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Medicare's 2005 chemotherapy demonstration project cost the Centers for Medicare & Medicaid Services (CMS) about $220 million, with beneficiary liability totaling approximately $55 million.

The Oncologic Drugs Advisory Committee voted 7-to-3 against recommending accelerated approval for Genasense (oblimersen sodium, Genta) to treat relapsed/refractory chronic lymphocytic leukemia (CLL) in combination with fludarabine (Fludara) and cyclophosphamide.

"Declining reimbursement rates are forcing oncologists to manage their practices more efficiently,"

As half of all breast cancers occur in patients beyond the age of 65 and a quarter beyond the age of 75, a significant number of patients with metastatic breast cancer are elderly. New hormonal therapies, such as aromatase inhibitors, appear to have favorably improved the survival of these patients. Side effects such as osteoporosis or cognitive issues appear manageable. Information specific to elderly patients has recently emerged in the field of chemotherapy for metastatic breast cancer. This article reviews data on anthracyclines, taxanes, capecitabine (Xeloda), gemcitabine (Gemzar), trastuzumab (Herceptin), and bevacizumab (Avastin). For most patients in this setting, sequential single-agent chemotherapy appears at this time to be the preferred course of treatment.

As half of all breast cancers occur in patients beyond the age of 65 and a quarter beyond the age of 75, a significant number of patients with metastatic breast cancer are elderly. New hormonal therapies, such as aromatase inhibitors, appear to have favorably improved the survival of these patients. Side effects such as osteoporosis or cognitive issues appear manageable. Information specific to elderly patients has recently emerged in the field of chemotherapy for metastatic breast cancer. This article reviews data on anthracyclines, taxanes, capecitabine (Xeloda), gemcitabine (Gemzar), trastuzumab (Herceptin), and bevacizumab (Avastin). For most patients in this setting, sequential single-agent chemotherapy appears at this time to be the preferred course of treatment.

It is an unusual oncologist in the United States who has not had a patient receive a second opinion at the M. D. Anderson Cancer Center (MDA). Long a respected and well-known force in cancer research and patient care, MDA has exerted significant national and international influence not only with scientific publications but also through its training programs and large clinical operation. This book will add to that influence with concise disease-oriented chapters covering the patient population a medical oncologist will see in practice. The MD Anderson Manual of Medical Oncology is not a small handbook. Rather, it is a hardbound text of more than 1,000 pages authored by nearly 100 MDA clinicians.

In its 2005-2006 annual report, the President's Cancer Panel (PCP) departed from its norm of examining a specific cancer-related issue and instead looked at what has emerged from the recommendations made in its two previous reports.

Optimal mucositis management requires a good assessment tool; an oral care protocol that includes cleaning, flossing, rinsing, and lip care; cryotherapy where appropriate; and pain management

President Bush has appointed John E. Niederhuber, MD, as director of the National Cancer Institute (NCI). He is the Institute's 13th director, succeeding Andrew C. von Eschenbach, MD, who has been nominated as commissioner of the Food and Drug Administration (FDA).

Hana Biosciences has initiated a multicenter phase II clinical trial of Marqibo (vincristine sulfate liposome injection) in patients with relapsed or refractory acute lymphoblastic leukemia (ALL). The study is designed to support a phase III pivotal clinical trial of Marqibo for ALL, the company said in a press release. The primary objective of the phase II open-label study is to assess the efficacy of weekly doses of Marqibo plus pulse dexamethasone as measured by complete response rate. Hana expects to enroll up to 44 patients.

With the lure of large profits, low arrest risk, and relatively light sentences, it is no wonder that criminals are trafficking in counterfeit pharmaceuticals.

Nearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal.

Obesity is a complex, chronic disease that has reached epidemic proportions in the United States. Obesity is now linked with numerous health conditions, including many oncologic diagnoses. Its association with prostate cancer, the most prevalent cancer in men, has also been investigated, with studies suggesting a direct relationship between increasing obesity and prostate cancer mortality. Outcomes data for specific interventions in obese patients with prostate cancer have only recently begun to emerge. Surgery, while feasible even in the very obese, may result in less than optimal cancer control rates. Brachytherapy data are emerging, and are promising. No outcomes data are available for the use of external-beam radiation in obese patients. Long-term data for external-beam radiation, as well as for surgery and brachytherapy, are required to determine the most appropriate treatment for obese patients with prostate cancer. These data, coupled with a more thorough understanding of the biochemical relationship between obesity and prostate cancer, will be necessary to make optimal management decisions for obese patients with prostate cancer in the future.

Obesity is a complex, chronic disease that has reached epidemic proportions in the United States. Obesity is now linked with numerous health conditions, including many oncologic diagnoses. Its association with prostate cancer, the most prevalent cancer in men, has also been investigated, with studies suggesting a direct relationship between increasing obesity and prostate cancer mortality. Outcomes data for specific interventions in obese patients with prostate cancer have only recently begun to emerge. Surgery, while feasible even in the very obese, may result in less than optimal cancer control rates. Brachytherapy data are emerging, and are promising. No outcomes data are available for the use of external-beam radiation in obese patients. Long-term data for external-beam radiation, as well as for surgery and brachytherapy, are required to determine the most appropriate treatment for obese patients with prostate cancer. These data, coupled with a more thorough understanding of the biochemical relationship between obesity and prostate cancer, will be necessary to make optimal management decisions for obese patients with prostate cancer in the future.

The high prevalence of pain in the cancer population underscores why pain management is integral to comprehensive cancer care. How well pain is controlled can have a profound effect on the cancer experience for both patient and family. The goals of pain assessment are to prevent pain if possible, and to identify pain immediately should it occur. This can be facilitated by standardized screening of all cancer patients for pain, on a routine basis, across care settings. A comprehensive assessment of pain follows if a patient reports pain that is not being adequately managed. Oncology nurses play a huge role in pain assessment and management throughout the course of a patient's disease. A basic understanding of the types of pain seen in the cancer population as well as inferred neurophysiologic pain mechanisms and temporal patterns of pain can help focus the pain assessment. This in turn will lead to targeted pain management strategies

Eliminating cancer disparities-not only for racial/minority groups but for all underserved populations-must be a priority for those involved in cancer care. For individual practitioners, the first step in addressing disparities is accomplished through understanding the possibility that disparities exist in varying depth and complexity for each racial or ethnic minority patient.

The FDA has approved Atripla, a fixed-dose combination of three previously approved antiretroviral drugs that is taken once a day in tablet form to treat HIV-1 infection.

More than half of men receiving high-dose-rate brachytherapy for localized prostate cancer report some side effects that in some cases persist for up to 16 years

The combination of lenalidomide (Revlimid) with melphalan and prednisone (R-MP) is highly active and well tolerated in older adults with newly diagnosed multiple myeloma.

Focus groups, mentoring, and expanded recruitment efforts have helped Roswell Park Cancer Institute (RPCI) keep its vacancy rate low in the midst of a nursing shortage

An evaluation of the US Environmental Protection Agency's most recent assessment of dioxin has concluded that EPA understated the uncertainly about the chemical's health risks and may have overstated the risk of human cancer.

In an ideal world, palliative care would be integrated into therapeutic care from the time of cancer diagnosis—not limited to hospice or end-of-life care.

"Tumor flare reaction is a new side effect associated with lenalidomide (Revlimid), an immunomodulatory agent being investigated as a treatment for chronic lymphocytic leukemia [CLL],"

The FDA has granted expanded approval to Enzon's Oncaspar (pegaspargase) as part of multidrug chemotherapy for treating children and adults with newly diagnosed acute lymphoblastic leukemia (ALL

In a hearing convened by House Ways and Means Subcommittee on Health chairwoman Nancy Johnson (R-CT), Congress sought input on the effects of the new average sales price (ASP) payment system for cancer drug reimbursement on the delivery and access of cancer care. American Society of Clinical Oncology (ASCO) interim executive vice president and chief executive officer, Joseph S. Bailes, MD, testified at the hearing.

Merck & Co.'s antiemetic Emend (aprepitant) has been granted expanded approval by the FDA to prevent postoperative nausea and vomiting (PONV). Emend, a substance P/neurokinin 1 (NK-1) receptor antagonist, works through a mechanism distinct from that of the 5-HT3 receptor antagonists. Approval was based on two randomized double-blind studies of 1,658 patients undergoing open abdominal surgery. Emend was previously approved for the prevention of chemotherapy-induced nausea and vomiting.

Bioavailability studies show that oral spray delivery of the antiemetic 5-HT3 antagonist ondansetron is equivalent to oral delivery with ondansetron tablets (Zofran), Wayne Yates, MBA, and Greg Berk, MD, of Hana Biosciences, said at the American Society of Clinical Oncology 42nd Annual Meeting (abstract 8622). Hana Biosciences has submitted a New Drug Application to the FDA for the oral spray (brand name Zensana) for the prevention of nausea and vomiting associated with chemotherapy or radiotherapy, and the prevention of postoperatively induced nausea and vomiting.

Alemtuzumab (Campath) is well tolerated when given as front-line therapy for progressive B-cell chronic lymphocytic leukemia (BCLL) and produces a higher response rate than chlorambucil (Leukeran).

Insufficient time is a major source of stress and burnout in the practice of oncology, but oncologists can use a variety of strategies to increase their efficiency and get more satisfaction from their work and from life

The 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.