Roy A. Borchardt

Challenges in managing hepatitis C virus infection in cancer patients

Cancer patients have unique problems associated with hepatitis C virus (HCV) infection and treatment not seen in the general population. HCV infection poses additional challenges and considerations for the management of cancer, and vice versa. HCV infection also can lead to the development of cancer, particularly hepatocellular carcinoma and non-Hodgkin lymphoma. In severely immunocompromised cancer patients, diagnosis of HCV infection requires increased reliance on RNA detection techniques. HCV infection can affect chemotherapy, and delay of HCV infection treatment until completion of chemotherapy and achievement of cancer remission may be required to decrease the potential for drug-drug interactions between antineoplastic agents and HCV therapeutics and potentiation of side effects of these agents. In addition, hematopoietic stem cell transplant (HSCT) recipients have an increased risk of early development of cirrhosis and fibrosis. Whether this increased risk applies to all patients regardless of cancer treatment is unknown. Furthermore, patients with cancer may have poorer sustained virological responses to HCV infection treatment than do those without cancer. Unfortunately, not all cancer patients are candidates for HCV infection therapy. In this article, we review the challenges in managing HCV infection in cancer patients and HSCT recipients.

Zika virus: A rapidly emerging infectious disease.

Zika virus is a flavivirus transmitted to humans via the bite of infected mosquitoes. A recent outbreak in Brazil has spread to several surrounding countries, and the virus also has been reported in the United States. The virus is associated with microcephaly among newborns whose mothers were infected. Because no vaccine or treatment is available, efforts have focused on preventing mosquito bites and advising pregnant women and women trying to get pregnant to avoid active areas of Zika virus transmission. Clinicians should understand the infection, its diagnosis and testing, and monitor pregnant women for travel history to outbreak regions and for the presence of clinical symptoms. Patient education on preventive measures offers the best option to avoid Zika virus infection.

Multidisciplinary Cancer Care: Development of an Infectious Diseases Physician Assistant Workforce at a Comprehensive Cancer Center

The authors outline the process through which the infectious diseases department at The M. D. Anderson Cancer Center successfully integrated physician assistants into patient care services, as judged by an overall increase in departmental productivity, broadened patient care coverage, and physician satisfaction with midlevel services.

The Ebola virus epidemic: Preparation, not panic.

ABSTRACTThe largest-ever outbreak and first epidemic of Ebola virus disease is affecting several West African countries. Early symptoms of Ebola can mimic those of other tropical diseases. In a world of rapid global travel, physician assistants need to be capable of identifying patients at greatest risk for developing Ebola. Clinicians also should be familiar with associated symptoms, diagnosis, and treatment considerations.

Diagnosis and management of group A beta-hemolytic streptococcal pharyngitis.

Viral and Group A beta-hemolytic streptococcal (GAS) pharyngitis have overlapping signs and symptoms, but distinguishing between the two is critical to proper treatment. Antibacterial therapy is appropriate for GAS pharyngitis and may help prevent complications.

Transdisciplinary approach to managing hepatitis C virus infection in patients at a tertiary care cancer center

Hepatitis C virus (HCV) infection is a major problem worldwide, with 230 million reported cases, including 2.7 to 3.9 million cases (1.0%–1.5%) in the United States.1 The prevalence rates for HCV infection in patients with cancer range from 1.5% to 32%.2 Although HCV infection in this patient population is common, little is known about its management, and many oncologists remain unaware of current treatment options. Education of medical staff and the coordination of different specialties are essential to provide the appropriate patient stratification and best therapeutic approach to treating HCV infection in patients with cancer in the context of multiple comorbidities. Therefore, this special population of patients needs guided treatment and constant supervision. This commentary highlights the importance of treating HCV infection in patients with cancer and describes the educational experience with a transdisciplinary approach to treatment gained at our HCV infection clinic, the first clinic in the United States devoted to managing this infection in patients with cancer.3