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Should We Recommend Screening Mammography for Women Aged 40 to 49?In clinical trials, screening mammography has been shown to reduce mortality from breast cancer by about 25% to 30% among women aged 50 years and older after only 5 to 6 years from the initiation of screening. Among women 40 to 49 years old, the evidence supporting the efficacy of screening mammography is less convincing.
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Integrated PET-CT: Evidence-Based Review of Oncology IndicationsCombined-modality positronemissiontomography (PET)–computed tomography (CT) isbecoming the imaging method ofchoice for an increasing number ofoncology indications. The goal of thispaper is to review the evidence-basedliterature justifying PET-CT fusion.The best evidence comes from prospectivestudies of integrated PETCTscans compared to other methodsof acquiring images, with histopathologicconfirmation of disease presenceor absence. Unfortunately, veryfew studies provide this kind of data.Retrospective studies with similarcomparisons can be used to provideevidence favoring the use of integratedPET-CT scans in specific clinicalsituations. Also, inferential conclusionscan be drawn from studies whereclinical rather than pathologic dataare used to establish disease presenceor absence.
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Commentary (Ghosh et al): Advising Women at High Risk of Breast CancerDr. Wood has provided an excellentreview of the issuesfacing women at high risk fordeveloping breast cancer. In additionto emphasizing the significance of accuraterisk assessment, he describessurveillance techniques that enableearly detection of the disease and hasprovided a comprehensive review ofrisk-reduction options for women athigh risk.
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Developing Systemic Therapy for Esophagogastric CancerCancer Network spoke with Dr. Karyn Goodman about the importance of developing a systematic therapy regimen for the treatment of esophagogastric cancer.
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Genetic Testing in Gastrointestinal Cancers: A Case-Based ApproachIn this article, we use a case-based approach to focus on the hereditary aspects of the most common GI cancers, including pancreatic, gastric, and colon cancer.
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Romiplostim for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn August 22, 2008, the US Food and Drug Administration (FDA) granted marketing approval (licensure) to romiplostim (Nplate, Amgen Inc) for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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Management of Infections in Patients With Acute LeukemiaImprovements in outcome following treatment for acute leukemia have derived from various sources: the introduction of new chemotherapeutic agents; the development of effective drug combinations; the use of multistage approaches to induction consolidation, and maintenance therapy to optimize durable control; and advances in supportive care to reduce treatment-related mortality. Certainly, infectious morbidity and mortality have plagued effective antileukemic therapy for many years. As a result, control of infectious complications has been an important area of clinical study. Through the concerted efforts of many clinical investigators, progress has occurred, and, today, infectious mortality is an infrequent complication of antileukemic therapy.
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Venous Thromboembolism in a Gynecologic Cancer PatientMrs. S. is a 37-year-old Caucasian female who sought care at her home institution overseas during a period of several months for complaints of esophageal reflux, constipation, early satiety, increasing abdominal girth, and fatigue.
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Role of Laparoscopic Techniques in Colorectal Cancer SurgeryLaparoscopic intestinal resection is a relatively new application of endoscopic technology that has evolved as a direct result of the successes and benefits seen with laparoscopic gallbladder surgery. Currently acceptable and
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Diagnostic Use of Radiolabeled Antibodies for CancerAntibodies against a variety of tumor-associated antigens have been studied, as well as a number of modifications to the antibodies themselves, including Fab' fragments and chimeric, humanized, and human
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Role of the Genetic Counselor in Familial CancerThe authors offer a comprehensive overview of familial cancer risk counseling, providing both a general definition of this new genetic counseling specialty and specific components of the counseling process. Genetic counseling is, by and large, a referral service, and this is also true of cancer risk counseling. This places great importance on the health-care provider's ability to recognize families who may be at increased risk for an inherited form of cancer and should be referred for cancer risk counseling. It seems reasonable, therefore, to consider the issues relevant to making such a referral, including information on collecting an initial cancer history, strategies for handling a positive history, and the realities of DNA-based testing.
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A Phase I Study of Paclitaxel, UFT, and LeucovorinThis phase I study examines the dose escalation of UFT given in combination with fixed doses of oral leucovorin and weekly doses of paclitaxel in patients with metastatic solid tumor malignancies (excluding colorectal cancer). There are two main objectives for this study.
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Neuroblastoma: Biology and TherapyNeuroblastoma is the most common extracranial solid tumor of childhood, accounting for 15% of cancer-related deaths. These tumors have a predilection for young children; 60% of cases occur before age 2 years and 97%
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Commentary (Pisters): Adjuvant Chemotherapy for Resected Non–Small-Cell Lung CancerIn this issue of ONCOLOGY, Solomon,Mitchell, and Bunn providean excellent review on adjuvanttherapy for resected non–smallcelllung cancer (NSCLC). Theauthors have thoroughly reviewed therecent literature and highlight severalimportant areas for discussion. Theauthors appropriately frame the importanceof the clinical issue at hand.
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Roles of Advanced Practice Nurses in OncologyManaged care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care’s rapid transformation of specialty practices,
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You Never Forget Your First RadiologistThe radiologist could not have known exactly what was in store for me, but it obviously wasn’t good. Couldn’t he have dredged up even a nanoparticle of empathy
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Biomarkers in Colon Cancer: The Chasm Between Expectations and RealityAt this juncture, various commercially available assays for colon cancer may be of little added value, and accelerated biomarker development with clinical validation is desperately needed.
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Aromatase Inhibitors and Bone LossThe aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.
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Commentary (Look): The Effect of Tamoxifen on the EndometriumIn his excellent review, Dr. Barakat has made many useful observations about the effects of tamoxifen (Nolvadex) on the endometrium. As the potential number of women on tamoxifen increases, several points merit emphasis and dissemination to all gynecologists who may be asked by medical oncologists to render opinions on such patients.
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Caring for the Life You SavedWe may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.
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Integrating Genetics and Genomics Into Oncology NursingGenetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.
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Including Oncology Outcomes of Care in the Computer-Based Patient RecordChanges in the health care system have caused a shift in research to outcomes of care, effectiveness, efficiencies, clinical practice guidelines, and costs. The greater use of computer systems, including decision support systems, quality assurance systems, effectiveness systems, cost containment systems, and networks, will be required to integrate administrative and patient care data for use in determining outcomes and resource management. This article describes developments to look forward to in the decade ahead, including the integration of outcomes data and clinical practice guidelines as content into computer-based patient records; the development of review criteria from clinical practice guidelines to be used in translating guidelines into critical paths; and feedback systems to monitor performance measures and benchmarks of care, and ultimately cost out cancer care. [ONCOLOGY 9(Suppl):161-167, 1995]
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Rationale and Dose-Finding Studies of the Combination of Irinotecan and a Taxane on a Weekly ScheduleCisplatin (Platinol)-based chemotherapy has been the standard systemic therapy for both non-small-cell and small-cell lung cancer for the past 2 decades, though the efficacy and benefit remain modest. Recently, several novel
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Pain Management in Cancer Patients at Risk of Opioid AbuseIn this interview we discuss pain management for cancer patients who are at high risk of opioid abuse.
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Tailoring Treatment for Multiple Myeloma Patients With Relapsed and Refractory DiseaseResponses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
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Subacute Headache in a Patient With Metastatic Gastric CancerA 59-year-old man with metastatic gastric cancer presented to the oncology clinic with a 1-week history of positional headache, nausea, and vomiting. He stated that the headache was located in the frontal region, was 8 on a scale of 10 in intensity.
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Specialty Nutrition: New Approaches and Novel IngredientsSpecialty nutrition for patients with cancer is anexciting area in research. It is well known thatpatients with cancer experience many nutritionalproblems during the course of their disease-in particularanorexia and weight loss.[1,2] Specialty nutritioncan impact nutritional status directly by improvingweight and lean body mass, or indirectly by improvingcommon symptoms often associated with cancerand cancer therapies.
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Recognizing and Managing Side Effects Associated With Novel Targeted Therapies:Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.
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Quality of Life in Myelodysplastic SyndromesWhat is the impact of being diagnosed with myelodysplastic syndromes (MDS)? What are the physical/psychosocial ramifi cations of RBC transfusions to manage the extreme fatigue and weakness that accompany refractory anemia; of parenteral or oral iron chelation therapy for
