Catherine D. Cooksley

Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis.

Oral and gastrointestinal (GI) mucositis can affect up to 100% of patients undergoing high‐dose chemotherapy and hematopoietic stem cell transplantation, 80% of patients with malignancies of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary track mucositis increases mortality and morbidity and contributes to rising health care costs. Consequently, the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an expert panel to evaluate the literature and to create evidence‐based guidelines for preventing, evaluating, and treating mucositis.

The burdens of cancer therapy: Clinical and economic outcomes of chemotherapy-induced mucositis

Mucositis is a common but poorly studied problem among patients with solid tumors. The authors examined the clinical and economic outcomes of oral and gastrointestinal (GI) mucositis among patients receiving myelosuppressive chemotherapy.

Generalizability of cancer clinical trial results: Prognostic differences between participants and nonparticipants

The generalizability of clinical trial results is questionable, because fewer than 5% of cancer patients participate. The authors examined the comparability of clinical trial participants and nonparticipants and the potential impact of differences.

Aspergillus terreus: an emerging amphotericin B-resistant opportunistic mold in patients with hematologic malignancies.

Invasive aspergillosis (IA) has emerged as a common cause of morbidity and mortality among immunocompromised patients. At The University of Texas M. D. Anderson Cancer Center (Houston, TX), Aspergillus terreus is second to A. fumigatus as the most common cause of IA. In the current study, the authors compared the risk factors and outcomes associated with IA caused by A. terreus and IA caused by A. fumigatus.

Breast cancer: Is ethnicity an independent prognostic factor for survival?

A survival difference between white and black females has been reported after diagnosis and treatment for breast carcinoma. Although multivariate analyses demonstrate that the survival difference is less or nonexistent when additional prognostic factors are considered, study results have been inconsistent. The objective of this study was to examine further the role of ethnicity as an independent prognostic factor for breast carcinoma survival among white and black females treated over a 30‐year period.

Epidemiology and outcomes of serious influenza-related infections in the cancer population

Although patients with cancer generally respond favorably to vaccination, they may not receive annual influenza vaccinations. The current population‐based study described the epidemiology and outcomes of potentially preventable, serious influenza‐related infections in patients with cancer.

HIV-related malignancies: community-based study using linkage of cancer registry and HIV registry data

For people immunosuppressed by human immunodeficiency virus (HIV), we expect an increase in cancer incidence similar to that documented in transplant patients. We examined the cancer spectrum in an HIV-infected cohort, specifically malignancies not currently associated with acquired immunodeficiency syndrome (AIDS), in relation to the general population. Cancer incidence data for residents of Harris County, Texas, diagnosed between 1975 and 1994, were linked to HIV/AIDS registry data by Soundex code and date of birth to identify malignancies in an HIV-infected cohort of 14,986 persons. Incidence of cancer in this cohort was compared to the general population by standardized incidence ratio (SIR) analysis. From the HIV-infected cohort, 2289 persons (15%) were identified as having one or more malignancies, with 97% occurring in males. The linkage alone identified 29.5% of the malignancies, of which only 28.7% were diagnosed in males. Adjusting for age, HIV-infected men and women had incidences of cancer that were 16.7 [95% confidence interval (CI) 16.1–17.3] and 2.9 (95% CI 2.3–3.7) times that expected for the general population of Harris County, Texas. Besides Kaposis sarcoma, non-Hodgkins lymphoma, cervix cancer and brain lymphoma, non-AIDS related malignancies of Hodgkins lymphoma, non-melanotic skin cancer in males and colon cancer in females, exhibited significant SIRs of 5.6 (95% CI 3.6–8.4), 6.9 (95% CI 4.8–9.5) and 4.0 (95% CI 1.1–10.2). Increased incidences of lung, prostate and breast malignancies were not seen in this HIV cohort. Persons infected with HIV appear to be at increased risk for the non-AIDS related malignancies, Hodgkins lymphoma, non-melanotic skin cancer in males and colon cancer in females

Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer

Goals of work: Oral and gastrointestinal (GI) mucositis are frequent complications of chemotherapy and radiotherapy for cancer, contributing to not only the morbidity of treatment but its cost as well. The risk associated with specific chemotherapeutic agents, alone and in combination, has been characterized previously. In the current study, we sought to estimate the risk associated with newer regimens for the treatment of non-Hodgkin’s lymphoma (NHL) and common solid tumors. Methods: We reviewed published studies reporting phase II and III clinical trials of dose-dense regimens for breast cancer and NHL, TAC (docetaxel, adriamycin, cyclophosphamide) chemotherapy for breast cancer, and infusional 5-fluorouracil-based regimens for colorectal cancer. Platinum-, gemcitabine-, and taxane-based regimens for lung cancer, either alone or in combination with radiotherapy, were also considered. Using modified meta-analysis methods, we calculated quality-adjusted estimates of the risk for oral and GI mucositis by tumor type and regimen. Case reports are used to emphasize the relevance of the findings for patient care. Main results: Our findings demonstrate that mucosal toxicity remains an important complication of cancer treatment. Moreover, innovations in drug combinations, scheduling, or mode of administration significantly modulate the risk for both oral and GI mucositis. Conclusions: Ongoing review of the clinical trial experience will remain important as newer, targeted agents enter standard clinical practice.

Effects of smoking and radiotherapy on lung carcinoma in breast carcinoma survivors.

The combined effects of thoracic radiotherapy (XRT) and cigarette smoking are not known with certainty, but they have important implications for lung carcinogenesis after cancer therapy in some patients. The authors analyzed smoking, radiation, and both exposures on lung carcinoma development in women who were treated previously for breast carcinoma.

Tuberculosis in cancer patients: an update.

The demographics of tuberculosis (TB) and the therapy of malignancies have significantly changed since the last comprehensive review of TB in cancer patients. Fifty-six patients with both TB and malignancy were identified from January 1989 through December 1994 in a population of 61,931 newly registered cancer patients. The frequency of TB in cancer patients was 90 per 100,000. TB was more frequent in foreign-born patients (p < 0.001) and in racial and ethnic minorities (p < 0.001) than in non-Hispanic whites. TB developed during therapy in 48%. TB was discovered synchronously with the malignancy in 30% and in 21% occurred ≥18 months after therapy. Pulmonary TB occurred in 50 (89%) patients and extrapulmonary TB in nine (16%) (three had both). Chest radiographic findings did not suggest TB in 20%. TB was less frequent in lung cancer (p < 0.001), head and neck cancer (p = 0.002), and solid hematologic malignancies (p < 0.001) than it had been historically, but the frequency was unchanged in acute leukemia patients (p = 0.46). TB in cancer patients occurs at a nine times greater frequency than in the general population. It is now most frequent in leukemia patients.