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Commentary (Pirl): Psychiatric Assessment and Symptom Management in Elderly Cancer PatientsDrs. Winell and Roth provide agood overview of the commonpsychiatric disorders andcancer-related symptoms in elderly individualswith cancer. Because of thelarge and growing percentage of cancerpatients who are over age 65, theauthors duly highlight the importanceof this topic. The article is highly relevantto the clinical practice of oncologyand detailed information is includedto help guide treatment options formajor depression, anxiety, delirium,and other cancer-related symptoms.
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Radiation Therapy in Resectable/Resected Pancreatic Adenocarcinomas: Clearing Up the FogSurgical resection remains the sole modality that has proven capable of "curing" pancreatic cancer.
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Clinical Hypnosis for the Palliative Care of Cancer PatientsClinical hypnosis has been defined as a mind-body therapy that involves a deeply relaxed state, individualized mental imagery, and therapeutic suggestion.
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Commentary (Palesty et al)-Imatinib Mesylate: A Molecularly Targeted Therapy for Gastrointestinal Stromal TumorsDr. Eisenberg has produced anexcellent, concise, yet comprehensivereview of the evolutionof the KIT inhibitor imatinibmesylate (Gleevec) and the preoperativeand postoperative treatmentdilemmas surrounding mesenchymalgastrointestinal stromal tumors(GISTs), particularly in the face ofadvanced disease and recurrences. Thefocus of the article is on the naturalhistory of GISTs, from a molecularand pathobiologic perspective, toclarify the rationale for the use ofimatinib.
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Management of Infections in Patients With Acute LeukemiaSeveral recent studies have addressed the management of infectious problems in patients with acute leukemia. Although those studies have served to emphasize the fundamental management principles formulated and proven
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Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 2Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a
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Cancer Management Chapter 31: Chronic lymphocytic leukemiaChronic lymphocytic leukemia (CLL) is a clonal malignancy that results from expansion of the mature lymphocyte compartment. This expansion is a consequence of prolonged cell survival, despite a varied cell. The affected lymphocytes are of B-cell lineage in 95% of cases, and the remaining cases involve T lymphocytes, representing a distinct disorder.
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Chemotherapy in Soft-Tissue Sarcoma: Where Do We Go From Here?While the future is bright for the development and investigation of novel chemotherapeutics for treatment of soft-tissue sarcoma, investigators will need to gain better insight into the molecular drivers of pathogenesis, and give continued thoughtful consideration to clinical trial design.
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Ovarian Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Genetic Prostate Cancer Studies Are Needed to Push the Needle ForwardRobust genetic testing guidelines in the prostate cancer space must be supported by strong clinical research before they can be properly implemented, says William J. Catalona, MD.
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Treating Prostate Cancer: Where Do We Draw the Line?While there is no doubt that many indolent prostate cancers have been treated, it is unclear where one should draw the line between indolent and aggressive tumors.
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Physical Function in Men and Women With CancerFatigue is an extraordinarily common consequence of cancer and its treatment. Fatigue can result in diminished cognitive and physical functional capacity and may be the result of multiple causes.
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Novel Neoadjuvant Treatment Strategies for Triple-Negative Breast CancerExperts review the current landscape and potential use of neoadjuvant chemotherapy with additional novel agents for patients with localized TNBC.
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The Key to Improving Survival in Ovarian Cancer: Better Screening of Women With Vague Symptoms, Leading to Earlier Diagnosis, More Effective SurgeryAlthough the combination of CA-125 and HE4 appears indicated for use in symptomatic patients or in patients with an adnexal mass, there is no evidence that it would be indicated as a screening test in asymptomatic patients.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityThe population dynamics of cellular entry, traverse, and exit, through and from each phase of the cell cycle is coordinated throughout the day in the tissue of the human body. This coordination is particularly robust-ie, the daily peaks and valleys are particularly high and low-in tissues with the greatest average daily cellular proliferation. These tissues are also the most severely damaged by cancer treatments, most prominently cytotoxic drugs and ionizing irradiation.
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Successful Treatment of Melanoma Metastatic to the Left Atrium Using External Beam Radiation TherapyThe successful treatment of a patient with primary nasal melanoma metastatic to the lung, pulmonary vein, and left atrium using radiation therapy is described. The patient was effectively treated with a conventional external beam radiation fractionation scheme (rather than a more commonly used hypofractioned regimen) that was utilized to minimize risk of arterial embolus of the tumor or rupture of a vessel wall. A post-treatment CT demonstrated a significant decrease in the caliber of the right pulmonary vein and tumor thrombus. The patient never developed cardiac valvular dysfunction or acute life-threatening massive embolism of tumor from the atrium. Unfortunately, the patient experienced clinical decline secondary to the massive progression of intra-abdominal disease and subsequently died from multiple liver metastases and liver failure. Numerous studies and this case report demonstrate that radiation therapy can be very effective in the treatment of malignant melanoma, especially when only small volumes of disease need to be treated and adequate total doses are used. Therefore, radiation therapy appears to play an important yet underutilized role in the treatment of metastatic melanomas.
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New Insights Into the Cost-Effectiveness of Lung Cancer TreatmentDespite growing evidence that patients with advanced non–small-cell lung cancer have improved survival and better symptom control with modern systemic therapy, there is still resistance to the use of chemotherapy because
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Commentary (Oh/Kantoff): The Role of Cytotoxic Chemotherapy in Prostate CancerIn this review, we describe how clinical investigators addressed some of the challenges in prostate cancer chemotherapy trials 20 years ago, and we indicate what has evolved in the field since that time. We consider the impact that prostate-specific antigen measurement had in this setting, evolving clinical paradigms, multidisciplinary programs, and the current armamentarium of cancer treatment, including targeted molecular therapy, for patients with hormone-refractory disease.
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COUNTERPOINT-Prostate Cancer Genomic Analysis: Routine or Research Only?In this side of the Point/Counterpoint, Drs. Kelly and Knudsen state that limitations exist for guiding therapeutic treatment with genomic testing in prostate cancer patients.
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Performing Economic Evaluations Alongside of Cancer Clinical TrialsHealth care providers and financing organizations have become more aware of the resource constraints on the provision of medical services, thus increasing the importance of economic evaluations within the health care industry.[1,2] This has carried over to the evaluation of new, therapeutic strategies for cancer, which have traditionally been evaluated exclusively for safety and clinical efficacy.
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Breast Cancer in MenIn this issue of ONCOLOGY, Dr.Aman Buzdar provides a timelysynopsis of current perspectiveson breast cancer in men. I would onlyadd or expand upon a few points.
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High-Intensity Focused Ultrasound: A Canadian PerspectiveThe use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
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Managed Care: The View From Salick Managed CareIn the past few years, this country has seen a major change in the financing of health care. According to a recent survey by Foster Higgins, an international employee-benefits consulting agency, at the end of 1994, 63% of all privately insured Americans were enrolled in a managed care plan.
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Proton Therapy for Prostate CancerThis review discusses the rationale, history, and current status of proton therapy for prostate cancer-and controversies regarding it.
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Relevance of pCR in Breast Cancer TrialsAs part of our coverage of the ASCO Breast Cancer Symposium we discuss the clinical meaningfulness of pathologic complete response as a surrogate endpoint in breast cancer clinical trials.
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Expert Consultations in Breast Cancer: Critical Pathways and Clinical Decision MakingThis book is the 17th volume in the Basic and Clinical Oncology series edited by Bruce D. Cheson, MD. Like other volumes in this series, Expert Consultations in Breast Cancer follows a unique format and seeks to integrate advances in the basic understanding of breast cancer with promising new therapies and changing health- care economics. The integration of these different perspectives provides both a conceptual and pragmatic framework for clinical decision-making.
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'Economies of Scale' Yield Multiple Benefits for a Private, Physician-Run Oncology PracticeThe community oncology practice is the nation’s headquarters in the war on cancer. Eighty-five percent of all cancer patients receive their treatment in local community oncology practices.
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HE4-Another Marker for Gynecologic Cancers: Do We Really Need One?The data on HE4 as a prognosticator in both ovarian and endometrial cancer constitute, at most, an interesting observation, but most likely they are simply a reflection of total tumor burden. There are certainly not enough data to justify making major treatment decisions in ovarian or endometrial cancer on the basis of absolute marker levels. Proteomics and genomics seem more likely to make a difference in this area.
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Transplant Registries: Guiding Clinical Decisions and Improving OutcomesAfter nearly 30 years of dedication, the International Bone Marrow Transplant Registry (IBMTR) and the Autologous Blood and Marrow Transplant Registry (ABMTR), by nearly any criterion, can be considered a success. The Registry contains over 120,000 patient records that are an invaluable source of information on both autologous and allogeneic bone marrow transplantations. Through the voluntary efforts of more than 350 institutions, it annually registers over 20% of all transplants occurring in nearly 50 countries and, by some estimates, nearly half of all transplants in North America.
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Cervical CancerThis management guide covers the screening, diagnosis, staging, and treatment of cervical cancers.
