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More oncologists in the past few years have opted to consolidate with other practices in their area or sought employment at hospitals. Results from an ongoing survey highlights the ups and down of cancer care, with most professionals reporting they are happy with their chosen specialty.

ASCO recently released updated guidelines on the use of adjuvant endocrine therapy in hormone-receptor-positive breast cancer. While the guidelines focus on all postmenopausal women, those who are age 75 and older require special consideration. Unfortunately, meaningful data to help healthcare providers make treatment decisions for these patients are scarce, according to Peter Ravdin, MD, PhD, an executive committee member and scientific program planning member of SABCS 2010.

The effectiveness of RT in the palliative setting is sometimes overlooked; however, RT can provide excellent palliation for patients whose disease becomes refractory to other modalities.

Despite being heralded as a major public health breakthrough, the HPV vaccine has seen its fair share of controversy. Most recently, 24 U.S. states tried to pass a bill to make the vaccine mandatory for school-age girls. But the bill did not make it past the introductory stages in all but one state for the reasons, both scientific and cultural, that have plagued the HPV vaccine from the start: The vaccine fails to protect against 30% of the strains of HPV that cause cervical cancer; there is not enough known about possible adverse events; vaccination may lull young women into a false sense of security, leading to risky sexual behavior.Legal researchers, led by Dan Kahan, JD, from Yale Law School in New Haven, Conn., conducted a study to assess the factors that influence the perceptions of the risks and benefits of the HPV vaccine among the general public. They surveyed 1,538 U.S. adults and found that two factors influenced how their respondents viewed the HPV vaccination: biased assimilation and cultural credibility. “Biased assimilation refers to the tendency of individuals selectively to credit and dismiss information in a manner that confirms their prior beliefs,” the authors explained. With regard to cultural credibility, “the results of this [study] suggest that polarization grows where culturally diverse subjects see the argument they are disposed to accept being made by the advocate whose values they share, and the argument they are predisposed to reject being made by the advocate whose values they repudiate”( Law Hum Behav online, January 14, 2010).Individuals who have cultural values that favor authority and individualism perceive the vaccine as risky while individuals with cultural values that favor gender equality and pro-community/government involvement in basic healthcare are more likely to see the vaccine as low risk and high benefit.The authors suggested that policymakers avoid creating the impression that a scientific debate trumps cultural standards, and consider cultural norms and biases. 

Though there are no data yet on their efficacy, oleander extracts are promoted to treat cancer, AIDS, and congestive heart failure, and are being investigated in clinical trials.

With the new direction in research and clinical trials, treating patients who most benefit from treatment with minimal toxicity will continue to be the mainstay of personalized cancer therapy.

Bevacizumab has become a standard of care for first line therapy in a subgroup of advanced NSCLC patients. With the advent of other effective therapies in bevacizumab-eligible patients and the ongoing development and testing of biomarkers for cytotoxic agents, it remains to be seen whether continued use of bevacizumab will be justified in the absence of predictive biomarkers.

Despite the fact that bevacizumab and cetuximab are both in an advanced stage of clinical development for use in treatment for unresectable NSCLC (with bevacizumab already licensed for the use in clinical practice), several unanswered questions regarding these drugs remain. A number of ongoing trials have been specifically addressed to answer them, however, the first priority should be to personalize treatment, through clinical or biological markers, in order to better select patients who could benefit from targeted therapy with decreased toxicity.

Moreover, today’s new economic reality has forced policymakers to scrutinize every branch of medicine to cut costs. Not surprisingly, oncology has taken center stage in this debate.

Pathologies such as infections, or even tumors, crop up from time to time in patients examined for entirely unrelated issues. These "incidental findings"can put doctors-and patients-in a tight spot. How do they proceed with the patient, knowing that many of the asymptomatic signs of disease may never lead to clinical problems, or may simply be false positives?

Researchers in the radiation oncology department at UCLA’s Jonsson Comprehensive Cancer Center have received a $14 million grant to develop countermeasures that will help treat damage caused by radiological or nuclear threats such as a dirty bomb attack, with possible applications to radiotherapy-induced damage.

Rosetta Genomics, which has a test to identify tissues of origin for metastatic cancers with an unknown primary, just won back the rights to market its own test in the US. But it's expected to post a loss this year. If it can find missing cancers, why isn't Rosetta rolling in cash?

Dear Colleague: Targeted therapies and personalized medicine have become two major buzzwords in cancer care. But as breast cancer specialists, we have incorporated both into our practice for some time. For instance, tamoxifen is a targeted therapy, although we didn’t necessarily call it by that name. When it comes to personalized medicine, one of our goals has been to find better prognostic and predictive factors: Can we identify which patients will benefit from a specific therapy? Can we pinpoint those patients who can safely avoid chemotherapy? The 2010 San Antonio Breast Cancer Symposium (SABCS) offers all breast cancer specialists the chance to explore the wealth of data that we have amassed over the years. Join Oncology NEWS International for onsite reports from SABCS 2010 as we bring you a bird’s eye view of the research, trials, scientific advances, and controversies that are changing the way breast cancer is managed and treated. Check back here daily during the meeting and watch your inbox for our exciting reports from the SABCS 2010.

ONCOLOGYNURSE EDITIONApril 2011Volume 25 • Number 4Subscribe  |  Publication Services  |   ArchivesONCOLOGY's Nurse Edition publishes articles related to practical management issues in the care of patients with neoplastic disease. Through the Nurse Edition, ONCOLOGY aims to provide readers with useful insights into all aspects of patient management, with an emphasis on information and tools that can be applied to daily practice and patient education.

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A $3 billion cancer research program created by Texas voters in 2007 has set its primary goal as creating a new cancer trials network that will address the shortcomings of existing systems for clinical cancer research.

What should we do to fix this situation?

Vitamin B12 is part of the vitamin B complex and is essential for maintaining nerve function, fatty acid metabolism, and DNA and amino acid synthesis. By lowering homocysteine levels, it may also protect against cardiovascular disease. Vitamin B12 can be obtained through diet (including eggs, dairy products, poultry, meat, and fortified cereals) and in supplement form. Deficiency of B12 can lead to a wide variety of hematologic, neurologic, and psychiatric disorders and may increase the risk of cardiovascular diseases. Clinical evidence to support the role of vitamin B12 in decreasing cancer risk is mixed. Further research is needed.

Despite the fact that elderly patients comprise over 50% of the non-small cell lung cancer (NSCLC) population, our knowledge regarding the efficacy and safety of chemotherapy in this group is suboptimal. The “elderly” (defined as individuals ≥70 years of age) experience physiologically normal aging of their bone marrow and kidneys, which inherently increases toxicity to therapy. Standard practice has often been to discourage the use of combination chemotherapy in these patients; however, general consensus guidelines emphasize that performance status should primarily guide the choice of treatment. Elderly patients with advanced NSCLC treated with platinum doublet therapy demonstrate similar efficacy (but increased toxicity) to their younger counterparts. Patients with metastatic disease in which a targeted and/or biological agent(s) was added to chemotherapy experienced benefits similar to those treated with standard platinum doublets, but with increased morbidity and mortality. In the future, effective testing of molecular targeted therapies will have to include elderly patients among research cohorts or risk excluding a large population of eligible patients. Overall, elderly patients with advanced NSCLC, while experiencing greater toxicity, demonstrate the same response rates and survival benefits as their younger peers.

Calendar age and biological age do not always correspond. Pablo Picasso, source of the quote that begins the title of this commentary, lived a notoriously robust and active life through his later decades, dying in his nineties in the midst of a dinner party. In the oncology community, with the advent of targeted therapeutics and better supportive care, the disparity between the two is likely to be increasingly relevant to both research and practice. In this issue of ONCOLOGY, Chiappori et al review data supporting the idea that even in the context of standard cytotoxic chemotherapy, elderly patients with advanced NSCLC experience similar response rates and similar survival benefits to those seen in younger patients. They note that biases excluding elderly patients from clinical trials result in gaps in our knowledge of how to best treat older patients.

The review by Dr. Chiappori and colleagues in this issue of ONCOLOGY addresses an important challenge relating to the optimal management of elderly patients with lung cancer. The authors provide an excellent overview of the data in patients with various stages of non-small cell lung cancer (NSCLC). They also highlight the limitations of the existing data in the management of elderly NSCLC patients.

Nothing gets biopharma policy watchers more worked up than the possibility that the Centers for Medicare & Medicaid Services (CMS) will second-guess FDA approval decisions. In reality, though, CMS often has no choice but to apply its own interpretation to issues that also fall under the FDA’s jurisdiction-and implementation of the health care reform is bringing more of those cases to the fore.

Kaiser Health asked the question, see P&P contributor’s answer

The Fred Hutchinson Cancer Research Center has signed a formal agreement with China's version of the CDC. One goal is to carry out research on large datasets, with the aim of finding new cancer biomarkers.

This is important, mark your calender! Final Rules webinar on Thursday, December 2, 2010