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Commentary (Stopfer/Domchek): Evaluation and Management of Women With BRCA1/2 MutationsMore than a decade has passedsince the cancer predispositiongenes BRCA1 andBRCA2 were cloned. Collectively,these genes are responsible for virtuallyall hereditary breast/ovarian cancerfamilies as well as a smaller subsetof hereditary site-specific breast cancerfamilies.[1] Their discovery helped usherin a new age of predictive and preventivemedicine for those at risk ofbreast and ovarian cancer, two of themost common forms of cancer in womenin the United States.[2] Peshkin andIsaacs provide an excellent summaryof cancer susceptibility due to inheritedmutations in BRCA1 and BRCA2,including approaches to assessing personaland family history for the likelihoodof finding these mutations, theirassociated cancer risks, and options forclinical management.
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Stress and Burnout in OncologyThis article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house
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Mitomycin as a Modulator of Irinotecan Anticancer ActivityIrinotecan and mitomycin (Mutamycin) possess significant single-agent activity against several tumor types, and mitomycin activates topoisomerase I, the cellular target of irinotecan. We conducted a phase I dose-escalation study of irinotecan and mitomycin in 37 evaluable patients with solid tumors. Antitumor responses included 2 complete responses, 5 partial responses, 10 minor responses, and a CA 19-9 tumor marker response.
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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
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Sonography better to monitor small testicular lesionsThere is a lack of scientific evidence about the risk of testicular cancer associated with testicular lesions, but the conventional treatment approach has been immediate surgical removal because of the possibility of malignancy. A more conservative approach has served one Canadian institution well when it comes to active surveillance of small, incidentally discovered testicular masses.
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Clinical Hypnosis for the Palliative Care of Cancer PatientsClinical hypnosis has been defined as a mind-body therapy that involves a deeply relaxed state, individualized mental imagery, and therapeutic suggestion.
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"OMG, How Long Is This Going to Take?"It is hard to realize that an elderly patient's visit to you is likely the only trip outside his or her apartment for the week and the only contact with someone other than family or an aide. Doctor visits sometimes become the elderly's primary contact with the larger world.
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Managing Depression in Patients With CancerThe diagnosis and treatment of depression in the cancer setting can improve patients’ quality of life, their adherence to therapy recommendations, and the illness experience, all of which may affect survival outcomes.
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Molecular Testing to Optimize and Personalize Decision Making in the Management of Colorectal CancerRecent improvements in our understanding of the biology of colorectal cancer have led to the identification of several important prognostic and predictive markers of disease-associated risk and treatment response for the individual patient.
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Epirubicin, Cisplatin, Oral UFT, and Calcium Folinate in Advanced Gastric CarcinomaUFT (uracil and tegafur in a 4:1 molar ratio) plus calcium folinate treatment has favorable activity and tolerable toxicity in patients with advanced gastric carcinoma. High response rates have been reported in patients with
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Uterine Sarcomas: The Latest Approaches for These Rare but Potentially Deadly TumorsIn this review we discuss preoperative diagnosis and the role of pathology, and we summarize the current literature regarding the management of uterine sarcomas.
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Psychological Outcomes Associated With Anemia-Related Fatigue in Cancer PatientsThis article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors.
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UFT and Its Metabolites Inhibit Cancer-Induced Angiogenesis via a VEGF - Related PathwayTreatment with UFT for spontaneous lung metastasis of murine renal carcinoma (RENCA) after resection of the primary tumor has resulted in significant prolongation of the life span of tumor-bearing animals. UFT inhibited the growth of metastatic nodules in the lung, apparently via decreased density of microvessels in the metastatic foci. Subsequent experiments used dorsal air sac assay to directly trace newly forming microvessels.
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Early Engagement in Physical Activity and Exercise Is Key in Managing Cancer CachexiaDespite consensus on the diagnosis and staging of cancer anorexia/cachexia syndrome, there is currently no accepted standard of care, and affected patients remain widely undertreated.
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UFT/Leucovorin Plus Weekly Paclitaxel in the Treatment of Solid TumorsThe palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) derivative combined with oral leucovorin plus weekly intravenous paclitaxel.
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Hodgkin LymphomaThis management guide covers the risk factors, screening, diagnosis, staging, and treatment of Hodgkin lymphoma.
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Nursing Challenges of Caring for Patients with HIV-Related MalignanciesMoran provides a comprehensive overview of the myriad nursing challenges posed by patients who have a dual diagnosis of HIV disease and cancer. At least two factors make it imperative for nurses to become increasingly proficient in the care of patients with HIV-related malignancies. First, it is now estimated that 1 in every 250 people in this country is infected with HIV, with the largest increases occurring in heterosexual men and women.[1] Second, patients with HIV disease are being seen in virtually all health-care settings, and many dedicated oncology and HIV/AIDS services are now being mainstreamed into general medical services. Thus, nurses who may have had little experience with this patient population in the past are now much more likely to encounter these patients.
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Development and Characterization of Darbepoetin AlfaStudies on human erythropoietin (EPO) demonstrated that there is a direct relationship between the sialic acid-containing carbohydrate content of the molecule and its serum half-life and in vivo biological activity, but an
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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
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Advantages of Every-3-Week Dosing of Erythropoietic Agents to Manage Chemotherapy-Induced AnemiaPatients receiving chemotherapy for cancer often develop anemia, which can contribute to increased morbidity and reduced quality of life.[1] It is important for clinicians to be aware of current clinical studies in the treatment of chemotherapy-induced anemia. In patients with nonmyeloid malignancies, chemotherapy-induced anemia can be successfully treated using erythropoiesis-stimulating agents (ESAs). The application of these agents has evolved from more frequent to less frequent administration and from weight-based to single, fixed doses. Emerging data show that ESAs can be given safely on the same day as chemotherapy without loss of efficacy,[2] and that these agents may be administered as infrequently as every 3 weeks.[3,4] The every-3-week schedule is convenient and may reduce the burden on patients and their caregivers by reducing the number of visits to the clinic.
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Phase II Study of Docetaxel and Irinotecan in Metastatic or Recurrent Esophageal Cancer: A Preliminary ReportThe outcomes for patients with metastatic or recurrent esophagealcancer are dismal, with 1-year survival rates of approximately 20%. Inthis phase II study, we studied the combination of docetaxel (Taxotere)and irinotecan (CPT-11, Camptosar) in patients with metastatic orrecurrent esophageal cancer. Eligible patients included those withhistologic or cytologic diagnosis of adenocarcinoma or squamouscancer of the esophagus or gastroesophageal junction who had receivedno previous chemotherapy for metastatic esophageal cancer. Previouschemotherapy in the neoadjuvant or adjuvant setting was allowed.Patients received irinotecan at 160 mg/m2 over 90 minutes followed bydocetaxel at 60 mg/m2 intravenously over 1 hour, with chemotherapycycles repeated every 21 days. Patients were reevaluated every twocycles. Of a planned 40 patients, 15 were enrolled, with 14 patientsevaluable for toxicity and 10 evaluable for response and survival. Thecombination of docetaxel and irinotecan resulted in a response rate of30%. An additional 40% achieved stable disease. The median survivalwas 130 days, with three patients still alive at the time of this analysis.The toxicities included 71% incidence of grade 4 hematologic toxicities,with 43% febrile neutropenia. One patient died of cecal perforationafter one cycle. There was no evidence of pharmacokinetic interaction,as systemic clearance of both drugs was similar to that seen after singleagentadministration. In conclusion, the regimen of docetaxel andirinotecan is active in metastatic or recurrent esophageal cancer.However, this combination chemotherapy regimen has an unacceptablerate of febrile neutropenia. This regimen needs to be modified toreduce the incidence of febrile neutropenia.
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Diagnostic Dilemma: DermatologyA 49-year-old Caucasian man presented with progressing erythematous plaques on the face and neck in December 2007. He was treated with topical steroids, presumably for dermatitis, without improvement.
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Putting Lung Cancer Clinical Trials Into PerspectiveGanti and colleagues have provided a comprehensive overview on recent presentations involving lung cancer.
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Pregnancy After Breast Cancer: From Psychosocial Issues Through ConceptionWomen face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following
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Supportive Management of the Patient With Pancreatic Cancer:The oncology nurse attends not only to the physiologic needs of the patient with pancreatic cancer but also to the educational, economic, logistic, and psychosocial factors that impact on quality of care. Managing patient care
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Commentary (Lohr): Diagnosis of Venous Thromboembolic Disease in Cancer PatientsThis article nicely describes concernsabout the underdiagnosisof deep vein thrombosis(DVT) and superficial vein thrombosisin patients with malignancy. Theincidence of these conditions in thissetting has been demonstrated to beas high as 51% in postmortem studies,as opposed to the clinically recognized15% rate. The articlereinforces the need for better diagnostictools than are currently availablein clinical practice. It alsostresses the need for a high clinicalsuspicion. Duplex ultrasound shouldbe used as a first step, and othermodalities listed in the article needto be used when appropriate.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Hypersensitivity Reactions to Oxaliplatin: Incidence and ManagementOxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.
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Coming to Grips With Hand-Foot SyndromeHand-foot syndrome is a localized cutaneous side effect associatedwith the administration of several chemotherapeutic agents, includingthe oral fluoropyrimidine capecitabine (Xeloda). It is never life-threateningbut can develop into a painful and debilitating condition thatinterferes with patients' normal daily activities and quality of life. Severalsymptomatic/prophylactic treatments have been used to alleviatehand-foot syndrome, but as yet there is insufficient prospective clinicalevidence to support their use. The only proven method of managinghand-foot syndrome is treatment modification (interruption and/or dosereduction), and this strategy is recommended for patients receivingcapecitabine. Retrospective analysis of safety data from two largephase III trials investigating capecitabine as first-line therapy in patientswith colorectal cancer confirms that this strategy is effective inthe management of hand-foot syndrome and does not impair the efficacyof capecitabine. This finding is supported by studies evaluatingcapecitabine in metastatic breast cancer. Notably, the incidence andmanagement of hand-foot syndrome are similar when capecitabine isadministered in the metastatic and adjuvant settings, as monotherapy,or in combination with docetaxel (Taxotere). It is important that patientslearn to recognize the symptoms of hand-foot syndrome, so thatprompt symptomatic treatment and treatment modification strategiescan be implemented.
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Evolving Landscape of HR+ Metastatic Breast Cancer ManagementClosing out their review of treatment strategies for HR+ metastatic breast cancer, a panel of experts highlights ongoing investigations and future directions in care.
