Authors
Latest:
Current Management of Depression in Cancer PatientsDepression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be
Latest:
Commentary (Carr/Goudas): An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainTo assist in converting patients from one opioid agent to another in their daily practice, many oncologists carry pocket dosage conversion guides based on package inserts approved by the US Food and Drug Administration (FDA). One such guide issued by the manufacturer of transdermal fentanyl (Duragesic), reproduced in Table 3 of the expert consensus article written by Breitbart et al, presents the equivalent of 25 µg/h of transdermal fentanyl as 45 to 134 mg/d of oral morphine. In another guide, distributed by one of the manufacturers of controlled-release morphine, the 25 µg/h strength of transdermal fentanyl is said to be equianalgesic to 15 mg of controlled-release morphine administered every 12 hours (and both are deemed equivalent to 10 mg of controlled-release oxycodone every 12 hours). Faced with such a wide range of conversion factors, it is of little surprise-as Breitbart et al point out-that clinicians often fail to achieve equianalgesia when converting patients from one opioid to another.
Latest:
DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosispplication of the techniques of flow cytometry and image analysis to quantitation of DNA and estimation of events in the cell cycle in human tumors has achieved considerable popularity as a laboratory procedure but so far has failed to be of practical clinical value. As brilliantly summarized by Dr. Ross, retrospective studies have repeatedly shown abnormal DNA values to be of prognostic significance in several organ systems, among them, tumors of the urothelium [1] and prostate [2] and, perhaps to a lesser extent, mammary carcinomas [3].
Latest:
Immune Checkpoint Inhibition in Lung Cancer: The Good, the Bad, and the UglyImmune checkpoint inhibitors are a reality for the treatment of patients with NSCLC, and if approved for SCLC, would be a treatment breakthrough we have not seen for decades.
Latest:
Strategies for Communicating Treatment Risks and Uncertainty of OutcomesIn this video, Professor Dame Lesley Fallowfield explains why oncologists need to be aware of their own tolerance of uncertainty before discussing possible treatment risks and outcomes with patients.
Latest:
Anastrozole: A New Selective Nonsteroidal Aromatase InhibitorAromatase (estrogen synthetase) is the enzyme complex responsible for the final step in estrogen synthesis-the conversion of androstenedione and testosterone to estrone and estradiol, respectively. Inhibitors of this enzyme
Latest:
Cytoreductive Surgery for Advanced Ovarian Cancer: Quo Vadis?This article focuses on the recent debate regarding when-or whether-patients with ovarian cancer should undergo aggressive surgical resection.
Latest:
Commentary (Kosecoff/Michelson): Current Status of Practice Guidelines in OncologyIt is somewhat bittersweet that an article about the need for cancer guidelines is being written in 1995. On the one hand, it is heartening that Dr. Winn has patiently organized a coherent framework for creating and implementing guidelines. On the other hand, it is quite bitter medicine to realize, as Dr. Winn points out, that even today, "follow-up studies.... have not been able to
Latest:
Hepatic Colorectal Metastasis: Current Status of Surgical TherapyMetastatic colorectal cancer to the liver develops in over 50,000 US patients each year and is rapidly fatal if untreated. Even the most active chemotherapeutic agents rarely prolong survival for more than 3 years. Liver
Latest:
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.
Latest:
Ductal Lavage: What We Know and What We Don’tDr. Newman has written a comprehensiveand judicious reviewon the highly topical subjectof ductal lavage, and is to becongratulated. We would like to giveparticular emphasis to several of theissues she raises.
Latest:
Outwitting the Blood-Brain BarrierThe blood-brain barrier and the blood-cerebrospinal fluid barrier are major physical impediments to therapeutics targeting central nervous system neoplasms. We review this topic from the perspective of a group whose focus is on the neurovascular unit.
Latest:
Myeloproliferative Neoplasms: Translating New Discoveries Into Better Outcomes, Better Quality of LifeIn this review, we demonstrate the evolving landscape of clinical investigation as researchers and clinicians attempt to address the important therapeutic needs of patients with myeloproliferative neoplasms.
Latest:
Carboplatin/Paclitaxel Induction in Ovarian Cancer: The Finer PointsThe regimen consisting of carboplatin and paclitaxel represents the backbone of ovarian cancer treatment. Here, we reflect on our experience administering the carboplatin/paclitaxel regimen to scores of ovarian cancer patients over the past decade and a half.
Latest:
Cervical Cancer: Issues of Sexuality and FertilityCarter et al provide a nice summaryof current knowledge ofsexual dysfunction in and rehabilitationof women with invasivecervical cancer. The prevailing perspectiveof their review, however,seems to be that most women treatedfor cervical cancer are white, middleclasspatients at major cancer centers.In order to make a difference in thequality of life of the majority of cervicalcancer survivors, we have to understandwho they are and recognizethe impact of social and gender inequalityon their lives and relationships.
Latest:
Renal Cancer Management in a Patient With Chronic Kidney DiseaseA 69-year-old man presented in the urology clinic for evaluation of bilateral renal masses, discovered incidentally during routine exams for follow-up of his chronic kidney disease.
Latest:
Clinical Management of EGFRI-Associated Dermatologic Toxicities: Pharmacy PerspectiveThis article describes agents used to treat the dermatologic toxicities commonly seen during therapy with epidermal growth factor receptor inhibitors. Therapeutic options include topical emollients, antibiotics, corticosteroids, and other agents for supportive care. While medical approaches to these adverse reactions are still in a "learning phase," continued experience will provide further insight into effective management strategies.
Latest:
Antiestrogen Therapy: Uncertainties and Risk AssessmentTamoxifen is by far the most clinically tested antiestrogenic drug currently used as adjuvant therapy for breast cancer and it continues to provide considerable benefit in this setting. The balance from clinical trials indicates a strong association between the use of tamoxifen and an increase in uterine tumors (three to sixfold). In rats, tamoxifen is a mutagenic, genotoxic hepatocarcinogen.
Latest:
Long-Acting Octreotide LAR Depot in the Treatment of Advanced Hepatocellular CarcinomaHepatocellular carcinoma (HCC) is the third most frequent cause of cancer death worldwide, causing 549,000 deaths in 2000-10% of all cancer deaths. There are strong etiologic associations with hepatitis C, hepatitis B, alcohol, other causes of cirrhosis, and dietary aflatoxins. The US incidence of HCC is 2.4/100,000 persons/year and rising due to the increased prevalence of hepatitis C.[1] After the current cohort of patients infected with the chronic hepatitis C virus passes, there will likely be a continued increase in the US incidence of HCC due to increasing rates of obesity-related nonalcoholic steatohepatitis, which causes many cases of "cryptogenic cirrhosis."
Latest:
Aggressive Pituitary TumorsAlthough almost all pituitary tumors are benign adenomas, a surprisingly large number of these tumors invade tissues outside of the pituitary gland. Such invasion, by itself, is not diagnostic of pituitary carcinomas, which are
Latest:
Thyroid and Parathyroid CancersThis management guide of endocrine malignancies covers the risk factors, diagnosis, screening, and treatment of both thyroid and parathyroid cancers.
Latest:
Commentary (Bartella): The Application of Breast MRI in Staging and Screening for Breast CancerDr Gundry comprehensivelydiscusses the role of breastmagnetic resonance imaging(MRI) in staging and screening breastcancer. I will emphasize and expandon some of the author’s key points.
Latest:
Systemic Approaches for Multifocal Bronchioloalveolar Carcinoma: Is There an Appropriate Target?Bronchioloalveolar carcinoma (BAC) is a subset of pulmonary adenocarcinoma characterized by distinct and unique pathological, molecular, radiographic, and clinical features. While the incidence of pure BAC is rare, comprising only 1% to 4% of non–small-cell lung cancer (NSCLC), mixed subtypes (including BAC with focal invasion and adenocarcinoma with BAC features) represent as much as 20% of adenocarcinomas-and that figure may be increasing. Despite the longstanding recognition of this entity, there is no established treatment paradigm for patients with multifocal BAC, resulting in competing approaches and treatment controversies. Current options for multifocal BAC include both surgery and systemic therapies. Unfortunately, prospective data on systemic approaches are limited by study design and small patient numbers; there are only seven phase II studies involving four therapies. This article evaluates key characteristics of BAC, including the current understanding of histopathology and tumor biology. In addition, it comprehensively reviews the systemic phase II studies in an attempt to clarify the therapeutic challenges in this disease. It also includes the first proposed treatment paradigm that integrates both EGFR mutational status and the sub-histologies, mucinous and nonmucinous BAC.
Latest:
Twenty Years of Systemic Therapy for Breast CancerThe past 2 decades of systemic therapy for breast cancer have beena period of monumental change, in terms of both theory and technology.Adjuvant therapy developed from two strands of research-one insystemic chemotherapy and one in hormonal therapy-both of whichwere aided by the application of higher statistical methodology to clinicaltrials. The agent with the single greatest public health impact inoncology has been tamoxifen, but problems with tamoxifen therapy ledto the development of the aromatase inhibitors, and further researchled to the use of hormonal therapy in a chemopreventive capacity. Theevolution of systemic chemotherapy for breast cancer has been an interplaybetween theory-driven approaches and new agents. By the late1980s, accumulating data revealed that overexpression of HER2 (erbB2)played an important role in a substantial portion of breast cancers,which prompted the development of trastuzumab (Herceptin), an agenttargeting HER2-positive disease. Determining HER2 status proved essentialto assessing patient eligibility for trastuzumab therapy. Decodingof the human genome and application of bioinformatics furtherrevolutionized the possibilities in breast cancer treatment.
Latest:
Where Expert Opinion Meets Public ResistanceThere is concern and growing evidence that the supply of medical oncologists in the United States will be insufficient to meet the needs of future patients. With an aging population and increasing complexity of cancer therapies, it is clear there will be more patients and that they will live longer and require expert care. It is equally clear that the number of specialists trained in cancer medicine is not growing fast enough to meet projected needs, so new models of care will need to be designed and implemented. Innovation in practice models will require the integration of non-physician practitioners (nurse practitioners and physician assistants) into multidisciplinary teams, broader use of technology to allow virtual consultations and the secure exchange of vital health information, increased utilization of community services, and public acceptance.
Latest:
Data confirm feasibility of conducting studies in rare tumorsThere is strong rationale for both the octreotide LAR and everolimus studies in NET”, said Dr. Siu, associate professor of medicine at the University of Toronto and Princess Margaret Hospital. “And I applaud both sets of authors for conducting trials in rare tumors.”
Latest:
Fluid ComplicationsMalignant pleural effusion complicates the care of approximately 150,000 people in the United States each year.
Latest:
Physical Late Effects in Adult Cancer SurvivorsToday there are nearly 12 million individuals living in the United States who have ever received a diagnosis of cancer.[1] This number is growing, having just been recently updated to approximately 11.9 million from a previous estimate of about 10.8 million cancer survivors.[2] One half of all men and one in three women will be diagnosed with cancer in their lifetime, with the largest burden being during later life; one in seven Americans 65 years of age and older has a past or present cancer diagnosis.[3]
Latest:
Early-Stage BRCA2-Linked Breast Cancer Diagnosed in the First Trimester of Pregnancy Associated With a Hypercoagulable StateThis feature examines the case of a patient with newly diagnosed breast cancer in the setting of a first-trimester pregnancy presenting to our multidisciplinary breast cancer clinic.
Latest:
Implementing EHRs in Community Oncology PracticesTo provide quality healthcare, communication is vital. Using an EHR, physicians can more easily communicate regarding current and past medical conditions with other providers in their practice, with referring or co-managing physicians, and with patients themselves.
