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Further Thoughts on Adjuvant Treatment for Older Breast Cancer PatientsThe adjuvant treatment of breast cancer is facing a challenging phase due to the increasing knowledge of breast cancer biology and consequent need to personalize treatments. Medical oncologists are asked to practice evidence-based medicine, but their approach is often based on results of trials conducted in extremely heterogeneous populations.
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Hematopoietic Stem Cell Transplantation for Non-Hodgkin's LymphomaIt has been demonstrated that completemolecular remission in follicularlymphoma is associatedwith an improved outcome. Therefore,the object of modern therapyfor indolent lymphoma should be toachieve this goal.
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Principles of Chemoradiation: Theoretical and Practical ConsiderationsChemotherapy agents known to enhance the effects of radiation in preclinical studies have been used concurrently with radiotherapy in numerous clinical trials with the prospect of further enhancing radiation-induced
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Using Video to Facilitate Shared Decision-Making in Palliative CareIn this interview we discuss the use of video to facilitate shared decision-making in the palliative care setting and improve patient understanding regarding goals of care.
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Managing the Patient With Borderline Resectable Lung CancerDespite recent therapeutic advances, lung cancer continues to be one of the leading causes of cancer-related mortality. Of the various histologic subtypes, non–small-cell lung cancer (NSCLC) is the most common-accounting for approximately 85% of all lung cancers-and will be the focus of this article. In general, the treatment of lung cancer may include surgery, radiation therapy, systemic therapy (eg, chemotherapy with or without targeted therapy), or a combination of the above. Surgery continues to offer the best chance of long-term cure. The initial treatment of stage I and II NSCLC usually entails surgical resection, whereas stage IV disease is primarily treated with systemic agents, in light of the lack of curative potential with surgery and/or radiation therapy alone. It is locally advanced NSCLC, including stage IIIA and IIIB disease, that continues to pose a therapeutic dilemma, given its heterogeneous nature.
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Anti-Angiogenesis Therapy in Ovarian Cancer: Which Patient is It Most Likely to Benefit?This review summarizes the major clinical trials that led to the approval of antiangiogenic drugs for ovarian cancer and gives a brief view into novel combinations of bevacizumab with other targeted therapies in an attempt to enhance the efficacy of bevacizumab.
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Incidence and Management of AIDS-Related LymphomaOver time, the spectrum of the acquired immune deficiency syndrome (AIDS) epidemic has changed, especially with the advent of highly active antiretroviral therapy (HAART). The goal of this article is to delineate changes
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Mantle Cell Lymphoma: Clinicopathologic Features and TreatmentsDrs. Baidas, Cheson, Kauh, and Ozdemirli present a thorough and balanced review of mantle cell lymphoma (MCL) and the various current treatment options. MCL has been recognized as a distinct pathologic entity for over a decade. It represents 6% to 9% of all non- Hodgkin’s lymphoma cases, and the diagnosis is based on a combination of morphologic, immunophenotypic, and cytogenetic criteria as discussed in the article. The hallmark of MCL is t(11;14)(q13;q32), a translocation that juxtaposes the Bcl-1 gene on chromosome 11 and immunoglobulin (Ig)H promoter on chromosome 14, leading to overexpression of cyclin D1. Although it had been considered an indolent lymphoma for many years, MCL has a poor prognosis with short remissions and a median survival of 3 to 4 years.[1,2]
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The Emerging Role of Checkpoint Inhibitor Therapy in Hodgkin LymphomaUltimately, the management goal is not for patients with relapsed/refractory disease to live with chronic Hodgkin lymphoma while receiving immune checkpoint blockade therapy, but rather to cure more patients with first- or second-line therapy.
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Patient-Reported Outcomes of Pain and Related Symptoms in Integrative Oncology Practice and Clinical Research: Evidence and RecommendationsABSTRACT Pain is a primary concern among patients with cancer and cancer survivors. Integrative interventions such as acupuncture, massage, and music therapy are effective nonpharmacologic approaches for cancer pain with low cost and minimal adverse events. Patient-reported outcomes (PROs) that have been validated in many clinical and research settings can be used to evaluate pain intensity, associated symptom burden, and quality of life. Clearly defined, reliable PROs can improve patient satisfaction and symptom control. As integrative oncology continues to evolve and expand, cancer-related pain PROs must be standardized to accurately guide clinicians and researchers. Well-validated pain PROs, such as the Brief Pain Inventory, are among the most commonly used for pain intensity assessment. Multiple symptom assessment tools such as the MD Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Edmonton Symptom Assessment System, and the Patient-Reported Outcomes–Common Terminology Criteria for Adverse Events measurement system can also capture pain-associated symptom burden. Electronic PROs provide flexibility in collecting and analyzing PRO data. Clinical trials using carefully selected PROs and rigorous statistical analysis plans are fundamental to conducting high-quality integrative oncology research and promoting utilization of effective integrative interventions to improve patient outcomes. In this review, we aim to summarize current, validated PROs specific to cancer-related pain to aid integrative oncology clinicians and researchers in patient care and in study design and implementation.
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Neoadjuvant Strategies for Pancreatic CancerWe have made much progress over the past 30 years in the surgical management of pancreatic cancer, and perioperative mortality rates are low in centers with experience in the treatment of this disease. However, surgical resection is clearly limited in achieving local and systemic control of pancreatic cancer, and chemoradiation will likely become a part of any successful pancreatic cancer treatment program.
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Healing Pain-The Innovative Breakthrough Plan to Overcome Your Physical Pain & Emotional SufferingDr. Ann Berger does an excellent job of writing to the chronic pain sufferer in her book Healing Pain. Health-care providers and family caregivers will also find it an excellent resource and can benefit greatly from reading this work. Throughout the book the author maintains a true sense of hope for the individual experiencing significant pain. Her ability to communicate this sense of hope will be rather contagious for the health-care provider who may have become less than enamored with our ability to accomplish pain management in individuals with complex pain syndromes.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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Liposomal Doxorubicin in Combination With Bortezomib for Relapsed or Refractory Multiple MyelomaLiposomal doxorubicin received FDA approval for use in combination with bortezomib in patients with multiple myeloma who have not previously received bortezomib and have received at least one prior therapy.
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Expert Discusses Importance of Fertility Preservation in Breast CancerAnn H. Partridge, MD, MPH, talks about how fertility preservation can positively impact the psychosocial health in patients with breast cancer.
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Thromboembolic Complications of Malignancy: Part 2Thromboembolism affects many patients with solid tumors and clonalhematologic malignancies. Thromboprophylaxis with low-molecularweightheparin (LMWH) is indicated for surgery and other high-risksituations, but not routinely for central venous catheters or nonsurgical,ambulatory management. Thrombotic events require full anticoagulationfor the duration of active disease and/or the prothromboticstimulus. LMWHs are safe and more effective than both unfractionatedheparin for initial therapy and warfarin for secondary prevention. Antiinflammatoryand antiangiogenic properties might account for thisadvantage and for a survival benefit of chronic LMWH in subgroupsof cancer patients. Ongoing studies are characterizing the cost-effectivenessand antitumor mechanisms of LMWHs, the potential utility ofnewer anticoagulants, and the ability of predictive models to identifyhigh-risk candidates for thromboprophylaxis.
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Mammography in One's 40s: Considering the ArgumentsAnn Kelsall is a medical writer who reported on the NIH Consensus Development Panel meeting for Oncology News International. Here she considers, from the woman's perspective, the panel's arguments against mammography screening for women ages 40 to 49.
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Clinical Trials in Ovarian Cancer, Part 2The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.
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Management of Sleep-Wake Disturbances Comorbid With CancerIn both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.
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Trouble Sleeping During Breast Cancer Adjuvant Chemotherapy TreatmentsThe patient, “TB,” is a 44-year-old Caucasian, married woman with three daughters, 21, 18, and 10 years of age.
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Phase I Study of Docetaxel and Concomitant Chest RadiationData from the Radiation Therapy Oncology Groupand Eastern Cooperative Oncology Group indicate that increased survival
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Expert Details ‘Exciting’ Bispecific Combos for LymphomaCombining bispecific antibodies with other agents such as R-CHOP and R-CHP for various subtypes of lymphoma has the potential to produce exciting results, according to an expert from Dana-Farber Cancer Institute.
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What Is the Indication for Sorafenib in Hepatocellular Carcinoma? A Clinical ChallengeIn this review article we will discuss the current data on, and future role of, sorafenib in the treatment of hepatocellular carcinoma beyond Child-Pugh A cirrhosis, in conjunction with local therapy, and in a transplant setting.
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Managing Painful Surface WoundsGina, age 9, and Rosemary, age 66. They had different cancers, but developed similar skin ulcers over their entire bodies. Gina's wounds were open to air for 4 weeks. Her pain was severe. Two weeks after starting wound care, Gina allowed us to take pictures of her wounds. We promised to teach doctors and nurses how to care for her wounds. Unfortunately, Gina died. The pictures were lost. A year later, Rosemary was admitted with a similar skin condition and allowed us to photograph the progression of her wound care. Our promise to Gina is now kept. Here we describe the wound care plan necessary to relieve the pain and discomfort of partial-thickness wounds from dermatological conditions in oncology patients.
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Lower Genital Tract Neoplasia in Women With HIV InfectionAlthough overall death rates from the acquired immune deficiency syndrome (AIDS) are declining rapidly, the incidence of human immunodeficiency virus (HIV) in women continues to climb, and HIV-associated gynecologic disease is also likely toincrease over the next decade. In this paper on lower genital tract neoplasia in women with HIV infection, Abercrombie and Korn review some of the many studies documenting the increased incidence of cervical human papillomavirus (HPV) and HPV-asso-ciated disease in this population. The clinical importance of these studies is underscored by recent data from New York City, where the incidence of invasive cervical cancer increased significantly from 1990 to 1995 in HIV-positive women, compared to the general popu-lation of 25- to 49-year-old women.[1]
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HPV Blood Test Could Predict Prognosis in Head and Neck CancerHead and neck cancer patients who have a human papillomavirus (HPV) infection detectable with a blood-based biomarker have a better prognosis compared with HPV-negative patients.
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Clinical Trials in Breast and Endometrial CancerMany clinical trials in breast and endometrial cancers are underway and recruiting 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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COUNTERPOINT: Primary Debulking Surgery vs Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian CancerIn a Significant Percentage of Patients, Neoadjuvant Therapy Yields Equivalent Survival, With Better Quality of Life and Lower Costs
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Prophylactic Cranial Irradiation in Small-Cell Lung Cancer: Is It Ever Indicated?Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]
