Blood & Cancer

How are community oncologists adapting to the COVID-19 pandemic? Podcast host David H. Henry, MD, of Pennsylvania Hospital in Philadelphia, explores this question with Matthew Lonergan, MD, of Willamette Valley Cancer Institute (WVCI) and Research Center in Eugene, Ore. Dr. Lonergan explains how WVCI is attempting to minimize staff exposure to COVID-19, how physicians there are dealing with the transition to telemedicine, and how a lack of resources has affected WVCI. Dr. Lonergan and Dr. Henry also discuss how the COVID-19 pandemic has changed research, tumor boards, and other meetings. And the pair compare the response to the current pandemic with the response to HIV and the Spanish flu. Disclosures: Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Lonergan reported having no financial disclosures relevant to this episode. *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on

In the “new normal” of treating cancer patients during COVID-19, when do you decide to start treatment or pause it? Narjust Duma, MD, a thoracic oncologist at the University of Wisconsin, Madison, shares how she makes those decisions in partnership with her lung cancer patients and how the discussions are complicated by the fear and uncertainty around the pandemic. Later in the podcast, Dr. Duma and podcast host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, explore how telehealth changes patient encounters, use of liquid biopsies to keep patients out of the hospital, and the importance of checking in with mentees. Disclosures Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Duma reported having no financial disclosures relevant to this episode. *   *   *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiew

As the nation’s health care system braces for COVID-19 cases, physicians who’ve faced the pandemic first have critical lessons for everyone. In this bonus episode, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region’s early outbreaks. And they share some creative approaches that are uniting Seattle’s critical care departments.

Zainab Shahid, MD, medical director of bone marrow transplant infectious diseases at the Levine Cancer Institute/Atrium Health in Charlotte, N.C., breaks down when cancer patients should seek testing for COVID-19 and how they should be treated. Dr. Shahid also compares notes with Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital in Philadelphia, on how the COVID-19 pandemic has changed the world of medical education. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, celebrates National Doctors Day amid the COVID-19 pandemic. Topics covered in this podcast: How the education of trainees as changed. Use of telehealth screening and visits. COVID-19 case volume and when oncology patients should seek testing. Which patients should be considered immunocompromised. *   *   *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Tw

Susan Dent, MD, codirector of the cardio-oncology program at Duke University in Durham, N.C., reflects on virtual grand rounds, telehealth, the screening of patients before clinic visits, and other new realities of cancer care in the age of COVID-19. Dr. Dent also discusses the importance of assessing breast cancer patients for cardiotoxicity. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the importance of advance directives. *  *  *   Cardiotoxicity in breast cancer treatment HER2 drugs (such as trastuzumab) and conjugates If given appropriately, these drugs have limited cardiotoxicity. The mechanism of cardiotoxicity is a “stunning of the heart.” If there is a significant drop in left ventricular ejection fraction, hold the drug. When problems arise, they tend to occur early on. Important to assess baseline risk factors. Older individuals with underlying hypertension, diabetes, and other conditions need monitoring. Anthracyclines The appropriate/safe dose of

David Henry, MD, welcomes Bernard A. Mason, MD, to discuss Dr. Mason's favorite digital tools for working as a physician in part 1 of 2. Dr. Mason is an oncologist with the Pennsylvania Hospital and the University of Pennsylvania, both in Philadelphia.  Dr. Mason explains the actual benefits for doctors and health care providers for popular apps and services from storage to maps. He and Dr. Henry explore the following: One drive Google Drive Google Photos Google Maps Offline HERE WeGo This week's installment of Clinical Correlation, Ilana Yurkiewicz, MD, poses a complicated question about oncologist-patient relationships: Do they ever actually end? *  *  *   For more MDedge Podcasts, go to https://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD, on Twitter: @davidhenrymd Ilana Yurkiewicz, MD, on Twitter: @ilanayurkiewicz

There’s an art to taking a thorough bleeding history. In this episode, Adam Cuker, MD, director of the Hemophilia and Thrombosis Center at the University of Pennsylvania, Philadelphia, shares the most important questions to ask and the challenges in assessing risk in patients about to undergo surgery and those with active bleeding. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about delivering good news to patients.    Practice points: Always take a thorough bleeding history. Ask patients about bleeding from head to toe. Even if the basic laboratory evaluation is normal, the patient may still have a bleeding disorder. *  *  *  Assessing bleeding risk before surgery  How do you advise patients about to go into surgery who say they bruise easily? This situation comes up frequently. In the case of emergency/urgent surgery, there’s not time for a prolonged evaluation. Take a careful bleeding history: Always ask patients about any history of spontaneous bleeding. Ask abou

Ever read through a study and wondered how to apply the hazard ratio, or if you should change your practice because of a secondary endpoint finding? In this episode, Lauren M. Catalano, MD, of the University of Pennsylvania, Philadelphia, explains all the common terms and why they matter in the context of the KEYNOTE-024 trial.  In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about how to prepare for an unexpected bad outcome. Practice points: Don’t skip over the statistical analysis portion of a paper. Use Google to find simple definitions for unfamiliar biostatistics terms. Understanding the statistical elements is essential to determining the quality of the research. * * * Understanding statistics in the context of KEYNOTE-024 Article discussed: Updated analysis of KEYNOTE-024: Pembrolizumab versus platinum-based chemotherapy for advanced non–small cell lung cancer with PD-L1 tumor proportion score of 50% or greater. J Clin Oncol. 2019 Mar 1;37(7):537-46.  Primary e

A diagnosis of acute myeloid leukemia (AML) was once an emergency, requiring immediate treatment. Today, the need to start treatment is still urgent, but many patients can benefit by waiting a few days for testing to reveal a fuller picture of the disease. That’s the advice of James M. Foran, MD, of the Mayo Clinic. He joins Blood & Cancer host David H. Henry, MD, of the Pennsylvania Hospital, Philadelphia, to walk through some patient scenarios and the newest treatment options. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what patients do and do not remember from their visits. Practice points: Rapid testing results can drive important choices in the initial treatment of AML. Adjunctive therapies may improve survival by 7%-20% in appropriate patients. Although a total work-up may take up to 2 weeks, new research suggests it is feasible to get rapid sequencing/cytogenetic testing and assign treatment within 7 days. Treatment varies: Daunorubicin and cytarabi

The million-dollar question in the treatment of chronic lymphocytic leukemia (CLL) is what to do after a patient relapses following treatment with venetoclax. Anthony Mato, MD, and Lindsey Roeker, MD, both of Memorial Sloan Kettering in New York, join podcast host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to explore the evidence about this question and to review the initial patient work-up and treatment strategies. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses patients compliance and how clinician biases can influence compliance. Practice points: For patients with CLL with unmutated immunoglobulin variable heavy chain gene (IgVH), novel agents are the first therapy. Evidence is limited about the best treatment approach after relapse on venetoclax.  * * *  Initial work-up in patients with CLL The initial work-up for patients with CLL is often fluorescent in situ hybridization (FISH), looking for trisomy 12, as well as deletion of 13q, 17p, and

Chimeric antigen receptor (CAR) T-cell therapy is one of the hottest advances in lymphoma treatment, but who should get it and what does the process look like? Allison Winter, MD, of the Cleveland Clinic helps answer those questions on the podcast. She joins Blood & Cancer host David H. Henry, MD, of the Pennsylvania Hospital, Philadelphia, to break down the side effects and look ahead to possible off-the-shelf products. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses optimism bias. She recalls a time when a patient’s drive for optimism affected what she told them and whether that was a good or bad thing.  Practice points: The time to refer a patient for CAR T-cell therapy is at relapse. CAR T-cell therapy side effects are serious and include cytokine release syndrome and neurotoxicity.*  *  *   CAR T-cell therapy use in lymphoma  For patients with diffuse large B-cell lymphoma, treatment after relapse typically involves salvage therapy, and if they are chemot

Think of biosimilars as your mother’s minestrone soup: It’s the same recipe and ingredients every time, but not every batch is chemically identical, even if it tastes about the same. That’s how Brian T. Hill, MD, PhD, of the Cleveland Clinic, describes biosimilars. He joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss how biosimilars are made and approved, and how they differ from generic drugs.  In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about percentages -- what they mean, what they don’t mean, and how they can be interpreted in oncology.  * * * What are biosimilars? Monoclonal antibodies and biologics are complex and large proteins that are made in cells and bioreactors. Because they are made in “nature” instead of a synthetic reaction (discussed with generics), slight differences can be expected in the molecular structure.  Those slight variances do not create clinically meaningful differences between the biosimi

Blood & Cancer takes you behind the podium at the American Society of Hematology annual meeting for an in-depth look at the latest developments in anemia and myelodysplastic syndrome, chimeric antigen receptor (CAR) T-cell therapy for mantle cell lymphoma, use of novel agents in follicular lymphoma, and a range of new advances being explored in chronic lymphocytic leukemia. Guests on the podcast include Brian T. Hill, MD, PhD, and Allison Winter, MD, both with the Cleveland Clinic, and Anthony Mato, MD, and Lindsey E. Roeker, MD, of Memorial Sloan Kettering Cancer Center in New York. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the gratitude that can come from surviving cancer. *  *  *  ASH19 abstracts discussed in this podcast: Abstract 843: Roxadustat in the treatment of anemia in patients with lower-risk myelodysplastic syndrome and low red blood cell transfusion burden. Abstract 754: (03:45) KTE:X19, an anti-CD19 CAR T-cell therapy in patients wit

When it comes to treating pain related to sickle cell disease, consider the underlying factors, from constipation to compression spine deformity. That’s just some of the advice from Ifeyinwa Osunkwo, MD, of Atrium Health and Levine Cancer Institute in Charlotte, N.C. She joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss her tips for treating pain and other complications of sickle cell disease. Dr. Osunkwo also provides an update on progress toward a cure in sickle cell disease that could be available to a large number of patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about why treating patients with cancer doesn’t make her sad. *  *  * Treating pain in sickle cell: In sickle cell disease, patients have acute episodes of vaso-occlusive crisis, as well as chronic pain. Consider whether the pain symptoms are an acute exacerbation of their chronic pain, an independent acute episode of pain, or chronic pain. In her practice, Dr

Daniel G. Haller, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to review the top three GI cancer trials presented at the 2019 ESMO World Congress on Gastrointestinal Cancer, and how they are changing practice.  Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the difficulty in using age to guide cancer treatment.   *  *  * BEACON trial for colorectal cancer Patients with BRAF mutations have a poor prognosis and typically fail treatment prior to second line therapy. BEACON is a phase 3 trial that was designed to test BRAF/MEK combination targeted therapies in patients with BRAF-mutated metastatic colorectal cancer. The study found that the three-drug combination of encorafenib, binimetinib, and cetuximab significantly improved overall survival in patients with BRAF-mutated metastatic colorectal cancer. The response rate for targeted triple therapy was 26%, compa

Thomas LeBlanc, MD, of Duke Cancer Institute in Durham, N.C., joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss the evolution of the palliative care field and some of the underrecognized ways that it can improve care for hematology-oncology patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a patient who put aside her own desire for hospice because of family pressure to pursue curative treatment. *  *  * Palliative medicine has evolved tremendously over the past decade; it used to be synonymous with hospice and dying. It is now a sophisticated medical subspecialty with growing and large evidence base.  Palliative treatments are aimed at maximizing patient's quality of life and can be provided alongside other curative treatments.  Physicians, physician assistants, and nurse practitioners form an interdisciplinary team along with patients and their families.  Palliative care specialists can work alongside oncologis

In this special edition podcast, we bring you the best of Clinical Correlation, a segment on the human side of hematology-oncology care. Clinical Correlation is written, recorded, and produced by Ilana Yurkiewicz, MD, of Stanford (Calif.) University. This episode includes five of our favorite Clinical Correlation segments.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

In this special edition podcast, Blood & Cancer revisits an interview with Ilana Yurkiewicz, MD, of Stanford (Calif.) University. Dr. Yurkewicz is the writer and producer of the podcast’s Clinical Correlation segment, which puts a human face on hematology-oncology care. She sits down with MDedge producer Nick Andrews for a wide-ranging interview that covers everything from the best advice she’s ever gotten to her favorite science fiction writer. The interview first aired on our sister podcast, Postcall.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Howard “Skip” Burris, MD, chief medical officer of Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast to talk about what it’s like to be the 2019-2020 president of the American Society of Clinical Oncology. Dr. Burris joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to share his priorities as president and how he finds the time for advocacy, research, and clinical practice. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a couple who had cancer at the same time.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

David Mintzer, MD, of the University of Pennsylvania, Philadelphia, joins the podcast to discuss noteworthy drug approvals in hematology-oncology in 2019. Dr. Mintzer and Blood & Cancer host, David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, discuss what these new treatment options mean for clinicians and patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, is at the annual meeting of the American Society of Hematology with a reminder that the way we talk about patients matters. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * *  Dr. Mintzer’s review of new drug approvals in 2019: https://www.mdedge.com/hematology-oncology/article/211340/mixed-topics/2019-glance-hem-onc-us-drug-approvals?channel=27979 More articles on FDA approvals in hematology-oncology: https://www.mdedge.com/hematology-oncology/news-fda/cdc * * *  For more MDedge Podcasts, go to mdedge.com/podca