Background Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. Objectives To better characterize the clinical characteristics and types of autonomic dysfunction in this population. Methods A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Autonomic impairment was graded on severity based on the Composite Autonomic Severity Score system. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. Results Of approximately 282 total patients in the UCLA Cardio-Oncology program, 24 were referred for suspected autonomic dysfunction and met the inclusion criteria. 22 had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, 7 had moderate, and 4 had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. Conclusion Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
Background: The US National Cancer Institute (NCI) Center for Global Health (CGH) serves as a clearinghouse of information on global oncology activities within the NCI and across the 70 NCI-designated Cancer Centers. Global oncology, as defined by the American Society of Clinical Oncology (ASCO), “addresses disparities and differences in cancer prevention, care, research, education and the disease's social and human impact around the world”. While CGH routinely reports on NCI-funded global oncology projects conducted at the cancer centers, there is limited reporting of non-NCI funded global oncology activities of the cancer centers. To address this gap, CGH has surveyed the cancer centers about their global oncology programs and projects informally in 2012 and 2014. The 2018 survey, in partnership with ASCO, represents the first systematically conducted survey, with new questions about cancer center global oncology programs, faculty, and trainees. Aim: The aim of the 2018 survey is to develop a summary report of cancer center global oncology programs for use by cancer centers as a knowledge sharing and collaborative tool; by the NCI to inform program development; and, by ASCO to better understand the current state of global oncology training at US institutions. Methods: CGH developed a 2-part online survey with questions about global oncology projects led by cancer centers, and the level of support for global oncology training and faculty engagement at cancer centers. CGH piloted the survey to 7 of the 70 cancer centers (10%) from January to March 2018. Revisions based on the pilot were made, and CGH fielded the survey to the rest of the 63 cancer centers (90%) from March to July 2018. CGH supplemented the survey data with an Internet search of cancer centers' Web sites. The submitted data will be compiled, analyzed, and organized into a summary report for distribution to NCI, ASCO, and the cancer centers. Results: Data from the 7 pilot institutions show that while all 7 institutions (100%) have a global oncology program, there is great variance in the percentage of global oncology faculty who receive external or administrative research grant support for their work. Three institutions (43%) report that 50% or fewer global oncology faculty receive external research grant support, and 6 institutions (86%) report that 50% or fewer global oncology faculty receive cancer center administrative fund support for their work. Additional results and analysis will be available and presented as part of this presentation. Conclusion: In addition to serving as a knowledge sharing and collaboration tool for cancer centers, the global oncology survey allows NCI, ASCO, and global oncology partners to understand the current landscape of and sources of support for global oncology training, research, and programming at the cancer centers. This information will inform future discussions on how to strengthen global oncology programming and partnerships.
Background: Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. Objectives: To better characterize the clinical characteristics and types of autonomic dysfunction in this population. Methods: A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. Results: Of approximately 282 patients in the UCLA Cardio-Oncology program, twenty-four patients met the inclusion criteria. Twenty-two had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, seven had moderate, and four had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. Conclusion: Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
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