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A 54-Year-Old Woman With Recurrent Headaches and SeizuresThe patient’s medical history is remarkable only for asthma and mild emphysema. The family history included a grandmother with gastric cancer. The patient had been taking estrogen replacement therapy since menopause 3 years earlier, and she was
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Cancer and Work: Protections Under the Americans with Disabilities ActWith about 12 million cancer survivors living in the US,[1] cancer affects millions of working Americans. Improvements in early detection and treatment have resulted in a significant number of newly diagnosed and long-term survivors of working age.
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Hormone Replacement Therapy: Making Informed DecisionsThe controversies regarding the association between hormonal replacement therapy (HRT) and cancers, the questions about HRT use in women with a high risk of breast cancer, and the increasing number of women with breast cancer and menopausal symptoms make HRT a significant cancer issue.
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Local Recurrence After Mastectomy or Breast-Conserving Surgery and RadiationApproximately 10% to 15% of patients with stage I/II invasive breast cancer will develop a clinically isolated local recurrence. The standard management of an ipsilateral breast tumor recurrence following breast-
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Barbara McAneny on How the Repeal of the ACA Without a Replacement Threatens the Health of Patients and the Success of Community PracticesIn this interview we discuss how the ACA, which was passed in 2010, changed the way oncologists treat their patients, and how a repeal of the law would affect patients’ access to care.
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Fluorescence-Guided Breast Cancer Surgery Tool May Be GamechangerPegulicianine-guided breast cancer surgery may allow practices to de-escalate subsequent radiotherapy, says Barbara Smith, MD, PhD.
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Are We Ready to Screen for Inherited Susceptibility to Cancer?Recent dramatic advances in the understanding of inherited susceptibility to several common adult-onset cancers have made possible the identification of individuals who may be at significantly increased risk of developing malignant disease. These advances may translate into some of the first opportunities for cancer prevention.
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Interdisciplinary Breast Cancer Care: Declaring and Improving the StandardThe contemporary management of breast cancer is a complex endeavorthat requires a truly collaborative team approach, characterizedby ongoing communication and active information-sharing amongthe multiple disciplines involved. Programs designed to provide comprehensivebreast cancer management by a team of multidisciplinaryspecialists were introduced in the late 1970s and have been increasingslowly. Patients attending comprehensive breast centers receive carefrom a broad-based multidisciplinary team that most often includessurgeons, radiologists, pathologists, medical oncologists, radiationoncologists, plastic/reconstructive surgeons, primary care physicians,gynecologists, nurses, social workers, patient advocates, and geneticrisk counselors. At the heart of comprehensive, interdisciplinary breastcare is the consensus planning conference that brings together teammembers on a regular basis to discuss individual patient cases and developcomprehensive treatment plans. This interactive and dynamicforum has become integral to the interdisciplinary management of breastdiseases and results in an increased level of communication betweenthe participating health-care professionals and the patients they treat.Several professional organizations, most prominently the AmericanSociety of Breast Disease, promote and support an interdisciplinaryapproach to breast care.
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Speech and Swallowing Rehabilitation for Head and Neck Cancer PatientsHead and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises. [ONCOLOGY 11(5):651-659, 1997]
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New Combinations With Epirubicin in Advanced Breast CancerSeveral trials have shown that anthracyclines and taxanes can be combined to achieve response rates ranging from 70% to 90%, with complete responses ranging from 19% to 41%. In an attempt to increase the activity while
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Hypersensitivity Reactions to Oxaliplatin: Incidence and ManagementThe paper by Gowda et al is anotherwell-done work on allergicreactions in patients treatedwith oxaliplatin (L-OHP, Eloxatin)for advanced colorectal cancer.Oxaliplatin was found to be an activeagent in the treatment of this disease10 years ago,[1] and its role in combinationwith leucovorin and fluorouracil(5-FU) is a cornerstone in thetreatment of advanced colorectalcancer,[2-7] as it will probably alsobecome in the adjuvant setting.[8] Althoughthe drug’s dose-limiting toxicityis a cumulative sensory neuropathy,allergic and idiosyncratic reactions mustalways be considered due to their severityand because they can representan important, irreversible reasonfor treatment discontinuation.
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The State of Prostate MRI in 2013: Into the BreachThe concept of multiparametric MRI comes at an important time in the history of prostate cancer screening. It is a method that provides anatomic information about the location, number, size, and risk of prostate cancers. It permits more accurate targeted biopsies that will improve the quality of tissue obtained, thereby reducing the rate of upstaging associated with random biopsies.
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Screening for Prostate Cancer With PSA Testing: Current Status and Future DirectionsThis article will present a detailed review of the body of evidence regarding the PSA assay, with reflections on the resulting future of prostate cancer screening.
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The Role of Physical Activity in Cancer Prevention, Treatment, Recovery, and SurvivorshipThis article will review these intersections of exercise and oncology, discuss the known mechanisms by which exercise exerts its salutary effects, and touch upon the future directions of exercise research in the oncology setting. Finally, recommendations are provided for clinicians to help patients with and without cancer take advantage of the benefits of physical activity.
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The Breast Cancer WarsUnited States seems to have a predilection for declaring "war" on its internal problems, be they poverty, drugs, or cancer. In the latter part of the past century particularly, military metaphors became part of the vocabulary used by Americans to
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Extra Care Required When Making Opioid ConversionsVIENNA, Austria-Since most palliative care pain patients will require one or more changes in drugs due to inadequate pain relief, “physicians caring for terminally ill patients must be familiar with multiple drugs and routes of delivery,” Eduardo Bruera, MD, chairman of the Pain Department, M.D. Anderson Cancer Center, said at the 9th World Congress on Pain, sponsored by the International Association for the Study of Pain.
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HER2 Targeting in Early Breast Cancer: More Options and More QuestionsTherapies targeting HER2 have revolutionized the treatment of breast cancer. Trastuzumab is the foundation of treatment for women with HER2-positive breast cancer. The challenge ahead is to develop predictors that can identify patients for whom trastuzumab alone will be sufficient.
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Current Clinical Trials of Molecularly Targeted Agents in Children With Cancer, Part 2A number of molecularly targeted agents directed at critical cell survival and cell proliferation pathways have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while simultaneously diminishing acute and long-term toxic effects. Systematic evaluations of targeted agents are essential to achieving continued improvements in outcome for children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these and other agents in pediatric populations.
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An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainMany cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines
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Health Economic Analysis of the Burden of Infusion Reactions on Patients, Caregivers, and ProvidersIn recent years, both the cost and efficiency of medical care have emerged as important considerations and areas of research. These considerations are of particular importance in the outpatient community oncology setting, where the demands for clinical productivity and evidence for quality and effectiveness are increasing amidst an evolving reimbursement system.
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CT Lung Cancer Screening: Public Healthcare Policy and Guidelines CollideThe development of CT lung cancer screening, the publication of results from the NLST in 2011, and the grade-B recommendation for CT lung cancer screening in high-risk smokers by the USPSTF raise a number of interesting national health policy issues.
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Which Non-Hodgkin's Lymphoma Patients Benefit From ABMT?I would like to take issue with Dr. Bruce Cheson's response to a reader's question on the role of high-dose chemotherapy/autologous bone marrow transplantation (ABMT) in patients with non-Hodgkin's lymphoma (Oncology News International, December, 1995, page 25).
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Every-2-Week Darbepoetin Alfa Is Comparable to rHuEPO in Treating Chemotherapy-Induced AnemiaThe safety and efficacy of darbepoetin alfa (Aranesp) at 3.0 µg/kg administered every 2 weeks and recombinant human erythropoietin (rHuEPO) given as 40,000 U weekly or 150 U/kg three times weekly were evaluated by
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Irinotecan/Cisplatin in Advanced, Treated Gastric or Gastroesophageal Junction CarcinomaWe conducted a phase II study to assess the response rate and toxicity profile of the irinotecan (CPT-11, Camptosar) plus cisplatin combination administered weekly to patients with at least one previous chemotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction. Patients with histologic proof of adenocarcinoma of the stomach or gastroesophageal junction with adequate liver, kidney, and bone marrow functions were treated with 50 mg/m² of irinotecan plus 30 mg/m² of cisplatin, both administered intravenously 1 day a week for 4 consecutive weeks, followed by a 2-week recovery period.
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Arkansas Pioneers 'Total Therapy' for Multiple MyelomaLITTLE ROCK, Ark--Little prog-ress has been made during the last 30 years toward improving the prognosis of patients with myeloma. Because of the patients' often brittle condition and advanced age, dose intensity concepts had not been evaluated until the late Tim McElwain from the Royal Marsden Hospital reported responses to high-dose melphalan [Alkeran] at 140 mg/m² in patients with refractory disease or high-risk newly diagnosed patients.
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Commentary (Moore): Are Cancer Patients Subject to Employment Discrimination?Mark Rothstein and colleagues have tackled a difficult and sensitive subject: the existence of, and reasons for, employment discrimination against cancer victims. Employment discrimination in any chronic disease is not uncommon, but may be even more widespread in cancer patients, whose treatment is very lengthy, often physically or mentally debilitating, and usually exceedingly expensive. Because improved therapeutic approaches to the treatment of cancer have led to increased rates of survival, there will be more and more survivors in our society in the future. In pediatric cancer, therapeutic advances continue to increase the survival rate, which now is estimated at about 70% overall [1]. Thus, the potential for increasingly greater numbers of employable cancer survivors is high. And with children, although representing only 1% of all cancers, the actual number of person-years saved will be exceedingly high [1]. Adult cancers are diagnosed at more advanced age and in many cases the patient is near retirement age. Nevertheless, the issue of employability and job discrimination is very important to resolve.
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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When Cancer Pain Breaks Through, What Can You Do?Oncology nurses must play an integral role in improving the treatment of breakthrough pain-one patient, one in-service for colleagues, and one clinical research study at a time.
