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Karen Kelly, MD, Discusses When to Start ImmunotherapyKaren Kelly, MD, sat down to discuss her presentation on when to start immunotherapy in a real world, patient setting.
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Dermatologic Challenges in Cancer Patients and SurvivorsThe increased approval of anticancer agents has led to unprecedented results, with improved quality of life and longer survival times, resulting in millions of individuals living with a diagnosis of cancer. Whereas these novel medical, surgical, and radiation regimens, or combinations thereof, are largely responsible for these remarkable achievements, a new, unexpected constellation of side effects has emerged. Most notably, cutaneous toxicities have gained considerable attention, due to their high frequency and visibility, the relative effectiveness of anti–skin toxicity interventions, and the otherwise decreasing incidence of systemic or hematopoietic adverse events. Optimal care dictates that dermatologic toxicities must be addressed in a timely and effective fashion, in order to minimize associated physical and psychosocial discomfort, and to ensure consistent antineoplastic therapy. Notwithstanding the critical importance of treatment-related toxicities, dermatologic conditions may also precede, coincide, or follow the diagnosis of cancer. This review provides a basis for the understanding of dermatologic events in the oncology setting, in order to promote attentive care to cutaneous health in cancer patients and survivors.
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Problem-Related Distress in Cancer Patients Drives Requests for Help: A Prospective StudyThe Moores UCSD Cancer Center has implemented the use of an innovative instrument for screening cancer patients at first visit to assist them with distress due to cancer-related problems. This 36-question screening instrument addresses physical, practical, social, psychological and spiritual problems. Patients are asked to rate the severity of each problem on a scale of 1 to 5, and to circle "Yes" if they would like staff assistance. Data from a prospective study of the first 2,071 patients to complete this questionnaire has been entered into a database and analyzed to identify common patient problems, demographics, and trends. The five most common causes of problem-related distress were fatigue, sleeping, finances, pain, and controlling my fear and worry about the future. The five most common problems for which patients circled "Yes" to ask for assistance were understanding my treatment options, fatigue, sleeping, pain, and finances. Compared to the entire population, patients who circled "Yes" on a particular problem, demonstrated a robust increase in problem-related distress.
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Management of a Superior Sulcus (Pancoast) TumorThe patient is a 74-year-old gentleman who presented with a visual disturbance and right shoulder pain. On routine chest x-ray, he was found to have a right apical lung mass.
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Precision Medicine in NSCLC The Power of Molecular TestingPersonalized therapy for non–small cell lung cancer has evolved significantly with the advent of comprehensive molecular testing.
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The Recklitis et al Article ReviewedThe psychological challenges of cancer can become more evident when treatment is complete. The focus on survival and acute symptom management fades and is supplanted by a re-focus on living with the after-effects of diagnosis and treatment. As well described by Drs. Recklitis, Varela and Bober, worry, anxiety, depression, fatigue, and sexual difficulties are some of the most common and yet sometimes intangible issues faced by survivors.
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Counseling Women at High Risk of Ovarian or Endometrial CancerPatient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.
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Preserving Fertility inYoung Women DiagnosedWith Breast CancerIn the US, breast cancer is the most common invasive cancer in women, with more than 200,000 diagnosed with the disease each year.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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The Use of Serum hCG as a Marker of Tumor Progression and of the Response of Metastatic Urothelial Cancer to Systemic ChemotherapyA 55-year-old woman with a history of metastatic melanoma in remission for 8 years presented to the emergency department with gross hematuria. A CT scan, ordered because the patient was in menopause, demonstrated a bladder tumor.
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Management Strategies in Acute Lymphoblastic LeukemiaThis review will cover the key elements of modern acute lymphoblastic leukemia treatment regimens, focusing primarily on front-line treatment and concluding with a brief discussion of the management of relapsed disease.
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Radiofrequency Ablation in Lung Cancer: Promising Results in Safety and EfficacyOnly about 15% of patients diagnosed with lung carcinoma eachyear are surgical candidates, either due to advanced disease orcomorbidities. The past decade has seen the emergence of minimallyinvasive therapies using thermal energy sources: radiofrequency,cryoablation, focused ultrasound, laser, and microwave; radiofrequencyablation (RFA) is the best developed of these. Radiofrequency ablationis safe and technically highly successful in terms of initial ablation.Long-term local control or complete necrosis rates drop considerablywhen tumors are larger than 3 cm, although repeat ablations can beperformed. Patients with lung metastases tend to fare better with RFlung ablation than those with primary lung carcinoma in terms of localcontrol, but it is unclear if this is related to smaller tumor size at time oftreatment, lesion size uniformity, and sphericity with lung metastases,or to differences in patterns of pathologic spread of disease. The effectsof RFA on quality of life, particularly dyspnea and pain, as well aslong-term outcome studies are generally lacking. Even so, the resultsregarding RF lung ablation are comparable to other therapies currentlyavailable, particularly for the conventionally unresectable or high-risklung cancer population. With refinements in technology, patient selection,clinical applications, and methods of follow-up, RFA will continueto flourish as a potentially viable stand-alone or complementarytherapy for both primary and secondary lung malignancies in standardand high-risk populations.
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Evidence grows for value of high-field MRI in prostate cancer Rx strategyVIENNA-Image-guided intensity-modulated radiotherapy, high-intensity focused ultrasound, and cryotherapy are increasing the curative treatment options for men with prostate cancer. The problem is how to determine which patients are most suitable for these therapies.
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Promoting Smoking Cessation Among Cancer Patients: A Behavioral ModelThe smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its
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Management of DeliriumMs. B is a 44-year-old married African-American female who was diagnosed with locally advanced right breast cancer in 2002. Immunohistochemistry in the original tumor was estrogen- and progesterone-receptor-negative, HER2-positive. Her past medical history is significant for hypertension and miscarriage in 1995.
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New Biomarkers in Prostate CancerIn this article, we review recent advances in the discovery of prostate cancer biomarkers, their integration into clinical practice, and implications for improving clinical management of the disease.
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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Inoperable Pancreatic Cancer: Standard of CareInoperable pancreatic adenocarcinoma is a dilemma that oncologists frequently encounter. Only 15% to 20% of patients are diagnosed when cancer of the pancreas is still surgically resectable. However, pancreaticoduodenectomy is the only curative option for this disease and should be offered to all patients who meet resection criteria and do not have significant comorbidities. For inoperable pancreatic cancer, the goals of treatment are to palliate symptoms and prolong life. Improved survival in locally advanced disease has been demonstrated with chemoradiation plus fluorouracil or with gemcitabine (Gemzar) alone. In metastatic disease, single-agent gemcitabine has been associated with improvement in symptoms and survival. Trials combining various chemotherapeutic agents with gemcitabine have not had a significant impact on overall survival, although meta-analyses suggest a small benefit. The targeted agent erlotinib (Tarceva) has shown a modest improvement in overall survival in combination with gemcitabine. This combination is another option for first-line therapy in patients with locally advanced or metastatic disease. Despite these recent advances, survival for patients with inoperable pancreatic cancer continues to be poor. Future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
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Cancer Metabolism as a Therapeutic Target: Metabolic Synthetic LethalityDrugs targeting different metabolic pathways induced in tumors may be used in combination with one another to induce synthetic lethality in cancer cells, while preserving the survival of normally proliferating cells.
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Autonomy Versus Paternalism in Latin AmericaIn this paper, Dr. Cherny beautifully reviews how to balance the patient's right to be adequately informed about his or her disease with the powerful cultural beliefs held in many parts of the world.
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Use of Bisphosphonates in the Treatment of Prostate CancerRecently, there has been much controversy over whether patients with prostate cancer should be treated with bisphosphonates not only to decrease pain, but to prevent metastasis.
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Breast Cancer During PregnancyThe care of a pregnant breast cancer patient is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. For the woman in this situation, the emotions usually
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Chemotherapy-Induced Nausea and Vomiting: Great Achievements but Room for ImprovementA review of "Chemotherapy-Induced Nausea and Vomiting: Which Antiemetic for Which Therapy?"
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Metastatic Malignant Melanoma From an Unknown Primary Presenting as a Large Axillary MassThe patient is an otherwise healthy male transferred from an outside hospital with a newly diagnosed melanoma from an unknown primary presenting as a large, left axillary mass.
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Hematopoietic Cell Transplantation, Second EditionHematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation.
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Diagnostic Evaluation of Hepatocellular Carcinoma in a Cirrhotic LiverHepatocellular carcinoma (HCC) is one of the world’s most common cancers. It is closely associated with cirrhosis, especially that due to viral hepatitis. The incidences of viral hepatitis and HCC are rising steadily in the United
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The Absent-Minded Professor: An Unusual Complication of MelanomaThe University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist.
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Should We Recommend Screening Mammography for Women Aged 40 to 49?In clinical trials, screening mammography has been shown to reduce mortality from breast cancer by about 25% to 30% among women aged 50 years and older after only 5 to 6 years from the initiation of screening. Among women 40 to 49 years old, the evidence supporting the efficacy of screening mammography is less convincing.
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Integrated PET-CT: Evidence-Based Review of Oncology IndicationsCombined-modality positronemissiontomography (PET)–computed tomography (CT) isbecoming the imaging method ofchoice for an increasing number ofoncology indications. The goal of thispaper is to review the evidence-basedliterature justifying PET-CT fusion.The best evidence comes from prospectivestudies of integrated PETCTscans compared to other methodsof acquiring images, with histopathologicconfirmation of disease presenceor absence. Unfortunately, veryfew studies provide this kind of data.Retrospective studies with similarcomparisons can be used to provideevidence favoring the use of integratedPET-CT scans in specific clinicalsituations. Also, inferential conclusionscan be drawn from studies whereclinical rather than pathologic dataare used to establish disease presenceor absence.
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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.
