What is chemotherapy dose intensity?
Chemotherapy dose intensity represents unit dose of chemotherapy administered per unit time. Dose intensity can be increased or decreased through altering dose administered, time interval of administration, or both.
Is dose intensity associated with survival in patients with early-stage cancer?
In patients with early-stage disease, retrospective analyses of randomized controlled clinical trials have suggested strong association between the dose intensity actually given and disease-free as well as overall survival. A 20-year follow-up of the early Milan trial of adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil...
Is growth factor support to sustain dose intensity cost effective?
Recent economic studies suggest that due to the impact of greater relative dose intensity on long-term outcomes, growth factor support to sustain dose intensity is both an effective and cost-effective management strategy.
What is the effect of chemotherapy dose intensity reduction on long-term survival?
Several retrospective and prospective randomized trials have shown that reductions in the chemotherapy dose intensity established in efficacy studies may compromise long-term disease control and survival.
What are the measures of quality care in cancer patients?
While appropriate measures of quality care in patients receiving cancer chemotherapy have been suggested, including adherence to guidelines, patient volume, and patient satisfaction delivered relative dose intensity where indicated and fe asible should be considered a major quality indicator of optimal cancer care.
Does lowering doses increase the risk of cancer?
As discussed in the article, there exists strong evidence in patients with responsive and potentially curable malignancies that reducing dose intensity by delaying treatments, lowering doses, premature discontinuation of treatment, or not treating increases the risk of disease recurrence and death from cancer.
Can myeloid growth factors increase chemotherapy dose intensity?
Randomized controlled trials as well as meta-analyses of those trials have demonstrated that the myeloid growth factors, in addition to reducing the risk and consequences of febrile neutropenia, are capable of sustaining or increasing chemotherapy dose intensity.
Is myelosuppression a toxicity?
Myelosuppression and particularly neutropenia and associated complications, including febrile neutropenia, continue to represent the major dose-limiting toxicity of cancer chemotherapy. [1] . Although neutropenic complications are associated with substantial morbidity, mortality, and cost, they are also frequently associated with chemotherapy dose ...
Is myelosuppression a surrogate for chemotherapy?
Myelosuppression as a Surrogate for Chemotherapy Dose Intensity. A number of studies have demonstrated that myelosuppression in general or leukopenia and neutropenia in particular encountered during a course of chemotherapy is significantly associated with improved survival across a range of human malignancies.
How does dose intensity affect chemotherapy?
Dose intensity can be increased or decreased through altering dose administered, time interval of administration , or both . Evidence supporting the importance of delivered chemotherapy dose intensity on clinical outcomes in patients with potentially curable malignancies comes from in vitro studies of cancer cell lines and abundant in vivo preclinical studies, in addition to retrospective and prospective clinical trials in both advanced and early-stage disease settings. Myelosuppression continues to represent the major dose-limiting toxicity of cancer chemotherapy, resulting in considerable morbidity and mortality along with frequent reductions in chemotherapy dose intensity, which may compromise disease control and survival. Several retrospective and prospective randomized trials have shown that reductions in the chemotherapy dose intensity established in efficacy studies may compromise long-term disease control and survival. Despite compelling data, surveys in the United States and elsewhere have reported that dose reductions and delays frequently occur in clinical practice, even in the potentially curative setting. Alternatively, an increase in dose intensity above standard may be achieved through either increasing the dose of individual agents (dose escalation) or compressing or shortening the treatment interval (dose-dense). In early studies, dose-dense schedules showed an increase in survival, whereas the benefit of dose escalation studies has been less consistent and may be accompanied by other dose-limiting toxicities. This article focuses on the rationale for delivering full chemotherapy dose intensity, the apparent reasons for failing to deliver treatment, and available strategies for sustaining full chemotherapy dose intensity when indicated. The delivery of full chemotherapy dose intensity in patients with potentially curable malignancies should be considered a quality of care indicator in clinical oncology.
Does dose escalation increase survival?
In early studies, dose-dense schedules showed an increase in survival, whereas the benefit of dose escalation studies has been less consistent and may be accompanied by other dose-limiting toxicities.
What is chemotherapy?
Tumor cells, which make up cancer, grow and reproduce (multiply) very quickly. Normal, healthy cells know to stop reproducing and growing when they touch other cells. Cancer cells keep growing, not knowing when to stop. RNA and DNA in the cell tell it how to grow and reproduce. These cancer cells go through a cycle, made up of phases.
What is dose-dense chemotherapy?
Dose-Dense Chemotherapy (DDC) is a way to give chemotherapy regimens more frequently than normally scheduled, with less time between doses. DDC hopes to kill as much of the tumor as possible. The actual dose of chemotherapy is not increased, but the time between doses is shortened.
What types of cancer is DDC used in?
Studies have found that premenopausal women with high-risk disease ( hormone receptor-negative, Her2 positive, and lymph node positive) see the greatest benefit from DDC in breast cancer treatment.