ORAL HEALTH IN OLDER MALE CANCER PATIENTS
In a recent secondary analysis of a prospective observational study published in The Journal of the American Geriatrics Society, researchers reported that mouth or tooth problems that cause difficulty eating in older male patients with cancer are associated with a greater risk of experiencing a lower quality of life, poorer emotional health, lower levels of physical functioning, and greater pain than in those without these problems. Sally S. Ingram, MD, and coauthors assessed the surveys of 150 male community-dwelling cancer patients (mean age, 67), who were asked whether they suffered from poor oral health that makes eating difficult. Using the Chi-square contingency tables, the Cochran-Mantel-Haenszel test, and t tests, researchers examined the relationship between those who reported tooth or mouth problems and various parameters, including comorbid conditions, activities of daily living, pain, anxiety, depression, quality of life, and overall health ratings.
More than one-third of the survey respondents (n = 54) reported mouth and tooth problems causing difficulty eating; these persons were diagnosed with cancer an average of 2.9 years before the survey, and 83.3% were cancer-free at the time of the survey. Compared with those without these problems, those with poor oral health had significantly lower global (P = 0.003) and subscale scores on quality-of-life analysis and higher levels of anxiety (P < 0.001) and depression (P = 0.01), and significantly more pain (P < 0.001) and lower physical functioning (P < 0.001). In addition, they were more impaired in activities of daily living (P < 0.001), and were more likely to describe their overall health as fair or poor (P = 0.01). Authors report that cancer located in the head and neck region is associated with a higher likelihood of having mouth or tooth problems (P = 0.005), but note that these problems were not associated with race, education, income, insurance coverage, age, comorbid conditions, alcohol consumption, tobacco or medical usage, type of cancer treatment, tumor stage at diagnosis or follow-up, perceived social support, or spirituality.
LEVOFLOXACIN IN CHEMOTHERAPY PATIENTS
Michael Cullen, MD, and colleagues have found in a recent randomized, double-blind, placebo-controlled trial that the incidence of fever, probable infection, and hospitalization can decrease in patients who receive chemotherapy for solid tumors or lymphoma with the prophylactic use of levofloxacin. The study, published in The New England Journal of Medicine, examined patients who were receiving cyclic chemotherapy for solid tumors, including breast cancer (35.4%), lung cancer (22.5%), and testicular cancer (14.4%), and lymphoma (12.8%), and who were at risk for temporary, severe neutropenia. The 1565 participants (median age, 55 years) were randomly administered either levofloxacin 500 mg once daily (n = 781) or matching placebo (n = 784) for 7 days during the expected neutropenic period. Primary outcome was the incidence of clinically documented febrile episodes (> 38° C) attributed to infection. Secondary outcomes included the incidence of all probable and severe infections, and hospitalization, but did not include a systematic evaluation of antibacterial resistance.
In the levofloxacin group, 3.5% of patients had at least one febrile episode, compared with 7.9% in the placebo group (P < 0.001) during the first cycle of chemotherapy. During the entire chemotherapy course, 10.8% of patients receiving levofloxacin had at least one febrile episode, compared with 15.2% of the placebo group (P = 0.01); the respective rates of probable infection were 34.2% and 41.5% (P = 0.004). In the levofloxacin group, hospitalization was required for the treatment of infection in 15.7% of patients, compared with 21.6% in the placebo group (P = 0.004). There were four infection-related deaths in each group; the respective rate of severe infection was 1.0% and 2.0% (P = 0.15). Authors reported that an organism was isolated in 9.2% of probable infections.