Vaccination against SARS-COV‑2 in oncology

The objective of the study a detailed, systematic review of the world literature data, which includes all aspects of recommendations for vaccination against SARS-COV‑2 in cancer patients.Materials and methods. Information search was carried out in PubMed, MedLine, Scopus, Web of Science, RSCI.The work included data from literature and information sources that were published before February 2021.Results. The data of retrospective and prospective clinical studies are analyzed. This paper reflects considerations and recommendations for the vaccination of cancer patients by Russian and foreign specialists in the context of COVID‑19 pandemic. The review presents current recommendations for vaccination against SARS-COV‑2 in patients with solid tumors, hematological malignancies, recipients of hematopoietic stem cells and cell therapy.Conclusion. To date, groups at increased risk of infection with the new coronavirus have been identified. These groups include patients with cancer. The presence of tumor does not allow a delay in start of therapy, and requires careful monitoring and observation. In this regard, despite the pandemic, the treatment of cancer patients must be continued regardless of the circumstances. Cancer patients should not be deprived of the opportunity to be vaccinated against SARS-COV‑2. Every patient should be decided individually. At the moment, there are no officially approved recommendations for vaccination against SARS-COV‑2 for cancer patients. Before the creation and approval of final recommendations for cancer patients, it is necessary to focus on compliance with sanitary and anti-epidemic measures and the prevention of COVID‑19 infection. The global cancer community continues to actively develop recommendations for the optimal vaccination against SARS-COV‑2 in cancer patients.The most relevant ones are outlined in this article.

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IMPACT OF THE COVID-19 PANDEMIC ON THE ONCOLOGICAL PRACTICE

Siberian Journal of Oncology ◽

10.21294/1814-4861-2020-19-3-5-22 ◽

2020 ◽

Vol 19 (3) ◽

pp. 5-22 ◽

Cited By ~ 1

Author(s):

A. D. Kaprin ◽

E. V. Gameeva ◽

A. A. Polyakov ◽

A. L. Kornietskaya ◽

N. A. Rubtsova ◽

...

Keyword(s):

Cancer Patients ◽

World Literature ◽

Web Of Science ◽

Treatment Options ◽

Current Data ◽

Course Of Disease ◽

Increased Risk ◽

The World ◽

The Impact ◽

Oncological Practice

Detailed, systematic review of the world literature data, including all aspects that reflect the impact of the COVID-19 pandemic on the oncological practice was conducted. The information sources were taken from Pubmed, MedLine, Scopus, Web of Science, and RSCI systems. The data from retrospective and prospective clinical trials have been analyzed. This review presents current data on the impact of COVID-19 on cancer patients, mortality and prognosis of cancer patients infected with COVID-19, treatment options for COVID-19, as well as the case report of the cancer patient with rare atypical COVID-19 course of disease. To date, the groups of increased risk of being infected with a new coronavirus have been identified. These groups include cancer patients. Despite the pandemic, treatment of cancer patients must be continued, since the presence of a tumor process does not allow the therapy to be delayed. The world cancer community is actively continuing to develop recommendations for optimal management of cancer patients in the context of the pandemic. The most relevant of them are described in this article.

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Impact of cancer on emergency department outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18618 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18618-e18618

Author(s):

Alexander S. Qian ◽

Edmund M. Qiao ◽

Vinit Nalawade ◽

Rohith S. Voora ◽

Nikhil V. Kotha ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Hospital Mortality ◽

Hospital Admission ◽

Cancer Patients ◽

Metastatic Cancer ◽

Inpatient Admission ◽

Cancer Site ◽

Patients With Cancer ◽

Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

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Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

Oncology Reviews ◽

10.4081/oncol.2011.34 ◽

2011 ◽

pp. 191-204

Author(s):

Alpesh N. Amin ◽

Steven B. Deitelzweig

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Assessment Model ◽

Major Surgery ◽

Medical Illness ◽

Patients With Cancer ◽

Increased Risk ◽

National Quality ◽

American Society

Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

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Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

Oncology Reviews ◽

10.4081/oncol.2011.191 ◽

2011 ◽

Vol 5 (3) ◽

pp. 191

Author(s):

Alpesh N. Amin ◽

Steven B. Deitelzweig

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Assessment Model ◽

Major Surgery ◽

Medical Illness ◽

Patients With Cancer ◽

Increased Risk ◽

National Quality ◽

American Society

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Paraneoplastic Syndromes in Patients with Cancer of the Larynx and Hypopharynx

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600705 ◽

2007 ◽

Vol 116 (7) ◽

pp. 502-513 ◽

Cited By ~ 22

Author(s):

Alfio Ferlito ◽

Alessandra Rinaldo

Keyword(s):

Cancer Patients ◽

Malignant Tumor ◽

World Literature ◽

Paraneoplastic Syndromes ◽

Malignant Neoplasms ◽

Patients With Cancer ◽

The World ◽

Symptoms And Signs

Paraneoplastic syndromes may be the first sign of a malignancy. They are systemic, nonmetastatic manifestations associated with a variety of malignant neoplasms and occurring in a minority of cancer patients. These associations of symptoms and signs are not directly related to the site or local manifestations of a malignant tumor or its metastases, but their recognition may facilitate the detection of malignancies or recurrences. Paraneoplastic syndromes are categorized into 6 types: Dermatologic or cutaneous, endocrine, hematologic, neurologic, osteoarticular or rheumatologic, and ocular. Different oncotypes have rarely been associated with paraneoplastic syndromes in patients with cancer of the larynx and hypopharynx. The world literature has been reviewed.

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Preventing Venous Thromboembolism in Ambulatory Patients with Cancer: A Narrative Review

Cancers ◽

10.3390/cancers12030612 ◽

2020 ◽

Vol 12 (3) ◽

pp. 612 ◽

Cited By ~ 1

Author(s):

Anne Rossel ◽

Helia Robert-Ebadi ◽

Christophe Marti

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Absolute Risk ◽

Narrative Review ◽

Relative Reduction ◽

Number Needed To Treat ◽

Chemotherapeutic Regimen ◽

Patients With Cancer ◽

Increased Risk ◽

Risk Of Cancer

Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modest among unselected patients given a rather low risk of events resulting in a number needed to treat (NNT) of 40 to 50. Moreover, this modest benefit is mitigated by a trend towards an increased risk of bleeding, and the economic and patient burden due to daily injections of LMWH. For these reasons, routine thromboprophylaxis is not recommended by expert societies. Advances in VTE risk stratification among cancer patients, and growing evidence regarding efficacy and safety of direct oral anticoagulants (DOACs) for the treatment and prevention of CAT have led to reconsider the paradigms of this risk–benefit assessment. This narrative review aims to summarize the recent evidence provided by randomized trials comparing DOACs to placebo in ambulatory cancer patients and its impact on expert recommendations and clinical practice.

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Low-Molecular-Weight Heparin in Cancer Patients: Overview and Indications

Hämostaseologie ◽

10.1055/s-0039-1677796 ◽

2019 ◽

Vol 39 (01) ◽

pp. 067-075 ◽

Cited By ~ 3

Author(s):

Minna Voigtlaender ◽

Florian Langer

Keyword(s):

Molecular Weight ◽

Cancer Patients ◽

Anticancer Agents ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Low Molecular Weight ◽

Vte Prophylaxis ◽

Patients With Cancer ◽

Increased Risk

AbstractAlthough venous thromboembolism (VTE) is a well-known cause of death in patients with cancer, both its treatment and prevention remain a challenge in daily practice. Direct oral anticoagulants have emerged as safe and efficacious alternatives to vitamin K antagonists in the general population, and recent clinical trials also support their use in select patients with cancer-associated VTE. Despite this, low-molecular-weight heparins (LMWHs), a comparatively ancient class of antithrombotic drugs, remain the anticoagulants of choice in many indications relevant to modern haematology and oncology. In addition to the treatment of established VTE, these indications include VTE prophylaxis in surgical or acutely ill, hospitalized medical cancer patients as well as the prevention of VTE in high-risk patients undergoing ambulatory chemotherapy. In a constantly changing landscape of approved anticancer agents, this review article summarizes pivotal clinical trial data and guideline recommendations regarding the use of LMWH in haematological and oncological patients, who constitute a highly vulnerable patient population due to their increased risk for both bleeding and VTE recurrence.

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Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

Current Oncology ◽

10.3747/co.22.2587 ◽

2015 ◽

Vol 22 (2) ◽

pp. 144 ◽

Cited By ~ 33

Author(s):

J.C. Easaw ◽

M.A. Shea-Budgell ◽

C.M.J. Wu ◽

P.M. Czaykowski ◽

J. Kassis ◽

...

Keyword(s):

Venous Thromboembolism ◽

Renal Insufficiency ◽

Cancer Patients ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Factor Xa ◽

Patients With Cancer ◽

Clinical Scenarios ◽

Increased Risk

Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy is used to treat vte; however, patients with cancer have unique clinical circumstances that can often make decisions surrounding the administration of therapeutic anticoagulation complicated. No national Canadian guidelines on the management of established cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic.PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations.Low molecular weight heparin is the treatment of choice for cancer patients with established vte. Direct oral anticoagulants are not recommended for the treatment of vte at this time. Specific clinical scenarios, including the presence of an indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant modifications in the therapeutic administration of anticoagulation therapy. Patients with recurrent vte should receive extended (>3 months) anticoagulant therapy. Incidental vte should generally be treated in the same manner as symptomatic vte. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, levels of anti–factor Xa could be checked at baseline and periodically thereafter in patients with renal insufficiency. Follow-up and education about the signs and symptoms of vte are important components of ongoing patient care.

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Thrombocytosis as a predictor of thromboembolic complications in patients with malignant diseases

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172437 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2506

Author(s):

Siniša Maksimović ◽

Aleksandar Jakovljević ◽

Darko Jović ◽

Ljiljana Latinović ◽

...

Keyword(s):

Cancer Patients ◽

Anticoagulant Therapy ◽

Clinical Stage ◽

Massive Pulmonary Embolism ◽

Therapeutic Modality ◽

Thromboembolic Prophylaxis ◽

Patients With Cancer ◽

The Moment ◽

Banja Luka ◽

The University

Background: To prove the frequency of thrombocytosis in patients with cancer, and the importance of anticoagulant therapy. Thrombocytosis represents an elevated platelet count of more than 350,000/mm3 which is one of the risk factors for venous thromboembolism.Methods: This study has analyzed 146 patients who were hospitalized at the Oncology Clinic of the University Clinical Centre, Banja Luka and the Day Oncology Hospital “S.tetik”, Banja Luka in the period between 2009 and 2014. These were patients with breast tumor, gastrointestinal or gynecological malignancies. Thrombocytosis was detected in 38 patients in the moment of diagnosing. All examinees were analyzed by sex, age, primary site of tumor, presence of comorbidity, relevant laboratory analyses, clinical stage of the disease (metastatic or localized disease).Results: In the observed sample of 146 patients, thrombocytosis was detected in 38 patients in the moment of diagnosing the disease (26%). Through the follow-up, DVT (deep venous thrombosis) was found in 13 patients (34.2%) and anticoagulant therapy was administered. Out of patients who were not on anticoagulant therapy because they had no thrombotic manifestations (25 patients, 65.8%), 2 ended up experiencing the development of a clinical presentation of massive pulmonary embolism with fatal outcome.Conclusions: The occurrence of thromboembolism significantly increases morbidity and mortality, as well as the total cost of treating cancer patients. Regardless of the fact that cancer patients are at a high risk of thromboembolic events, thromboembolic prophylaxis has not been adopted as a standard therapeutic modality because of potential bleeding.

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Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy

Hematology ◽

10.1182/hematology.2019000369 ◽

2019 ◽

Vol 2019 (1) ◽

pp. 71-79 ◽

Cited By ~ 1

Author(s):

Hanny Al-Samkari ◽

Jean M. Connors

Keyword(s):

Cancer Patients ◽

Competing Risks ◽

Bleeding Risk ◽

Patient Specific ◽

Severe Thrombocytopenia ◽

Recurrence Rates ◽

Patients With Cancer ◽

Clinical Scenarios ◽

Increased Risk ◽

Recurrent Vte

Abstract The association between malignancy and thrombosis has been recognized for over a century and a half. Patients with cancer have an elevated risk of both initial and recurrent venous thromboembolism (VTE) compared with patients without cancer owing to cancer- and patient-specific factors. Recurrent VTE is common despite anticoagulation, presenting additional management challenges. Patients with cancer also have an increased risk of bleeding when on anticoagulants compared with patients without cancer. This bleeding risk is heightened by the thrombocytopenia common in patients with hematologic malignancies and those treated with intensive myelosuppressive chemotherapy regimens. Despite the advancements in cancer-directed therapy made over the past 15 years, numerous large studies have confirmed that bleeding and VTE recurrence rates remain high in cancer patients. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult, because management of cancer-associated thrombosis requires anticoagulation despite known increased risks for bleeding. In the context of challenging illustrative cases, this review will describe management approaches to clinical scenarios in which data are sparse: cancer patients with recurrent VTE despite anticoagulation and cancer patients with a new VTE in the setting of severe thrombocytopenia.

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