Authors
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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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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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."
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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
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Thyroid and Parathyroid CancersThis management guide of endocrine malignancies covers the risk factors, diagnosis, screening, and treatment of both thyroid and parathyroid cancers.
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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.
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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.
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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.
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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.
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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.”
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Fluid ComplicationsMalignant pleural effusion complicates the care of approximately 150,000 people in the United States each year.
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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]
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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.
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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.
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UFT/Leucovorin vs 5-FU/Leucovorin in Colon CancerAdjuvant chemotherapy has been shown to alter the natural history of resected colon cancer. Two regimens (fluorouracil [5-FU] plus leucovorin and 5-FU plus levamisole) have been found to prolong disease-free survival and overall survival in affected patients.
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The Challenge of Managing Increasingly Complex Cancer ToxicityTo achieve real precision medicine we need not only the right therapy for each patient’s disease, we need the right toxicity management to improve overall health and quality-of-life outcomes.
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Rehabilitation for the Head and Neck Cancer PatientAs the economics of health care increasingly dictate the parameters of patient care delivery, the role of rehabilitation has taken on new meaning with regard to positive patient outcomes. This is particularly true for the head and neck cancer patient coping with devastating physical and functional changes. With treatment advances leading to increased survival, health-care providers must therefore focus on restoring function and assisting the patient to achieve an acceptable quality of life. For the head and neck cancer patient with multiple rehabilitation needs, this can best be accomplished through a comprehensive, coordinated approach, utilizing interdisciplinary clinical and community resources aimed at facilitating the rehabilitation process and ultimately achieving individualized rehabilitation goals.
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Graft-Versus-Host Disease: A Complex Long-Term Side Effect of Hematopoietic Stem CellConsider the following case study, which illustrates the complex physical and psychosocial care required for the patient developing graft-versus-host disease (GVHD) following an allogeneic hematopoietic stem cell transplantation (HSCT): Mr. SR is a 38-year-old male with a diagnosis of anaplastic large cell non-Hodgkin’s lymphoma (NHL).
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Surgical Management of Stage III (N2) Lung CancerThis video reviews the role of surgery in patients with stage III (N2) non–small-cell lung cancer, highlighting some of the challenges in studying these patients and the need for multidisciplinary patient evaluations.
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Breast Cancer Following Radiation for Hodgkin Lymphoma: Clinical Scenarios and Risk-Reducing StrategiesWe review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma.
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Treatment of Gynecologic Cancers: From Halsted to the 21st CenturyHalsted first proposed the concept of "radical surgery" for cancer in 1882, theorizing that cancer, along with all of its supporting tissues and regional lymph nodes, needs to be removed en bloc for the best chance of cure. Radical mastectomy with en bloc removal of the axillary nodes and pectoral muscles became the standard treatment for breast cancer. En bloc radical vulvectomy with complete superficial and deep inguniofemoral lymph node dissection became the standard of care for vulvar cancer. Subsequently, unilateral or bilateral pelvic node dissection extended the scope of the regional node dissection for vulvar cancer patients with metastases to groin nodes. Unquestionably, this surgically comprehensive technique improved cancer control rates for patients with locally extensive vulvar cancer, compared to results from piecemeal approaches that characterized surgical therapy in prior eras.
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Commentary (Goepfert/Elting/Martin): Inclusion of Comorbidity in a Staging System for Head and Neck CancerDr. Piccirillo presents an interesting concept. Although the knowledge that comorbidity and severity of symptoms have a bearing on the prognosis of a patient with cancer is not new, the attempt to measure this influence and include it into a reproducible staging system is commendable.
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How Can Oncology Healthcare Professionals Make a Difference in Tobacco Control?I would like to suggest three ways that oncology healthcare professionals can make a difference: help patients quit tobacco use, take an increased presence in tobacco control efforts, and embrace tobacco-free environments.
