, an oral Bruton’s tyrosine kinase (BTK) inhibitor, is an integral therapeutic option for patients with treatment-naïve and treatment-experienced CLL or low-grade NHL. Ibrutinib therapy demonstrated superior overall response rates compared with ofatumumab and other agents in treatment-experienced patients with CLL.
Many chemotherapy agents have the potential to impair fertility.1,2 Infertility resulting from cancer treatments can affect the quality of life for young cancer survivors.3 In 2017, an estimated 852,630 female patients were diagnosed with cancer in the United States, of whom 10.5% were aged <45 years.4

Clostridium difficile–related diarrhea is one of the most common types of nosocomial diarrhea in the United States, with an incidence of 15% to 25%.1 Infectious diarrhea resulting from C difficile is a common complication in patients undergoing hematopoietic stem-cell transplant (HSCT), with higher rates in those undergoing allogeneic than autologous HSCT (12%-18% vs 6%-8.5%, respectively).2-4

Patients undergoing hematopoietic stem-cell transplantation (HSCT) often receive highly emetogenic, multiday conditioning chemotherapy. Many patients experience nausea and vomiting, which may negatively affect quality of life, despite receiving triple therapy with dexamethasone, a neurokinin-1 (NK-1) receptor antagonist, and serotonin receptor antagonists (5-HT3).

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