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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
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Adjuvant Endocrine Therapy for Breast Cancer: Longer Therapy and the Need for Personalized Treatment-Should We Treat Beyond the Data?In the future, we also need to improve our ability to personalize the duration of endocrine therapy, with a goal of optimizing patient selection for extended therapy. Hopefully, clinical-pathologic indices and predictive biomarkers similar to the Oncotype DX 12-gene recurrence score or the PAM50 risk of recurrence score for adjuvant chemotherapy will soon emerge to guide adjuvant endocrine therapy.
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Bone-Targeted Therapy in Early Breast CancerIn this article, we describe the role of bone-targeted therapies, specifically for managing early breast cancer, by reviewing their bone-specific and cancer-specific benefits.
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Commentary (Moryl/Foley)-Opioid Rotation in Cancer Patients: Pros and ConsThe use of sequential therapeutictrials to determine the optimaldrug for a given patienthas become a standard strategy in painmanagement. We appreciate Estfanand colleagues’ thoughtful and practicalreview of the advantages and disadvantagesof opioid rotation in cancerpain management.[1] Their commentson the need for individualization ofopioid dose and ongoing monitoring,opioid choice in renal and liver insufficiency,compliance, and cost reductionare particularly important.
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Prognostic and Predictive Markers for the New ImmunotherapiesCharacterizing tumors by PD-L1 expression, immune infiltration, chemokine signature, and tumor mutational frequency may be a means of creating an integrated model for determining which patients may benefit from which immune-checkpoint inhibitors, either alone or in combination.
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The Neutropenic Diet....Still Ageless?As practicing doctors and a practicing nutritionist in a large pediatric oncology program, we applaud Nicole Fox and Alison Freifeld for questioning the utility of the neutropenic diet.
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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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The Application of Breast MRI in Staging and Screening for Breast CancerContrast-enhanced breast magnetic resonance imaging (MRI) is arelatively new but increasingly used modality for the detection of breastcancer. MRI has demonstrated utility in identifying additional tumorfoci and extent of disease in patients with known breast cancer. This isespecially useful with invasive lobular carcinoma, which is difficult toevaluate on mammography. MRI has been found to identify the primarytumor in 70% to 86% of cases of occult breast cancer. Contrastenhancedbreast MRI has shown some usefulness in the detection ofresidual cancer following surgery but is limited by postoperative changes.In patients who have undergone neoadjuvant chemotherapy, breast MRIis most accurate in those patients in whom there is little or no responseto chemotherapy. The use of contrast-enhanced breast MRI for breastcancer screening is controversial. It has only been used in a few smallstudies of high-risk patients. The limitations of breast MRI includeuptake in benign lesions and normal tissue, sensitivity for ductal carcinomain situ, cost, and availability. This paper will discuss the uses,benefits, and limitations of contrast-enhanced breast MRI in the stagingand screening of breast cancer.
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Meta-analysis: Methods, Strengths, and WeaknessesThe growing quantity of clinical research data has created a need to find ways to effectively provide an overview of information that addresses specific medical questions. Meta-analysis is being used ever more frequently for this purpose. Therefore, it is important to recognize both the strengths and weaknesses of this analytical methodology.
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Roles of Advanced Practice Nurses in OncologyThere is no doubt that managed care is changing health care and the practice environment of all health-care providers. As Baird states, “The economics of health care will probably exert a greater influence on the future practice of nursing than any other single factor.”[1]
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Radiation Dermatitis42-year-old Caucasian female who was in her usual state of health when her first mammogram showed suspicious calcifications and a spiculated mass in the upper outer quadrant of the right breast. An ultrasound-guided biopsy showed an invasive ductal carcinoma. She underwent a lumpectomy, with the excised tumor measuring 1.2 cm. The tumor was estrogen and progesterone positive and HER2/neu negative.
