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Early-Stage Breast Cancer and Adjuvant TherapyCarcinoma of the breast is the most common cancer in women in the United States and is second only to lung cancer as a cause of cancer death in women. The incidence of breast cancer has risen steadily over the past decade, with the most dramatic increase seen in smaller primary breast tumors, partly because widespread use of screening mammography permits earlier detection [1].
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Why Aren’t We Working Together?It’s not an outcome Dr. Harold Freeman, President and Founder, Ralph Lauren Center for Cancer Care and Prevention, or anyone else could have imagined, but since cancer patient navigators were introduced in the 1990s, we’re seeing battles and competition over just about every aspect of it.
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Radiologic Diagnosis of Extrathoracic Metastases to the LungBecause many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that
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Tools for Measuring and Improving the Quality of Oncology Care: The Quality Oncology Practice Initiative (QOPI®) and the QOPI Certification ProgramThe American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI®) is a voluntary program designed to assess and improve processes of care in oncology practices.
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Biphasic Tumors of the Female Genital TractIn this installment of Second Opinion, we are presenting two cases of tumors of the female genital tract, specifically, the ovary and uterus, which contain both epithelial and mesenchymal components and therefore have unique diagnostic and therapeutic implications. The first has an unusually poor prognosis and the second is notoriously difficult to diagnose.
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EGJ and Esophageal Cancers: Choosing Induction Therapy so as to Err on the Side of Overtreatment Rather Than Undertreatment When Staging Is ImperfectUntil anatomic staging and physiologic prediction models improve, induction therapy serves as a useful crutch that can mitigate the weaknesses in both of these important preoperative tasks.
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Geographical Information Systems: Applications and Limitations in Oncology ResearchThis review describes the development and technical capabilities of GIS, potential applications of Geographical Informational Systems in cancer research, and the limitations of such work.
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Neuroblastoma: Biology and TherapyNeuroblastoma is the most common solid extracranial tumor in children. Although the outcome of patients with localized disease has improved substantially, the prognosis for those with advanced disease is still poor, despite multimodality therapeutic efforts of increasing intensity over the last 20 years. Dr. Matthay provides an excellent overview review of the biology and treatment of this devastating but fascinating childhood malignancy.
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Gemcitabine and Irinotecan in Locally Advanced or Metastatic Biliary Cancer: Preliminary ReportChemotherapy has had limited success in biliary tract cancer. Of thenewer agents, gemcitabine (Gemzar) and irinotecan (CPT-11, Camptosar)both have single-agent activity in patients with advanced disease.We conducted a phase II trial to study the efficacy and toxicity of thecombination of gemcitabine plus irinotecan in patients with locallyadvanced or metastatic biliary tract cancer. The study has enrolled 14patients with histologically or cytologically documented cancer of thebiliary tract or gallbladder with bidimensionally measurable disease,Eastern Cooperative Oncology Group performance status 0 or 1,decompressed biliary tree, and no prior exposure to chemotherapy.Gemcitabine at 1,000 mg/m2 and irinotecan at 100 mg/m2 were bothadministered on days 1 and 8, every 21 days. In patients who had lessthan grade 3 hematologic and less than grade 2 nonhematologic toxicityfollowing cycle 1, the dose of irinotecan was increased to 115 mg/m2 forsubsequent cycles. A total of 65 cycles of chemotherapy have beenadministered, with an average of 4.5 cycles per patient (range: 1 to 11cycles). The median treatment duration was 3 months (range: 0.75 to 8months). An objective partial response was determined radiographicallyin two patients (14%) while stable disease for periods ranging from 4to 11.5 months was noted in six patients (43%). Toxicity consisted ofgrade 3/4 neutropenia in seven patients (50%) with no episodes offebrile neutropenia, grade 3/4 thrombocytopenia in four (28%), grade3 diarrhea in two (14%), and grade 3 nausea in one patient. Thecombination of gemcitabine plus irinotecan appears to possess modestclinical activity, and it is well tolerated in patients with advanced biliarycancer. Patient accrual is ongoing to this study.
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Allogeneic Marrow TransplantationAllogeneic marrow transplantation is used to reconstitute hematopoiesis in patients who have received myeloablative therapy for a hematologic malignancy or in patients with irreversible marrow failure, to reconstitute the immune system in patients with severe immunodeficiency, and to normalize metabolism in patients with select inherited metabolic deficiency disorders.
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Treatment of Stage I-III Non-Small-Cell Lung Cancer in the ElderlyElderly patients with stage I-III non-small-cell lung cancer (NSCLC) constitute a peculiar patient population and need specific therapeutic approaches. Limited resections are an attractive alternative for elderly patients with resectable NSCLC because of the potential reduction in postoperative complications. Curative radiation therapy is an acceptable alternative for elderly patients who are unfit for or refuse surgery. Hypofractionated stereotactic body radiation therapy is of particular interest for this population because of its favorable tolerance.
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Management of Breakthrough Pain Due to CancerThe most frequent pattern of pain related to cancer and cancer treatment consists of continuous pain punctuated by episodes of worsening pain. The cancer pain guidelines developed by the Agency for Health Care Policy and Research (AHCPR)
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Treatment Options for Patients With High-Risk NDMMConcluding their discussion on newly diagnosed multiple myeloma, expert panelists consider treatment options for patients with high-risk disease.
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Curbing Potential Radiation-Induced Cancer Risks in Oncologic Imaging: Perspectives From the ‘Image Gently’ and ‘Image Wisely’ CampaignsThe purpose of this review is to provide the oncology community with knowledge about the doses used in medical imaging, radiation-induced cancer risks from imaging, and considerations to keep in mind when balancing imaging benefits and risks in pediatric and adult oncologic settings.
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ACR Appropriateness Criteria® Resectable Stomach CancerFor resectable gastric cancer, perioperative chemotherapy or adjuvant chemoradiation with chemotherapy are standards of care. The decision making for adjuvant therapeutic management can depend on the stage of the cancer, lymph node positivity, and extent of surgical resection.
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The Safety of Paclitaxel/Platinum CombinationsThe effectiveness of paclitaxel (Taxol) in a range of tumors has been established in a large number of trials. In non–small-cell lung cancer, paclitaxel combined with cisplatin (Platinol) has been shown to be highly effective.
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Paclitaxel/Carboplatin vs Paclitaxel/Gemcitabine in Advanced Non–Small-Cell Lung CancerThe Hellenic Cooperative Oncology Group conducted a randomized phase III trial to compare paclitaxel (Taxol) 200 mg/m² IV 3-hour infusion on day 1 plus carboplatin (Paraplatin) at an area under the curve (AUC) of 6 (group
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Pathogenesis of AIDS-Related Kaposi's SarcomaEmmanoulides, Miles, and Mitsuyasu have written an excellent review summarizing our current understanding of the pathogenesis of AIDS-related Kaposi's sarcoma (AIDS/KS). The authors cover what is currently well established and also provide their viewpoint on future developments in AIDS/KS. My commentary will highlight some of the major questions related to this complex disease.
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Attacking a Moving Target: Understanding Resistance and Managing Progression in EGFR-Positive Lung Cancer Patients Treated With Tyrosine Kinase InhibitorsIn this article, we review the available literature addressing the competing treatment strategies in EGFR-Positive Lung Cancer and attempt to clarify best treatment practices, including the emerging role of T790M-directed therapies.
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Differentiated Thyroid Carcinoma: Risk Group Assignment and Management ControversiesIn this review, we provide a framework for clinical decision-making in the treatment of differentiated thyroid cancer. The clinical discussion and treatment recommendations are relevant to an adult population (more than 16
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Meta-analysis: Methods, Strengths, and WeaknessesMeta-analysis is a systematic, quantitative approach to the combination of data from several clinical trials that address the same question. This analytic approach can help resolve questions that remain unclear from the results
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Splenic Marginal Zone Lymphoma: Current Knowledge and Future DirectionsIn this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.
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Combination Therapies for Lung CancerAs part of our coverage of the AACR Annual Meeting, we discuss combination therapies and new research in the treatment of lung cancer.
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Triple- vs Double-Agent Chemotherapy for Advanced Non–Small-Cell Lung CancerIn our previous phase I/II studies, both the cisplatin (Platinol), gemcitabine (Gemzar), and vinorelbine (Navelbine) (PGV), and cisplatin, gemcitabine, and paclitaxel (Taxol) (PGT) regimens produced a median survival of
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Cancer Treatment and Cognitive Function: Chemotherapy Is Not the Only CulpritWith the growing number of cancer survivors, there is increased interest in understanding and preventing post-treatment sequelae that may limit full recovery to prediagnosis health.
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Role of Iron in Optimizing Responses of Anemic Cancer Patients to ErythropoietinMany patients with widespread cancer develop a hypoproliferative anemia,[1-3] which is often worsened by systemic cytotoxic chemotherapy. Some chemotherapeutic agents directly depress the capacity of bone marrow cells to proliferate,
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Cancer Vaccines: A New Frontier in Prevention and TreatmentVaccines have been exceptionally effective against diseases such as smallpox, measles, chickenpox, and polio. They are among the safest and most cost-effective agents for disease prevention. In recent years, vaccination has been considered for other diseases, including AIDS and cancer. Cancer vaccines can be categorized as preventive or therapeutic. Preventive vaccines, which are commercially available for cervical cancer and liver cancer, block infection with the causative agents of human papillomavirus and hepatitis B virus, respectively. The benefit of cancer treatment vaccines lies in their ability to "boost" the immune system response to cancer cells, which is generally low. Using vaccines in the treatment of cancer is relatively new, however, and chiefly experimental. Therapeutic vaccines for breast, lung, colon, skin, renal, prostate, and other cancers are now being investigated in clinical trials. Oncology nurses may play a significant role in reducing barriers to uptake of preventive vaccines among the general public and in increasing patients' acceptance of therapeutic cancer vaccines.
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Neoadjuvant Therapy As a Platform for Drug Development: Current Controversies and Regulatory PerspectivesThis commentary addresses our perspectives from a regulatory standpoint, as well as some controversies related to the use of neoadjuvant therapy as a platform for drug development.
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Communicating With Oncology Patients About Palliative CarePalliative care differs from other oncology care settings because it involves end-of-life discussions. This article is intended to help oncology nurses who deliver news that involves palliative care by describing components of breaking bad news, providing an example for how to break bad news, and suggesting methods for evaluating a nurse-patient interaction. One possible scenario for achieving a positive outcome after delivering unwelcome information will also be described. Applying the methods described in this article can help to promote a positive outcome when a nurse delivers bad news to a patient.
