ACTIVITY OVERVIEW
Despite advances in the management of chemotherapy-induced myelosupression, neutropenia remains a major dose-limiting toxicity of systemic antineoplastic therapy and is associated with substantial morbidity, mortality, and healthcare costs. Development of fever in the setting of neutropenia (febrile neutropenia [FN]) represents a potentially fatal condition because it places oncology patients at a considerable risk of developing major bacterial and/or fungal infections. Most episodes of FN require prolonged hospitalization, often leading to increased hospital expenditure and significant risks of inpatient mortality. FN may also lead to dose reductions or treatment delays in subsequent chemotherapy cycles, which may have a considerable life-threatening impact on disease control in responsive and potentially curable malignancies. Because prophylactic use of granulocyte-colony stimulating factors (G-CSFs) has been shown in multiple studies to reduce the risk, severity, and duration of FN, primary prophylaxis may minimize delays and dose reductions in chemotherapy regimens and potentially reduce FN-associated hospitalizations. As a result, several oncology guidelines advocate prophylactic use of G-CSFs in at-risk patents, specifically those receiving chemotherapy regimens that are associated with a greater than 20% incidence of FN. The focus of current research is to develop standardized clinical tools for identifying risk factors for FN-associated mortality and hospitalizations, identify optimal anti-infective strategies for FN, and define best practices for G-CSF prophylaxis in various oncology settings.
The following online journal club series presents results of 6 key primary research articles published in reputable peer-reviewed journals in 2010. Each journal club includes a summary of the study, an analysis of the study’s strengths and limitations, and clinical implications, all of which serve to provide practicing clinicians with an analytical portrait of the most current and significant research within the field. This online journal club series, in particular, is designed to provide healthcare professionals with an understanding of the most current advances and issues surrounding the management of FN.
GOAL
This educational activity will provide medical oncologists, oncology pharmacists, and oncology nurses with up-to-date information about the treatment and management of patients with chemotherapy-induced FN.
INTENDED AUDIENCE
This activity is designed for medical oncologists, oncology pharmacists, and oncology nurses working with patients with chemotherapy-induced FN. No prerequisites required.
STEERING COMMITTEE
Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.
Policy on Faculty and Provider Disclosure
It is the policy of The Institute for Johns Hopkins Nursing to require our continuing nursing education faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the educational activity.
Full Disclosure Policy Affecting CPE Activities:
As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of the University of Tennessee College of Pharmacy to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.
The Steering Committee reported the following:
Katherine DeLorenzo, MD (Co-Course Director)
Department of Medical Oncology
The Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins University
Baltimore, Maryland
Dr DeLorenzo reports receiving grants/research support as the principal investigator for ARIAD Pharmaceuticals, Inc, Amgen Inc, Genentech, Inc, and Novartis Pharmaceuticals Corporation.
Suzanne M. Cowperthwaite, MSN, RN (Co-Course Director)
Assistant Director of Nursing
The Kimmel Comprehensive Cancer Center
The Johns Hopkins University
Baltimore, Maryland
Ms Cowperthwaite reports having no relationships with commercial interests related to this activity.
Susan Hudock, PharmD, BCOP (Co-Course Director)
Johns Hopkins Hospital
Oncology Investigational Pharmacy
Baltimore, Maryland
Ms Hudock reports having no relationships with commercial interests related to this activity.
Jane C. Shivnan, MScN, RN, AOCN (Nurse Planner)
Executive Director
The Institute for Johns Hopkins Nursing
Baltimore, Maryland
Ms Shivnan reports having no relationships with commercial interests related to this activity.
Indu Lew, PharmD
Saint Barnabas Health Care System
Corporate Vice President
Pharmacy Education and Research
South Plainfield, New Jersey
Dr Lew reports having no relationships with commercial interests related to this activity.
Saroj Vadhan-Raj, MD
Professor of Medicine
Internist, Department of Sarcoma Medical Oncology
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Dr Vadhan-Raj reports receiving grants/research support from Amgen Inc, Bristol-Myers Squibb, Eisai Inc, EUSA, GlaxoSmithKline, Merck & Co, Inc, Nuvelo, Inc, and Sanofi-Aventis; serving as a consultant for S3Bio Inc; receiving honoraria from Amgen Inc, Cytogen Corporation, Johnson & Johnson, Merck & Co, Inc, and Sanofi-Aventis; and serving on the speakers’ bureau for Sanofi-Aventis.
Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution which receives the grant, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).
Planner Disclosures
Dr DeLorenzo reports receiving grants/research support as the principal investigator for ARIAD Pharmaceuticals, Inc, Amgen Inc, Genentech, Inc, and Novartis Pharmaceuticals Corporation.
No planners have indicated that they have financial interests or relationships with a commercial entity.
Off-Label Product Discussion:
The audience is advised that the original articles on which this educational activity is based may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. Readers will be informed of any discussion or reference to an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device in the journal clubs.
Gomez journal club: Antimicrobials (amikacin, cefipime, and piperacillin/tazobactam) were used
empirically for FN
Kubiak journal club: Caspofungin/micafungin mentioned for empiric treatment of FN
Rifkin journal club: Pegfligrastim has indication for use after autologous PBSCT
Miller journal club: Reactive (after FN has already manifested) use of pegfilrastim/filgrastim
Flores journal club: Reactive (after FN has already manifested) use of pegfilrastim/filgrastim
Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.
INTERNET CME POLICY
The Office of Continuing Medical Education (CME) at The Johns Hopkins University School of Medicine is committed to protect the privacy of its members and customers. Johns Hopkins University School of Medicine CME maintains its Internet site as an information resource and service for physicians, other health professionals, and the public. Continuing Medical Education at the Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet-based activity. Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine’s CME activity. CME collects only the information necessary to provide you with the services that you request.
THE INSTITUTE FOR JOHNS HOPKINS NURSING MISSION STATEMENT
The mission of The Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally.
Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing. Our service values are quality, integrity, flexibility, and personal attentiveness. We appreciate your thoughts and welcome your concerns. Please feel free to e-mail us: IJHN@son.jhmi.edu.
GRIEVANCE POLICY
A participant, sponsor, faculty member, or other individual wanting to file a grievance
with respect to any aspect of a program sponsored or co-sponsored by the UTCOP
may contact the Associate Dean for Continuing Education in writing. The grievance
will be reviewed and a response will be returned within 45 days of receiving the written
statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can
be made for a second level of review.
CME INFORMATION
Accreditation Statements — This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing, and The University of Tennessee College of Pharmacy. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.
Credit Designation Statement — The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 3.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This 1.2 contact hour educational activity is provided by The Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Contact hours will be awarded for this educational activity until November 30, 2012.
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based educational activity will provide a statement for 3.0 contact hours of credit (0.3 CEUs) and will be available for download following successful completion of the activity. Successful completion includes participating in the activity, completing a self-assessment instrument with a score of at least 70%, and completing an evaluation instrument. If you score less than 70% on the self-assessment instrument, you will be allowed to complete the examination one more time. ACPE Program #0064-0000-10-204-H01-P.
This continuing pharmacy education activity was produced under the supervision of
Glen E. Farr, PharmD, Associate Dean for Continuing Pharmacy Education, University
of Tennessee College of Pharmacy.
How to Receive Credit or Contact Hours
After reading this monograph, participants may receive credit or contact hours by completing the CME/CNE/CPE test, evaluation, and receiving a score of 70% or higher.
The estimated time to complete this activity: 3 hours.
Release date: November 30, 2010. Expiration date: November 30, 2012.
To obtain contact hours, you must complete this Educational Activity and post-test before November 30, 2012.
Fee: There is no fee for this educational activity.
Hardware & Software Requirements
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.
