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Conservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]

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Liposomal doxorubicin received FDA approval for use in combination with bortezomib in patients with multiple myeloma who have not previously received bortezomib and have received at least one prior therapy.

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Ann H. Partridge, MD, MPH, talks about how fertility preservation can positively impact the psychosocial health in patients with breast cancer.

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Thromboembolism affects many patients with solid tumors and clonalhematologic malignancies. Thromboprophylaxis with low-molecularweightheparin (LMWH) is indicated for surgery and other high-risksituations, but not routinely for central venous catheters or nonsurgical,ambulatory management. Thrombotic events require full anticoagulationfor the duration of active disease and/or the prothromboticstimulus. LMWHs are safe and more effective than both unfractionatedheparin for initial therapy and warfarin for secondary prevention. Antiinflammatoryand antiangiogenic properties might account for thisadvantage and for a survival benefit of chronic LMWH in subgroupsof cancer patients. Ongoing studies are characterizing the cost-effectivenessand antitumor mechanisms of LMWHs, the potential utility ofnewer anticoagulants, and the ability of predictive models to identifyhigh-risk candidates for thromboprophylaxis.

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Ann Kelsall is a medical writer who reported on the NIH Consensus Development Panel meeting for Oncology News International. Here she considers, from the woman's perspective, the panel's arguments against mammography screening for women ages 40 to 49.

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The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.

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In both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.

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The patient, “TB,” is a 44-year-old Caucasian, married woman with three daughters, 21, 18, and 10 years of age.

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Data from the Radiation Therapy Oncology Groupand Eastern Cooperative Oncology Group indicate that increased survival

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Combining bispecific antibodies with other agents such as R-CHOP and R-CHP for various subtypes of lymphoma has the potential to produce exciting results, according to an expert from Dana-Farber Cancer Institute.

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In this review article we will discuss the current data on, and future role of, sorafenib in the treatment of hepatocellular carcinoma beyond Child-Pugh A cirrhosis, in conjunction with local therapy, and in a transplant setting.

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Gina, age 9, and Rosemary, age 66. They had different cancers, but developed similar skin ulcers over their entire bodies. Gina's wounds were open to air for 4 weeks. Her pain was severe. Two weeks after starting wound care, Gina allowed us to take pictures of her wounds. We promised to teach doctors and nurses how to care for her wounds. Unfortunately, Gina died. The pictures were lost. A year later, Rosemary was admitted with a similar skin condition and allowed us to photograph the progression of her wound care. Our promise to Gina is now kept. Here we describe the wound care plan necessary to relieve the pain and discomfort of partial-thickness wounds from dermatological conditions in oncology patients.

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Although overall death rates from the acquired immune deficiency syndrome (AIDS) are declining rapidly, the incidence of human immunodeficiency virus (HIV) in women continues to climb, and HIV-associated gynecologic disease is also likely toincrease over the next decade. In this paper on lower genital tract neoplasia in women with HIV infection, Abercrombie and Korn review some of the many studies documenting the increased incidence of cervical human papillomavirus (HPV) and HPV-asso-ciated disease in this population. The clinical importance of these studies is underscored by recent data from New York City, where the incidence of invasive cervical cancer increased significantly from 1990 to 1995 in HIV-positive women, compared to the general popu-lation of 25- to 49-year-old women.[1]

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Head and neck cancer patients who have a human papillomavirus (HPV) infection detectable with a blood-based biomarker have a better prognosis compared with HPV-negative patients.

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Many clinical trials in breast and endometrial cancers are underway and recruiting patients.

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We may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.

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In a Significant Percentage of Patients, Neoadjuvant Therapy Yields Equivalent Survival, With Better Quality of Life and Lower Costs

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Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]

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A pilot phase II study examined the feasibility of 75 mg/m² of docetaxel (Taxotere) in combination with 50 mg/m²of doxorubicin and 500 mg/m² of cyclophosphamide (Cytoxan, Neosar) in the first-line treatment of metastatic breast cancer. This study was designed to evaluate the efficacy and toxicity of the docetaxel/doxorubicin/cyclophosphamide combination both alone and as induction before high-dose chemotherapy, supplemented by autologous peripheral blood stem-cell transplantation.

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This article includes a succinct review of current research into exercise in the cancer setting and a discussion of the American College of Sports Medicine exercise recommendations for cancer survivors. Common acute, long-term, and late effects of cancer and its treatment are also described in the context of ways in which these side effects impact the ability to exercise.

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Numerous trials have shown that the pharmacokinetic interferences of epirubicin (Ellence)/paclitaxel (Taxol) combinations produce less pharmacodynamic effect than doxorubicin/paclitaxel regimens. Paclitaxel is more easily

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Our objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic

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Specialty nutrition for patients with cancer is anexciting area in research. It is well known thatpatients with cancer experience many nutritionalproblems during the course of their disease-in particularanorexia and weight loss.[1,2] Specialty nutritioncan impact nutritional status directly by improvingweight and lean body mass, or indirectly by improvingcommon symptoms often associated with cancerand cancer therapies.

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Anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are members of the third generation of aromatase inhibitors that has now replaced aminoglutethimide (Cytadren), the progestins, and tamoxifen

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In this interview we discuss how obesity can affect cancer treatment, and how healthcare providers can better communicate with overweight patients on issues such as diet and exercise.

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With the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.

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Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.

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The National Cancer Institute's computerized information systems have been designed to help physicians cope with the information explosion by translating the medical literature into usable forms. Systems developed by the

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AZD1775, a small-molecule, WEE1-targeting TKI, significantly shrunk tumors when administered in combination with cisplatin and docetaxel in a phase I trial.