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Chemotherapy-Induced Peripheral NeuropathyChemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related side effect of several widely used drugs. Agents known to cause CIPN include platinum analogs, antitubulins, proteasome inhibitors, immunomodulatory agents, and some of the newer biologics.
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The Role of Intraperitoneal Therapy in Advanced Ovarian CancerIntraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.
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Pediatric Cancers in the New Millennium: Dramatic Progress, New ChallengesOver the past 50 years, great strides have been made in diagnosis, treatment, and survival of childhood cancer. In the 1960s the probability of survival for a child with cancer was less than 25%, whereas today it may exceed 80%. This dramatic change has occurred through significant and steady progress in our understanding of tumor biology, creation of specialized multidisciplinary care teams, incremental improvements in therapy, establishment of specialized centers with research infrastructure to conduct pivotal clinical studies, and the evolution of a cooperative group mechanism for clinical research. Most children with cancer in the United States, Europe, and Japan receive appropriate diagnosis and treatment, although access is limited in developing countries. The price of success, however, is the growing population of survivors who require medical and psychosocial follow-up and treatment for the late effects of therapy. Here we review the progress made in pediatric oncology over the past 3 decades and consider the new challenges that face us today.
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Breast Cancer Screening, Risk, and Options for High-Risk WomenWe speak with two experts to discuss breast cancer risk, genetics, and prevention options available to women at high risk of developing breast and ovarian cancer.
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Hepatic Metastasectomy for Breast Cancer and Melanoma: Trends in Highly Selected PatientsHepatic metastases remain a lethal and recalcitrant problem in the management of malignant disease, and the review by Drs. Zani and Clary of the role of hepatic metastasectomy for patients with stage IV melanoma or breast cancer is timely and welcome.
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Energy TherapiesEnergy therapies consist of interventions that are designed to interact with the biofield of a person. The concept of the biofield is based on the assumption that all living things have a natural flow of energy that is integral to their basic composition.
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Clinical Manual for the Oncology Advanced Practice NurseThis book is intended to serve as a quick reference for advanced practice nurses (APNs) caring for oncology patients, from diagnosis through treatment and rehabilitation. With the advances made over the past several years in prevention, early
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Current Status of Genetic Testing for Colorectal Cancer SusceptibilitySolomon et al have written a valuable primer to guide clinicians in identifying, diagnosing, and treating familial colon cancer syndromes. The authors succinctly describe the essential features of each of the well-defined hereditary colon cancer syndromes, including those associated with colonic adenomas (hereditary nonpolyposis colorectal cancer [HNPCC] and familial adenomatous polyposis [FAP]) and colonic hamartomas (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden syndrome). In addition to the specific features that might trigger recognition of one of these syndromes, we advise health-care providers to consider the possibility of hereditary cancer in cases with the following features:
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Bolstering oncologists’ awareness about cancer, cancer risk in gay communitiesMy organization, the National LGBT Cancer Network, estimates that there are one million lesbian, gay, bisexual, and transgender (LGBT) cancer survivors in the U.S. today. While you may not know it, you likely have LGBT cancer survivors in your community.
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Do Oncogenic Drivers Exist in Squamous Cell Carcinoma of the Lung?The Cancer Genome Atlas provides us with our first thorough insight into the genetic heterogeneity of squamous cell carcinoma of the lung; whether these findings will translate into personalized squamous cell lung cancer therapy is yet to be determined.
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Color Atlas of Clinical Hematology, Third EditionThe third edition of the Color Atlas of Clinical Hematology, authored by Drs. A. Victor Hoffbrand and John E. Pettit, contains 19 chapters covering the entire spectrum of hematology, including normal hematopoiesis, benign and malignant
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Releasing the Brake on the Immune System: The PD-1 Strategy for Hematologic MalignanciesIncorporation of PD-1 blockade into the treatment algorithms for hematologic malignancies is currently being pursued in multiple active clinical trials. Here we review the data on anti–PD-1 monoclonal antibodies to date and discuss ongoing and future clinical trials.
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Bone Complications of Cancer Treatment in the ElderlyOsteopenia and osteoporosis are increasingly common in cancer patients, owing to the aging of the population and to new forms of cancer treatment. Androgen and estrogen deprivation, as well as some forms of cytotoxic chemotherapy, may lead to osteopenia and osteoporosis. Patients at risk for osteoporosis include those treated with aromatase inhibitors and with androgen deprivation for more than 1 year. In addition, all patients 65 years of age and older are at risk of osteoporosis when treated with cytotoxic agents, and so should be screened for bone loss. Several treatments have been effective in the prevention and management of osteoporosis. In patients at risk for this complication, it is recommended to obtain a bone density evaluation and to start appropriate treatment. This may include calcium and vitamin D supplementation for mild forms of osteopenia, and bisphosphonate therapy or denosumab (Prolia) for more advanced osteopenia and osteoporosis.
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Will New Focus on Lenalidomide Risks Reveal More About Its Benefits?There's reason to question whether lenalidomide is the cause of secondary cancers in patients who take it as an adjuvant. But new scrutiny may help to clarify how it acts against the primary.
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Polypharmacy in View of Advances in Cancer TreatmentAdvances in science have prolonged the average life span, and people are living relatively longer than before. Nevertheless, we have much to achieve to prolong the "healthy life span." People in old age suffer from multiple chronic ailments, and many of them succumb to death by heart disease, cancer, or stroke.[1] To survive these diseases, patients continuously depend on concurrent multiple medications-also referred to as polypharmacy-and with that comes the responsibility of appropriate selection, administration, and monitoring of therapeutic modalities.
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Docetaxel in Combination With Flourouracil: Study Design and Preliminary ResultsThe relatively recent introduction of a new class of chemotherapeutic agents--the taxoids--has raised hope of improved survival for patients with advanced or metastatic cancer. Following encouraging preclinical results of taxoid combinations, this phase I, nonrandomized trial was designed to evaluate a 1-hour intravenous infusion of docetaxel (Taxotere) on day 1 combined with fluorouracil (5-FU) as a daily intravenous bolus for 5 consecutive days.
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Cancer Care and Accountable Care Organizations: The Unknown Patient Experience LandscapeACOs can provide the structure, but it’s up to the stakeholders to establish mutually agreeable goals for this new care delivery model. Achieving these goals will require a different set of dialogues and conversations among stakeholders, and patients and their advocates must have seats at the table.
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Endoscopic Ultrasound Fine-Needle Aspiration in the Staging of Non‑Small‑Cell Lung CancerPrecise mediastinal staging of non-small-cell lung cancer is extremely important, as mediastinal lymph node metastases generally indicate unresectable disease. Reliance on computed tomography (CT) and positron-emission tomography (PET) alone to stage and determine resectability is limited by false-positive results. Whenever possible, pathologic confirmation of metastases is desirable. Mediastinoscopy and transbronchial fine-needle aspiration are widely established but imperfect modalities. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) has emerged as a diagnostic and staging tool because of its safety, accuracy, and patient convenience. We reviewed 13 prospective studies evaluating the comparative performance of EUS for staging lung cancer. We conclude that EUS is a valuable staging modality. Further studies of the role of EUS compared to other modalities such as integrated PET/CT and endobronchial ultrasound (EBUS) are forthcoming.
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Commentary (Basen-Engquist/Cohen): Quality of Life in Low-Grade Non-Hodgkin’s LymphomaCancer treatment often has debilitating effects on the patients who receive it. Chemotherapy regimens can produce toxicities, such as gastrointestinal disturbances, hematologic deficiencies, fatigue, and neurotoxicity. Patients typically undergo these chemotherapy regimens to increase their disease-free survival time. Given that these therapies can negatively affect a patient’s quality of life (QOL), treatments need to provide clear curative potential and/or survival benefits to offset detrimental effects on QOL.
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POINT: Can Chemotherapy Be Eliminated in the Treatment of Follicular Lymphoma?Balancing the goal of obtaining a durable remission and that of avoiding a negative impact on quality of life argues against the routine use of chemotherapy in follicular lymphoma.
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Hormone Replacement Therapy: Making Informed DecisionsThe controversies regarding the association between hormonal replacement therapy (HRT) and cancers, the questions about HRT use in women with a high risk of breast cancer, and the increasing number of women with breast cancer and menopausal symptoms make HRT a significant cancer issue.
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In-Transit Melanoma: An Individualized ApproachThe management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior.
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Sexual Function of the Gynecologic Cancer SurvivorCurrent advances in the field of medicine have aided in the early detection and treatment of cancer, leading to an increased rate of survivorship among cancer patients after an initial diagnosis.
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Nonepithelial Malignancies of the BreastDrs. Chugh and Baker's concisereview highlights diseaseentities we hear little of, andmay never see, but of which we mustbe cognizant. The article serves as avaluable reminder that not every breastmass that is palpated or detected byradiologic screening represents eithera carcinoma or benign entity such as afibroadenoma. Although rare, the nonepithelialmalignancies must beconsidered in a complete differentialdiagnosis.
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Evolving Classification and Management of Myelodysplastic SyndromeMost adult patients with hematopoietic failure due to myelodysplastic syndrome (MDS) are treated with supportive care measures, including hematopoietic growth factors (epoetin alfa, darbepoetin alfa, filgrastim, pegfilgrastim, sargramostim), red blood cell or platelet transfusions, and antimicrobial agents. Allogeneic stem cell transplantation can be curative, but only a small subset of patients are eligible for transplantation, and until recently there were few options other than supportive care for transplant-ineligible patients. Since 2004, the US Food and Drug Administration (FDA) has approved three new therapies specifically for the indication of MDS: two DNA methyltransferase inhibitors (azacitidine and decitabine) and an immunomodulatory agent (lenalidomide). Several other drugs are used by clinicians for treatment of patients with MDS, but are not specifically FDA-approved for this indication. With several therapeutic options available, yet none of them effective in the majority of cases, it can be challenging for clinicians to choose the most appropriate treatment for an individual patient. Here we discuss a risk-based management approach to MDS that incorporates recent data regarding these new therapies. While many questions remain about the optimal use of newer agents, the long-standing perception of MDS as a syndrome where therapeutic nihilism is the only realistic approach is slowly beginning to change.
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Accelerated Partial-Breast Irradiation: A Promising Technique Under InvestigationBreast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.
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Stages 0 and I Breast CancerThis management guide covers the diagnosis and treatment of early-stage breast cancers, including lobular carincoma in situ (LCIS), ductal carcinoma in situ (DCIS), and both noninvasive and invasive disease.
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Book Review:Pediatric Hematology, Second EditionThe second edition of Pediatric Hematolgy, edited by the text's original editors, John S. Lilleyman and Ian M. Hann, as well as a new editor, Victor S. Blanchette, completely updates and expands upon the first edition (published in 1992). The new edition grew from 15 to 40 chapters, with contributions by many of the most well-known investigators and clinicians in pediatric hematology in the world. The textbook will especially be of value to practicing clinicians, house staff, and students.
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Granulocytic Sarcoma in an Older Woman: Case Considerations When There Is No Standard TherapyGranulocytic sarcomas have been reported in nearly every part of the body, including the gastrointestinal (GI) and genitourinary (GU) tracts, central nervous system (CNS), and respiratory, lymphatic, and skeletal systems. A few case series have been reported through the years.
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Chemo Brain in Cancer Patients: What Is It and How Can It Be Managed?Many patients complain of "chemo brain," or a drop in cognitive function during or after receiving chemotherapy, but there are strategies to manage chemo brain, as well as research on how chemotherapy affects the brain long-term.
