Palliative and Supportive Care

The three words “You’ve got cancer” can change someone’s life. After being diagnosed with cancer, questions arise: Can it be cured? Why me? Am I going to die? Luckily, as advances have been made in the treatment of cancer, the diagnosis of cancer is not necessarily a terminal one. In fact, many cancers, such as breast or colon cancer, when detected early enough, are curable, and treatment advances have resulted in long-term survivorship across many cancers.

Palliative care for patients and their families across the cancer disease trajectory-from diagnosis, through survivorship, to end of life-is essential for quality cancer care.

M.D. Anderson Cancer Center and AstraZeneca will collaborate to help advance the understanding of neuropathic pain caused by cancer chemotherapy.

On January 14, Dr. Judah Folkman, founder of the field of angiogenesis, died unexpectedly at age 74 in Denver, while en route to Vancouver for a lecture. Dr. Folkman was founder and director of the Vascular Biology Program at Children's Hospital, Boston, and professor of pediatric surgery and cell biology at Harvard.

Siemens Medical Solutions announced it has received FDA 510(k) marketing clearance for its ARTISTE Solution, a linear accelerator engineered specifically for Adaptive Radiation Therapy (ART).

Over the past few years, the number of new cancer drugs approved by FDA has been dwindling. Critics generally cite exorbitant costs, lack of accrual to trials, conflicts of interest, and government regulations as the primary reasons for the dearth of new molecular compounds.

Even a small copayment can significantly lower mam-mography rates among women age 65 to 69. Although cost sharing through deductibles and copayments "may result in more prudent use of medical care and avoidance of low-value services," the investigators wrote, it may also reduce the use of appropriate medical care.

Oncology News International has named four deputy editors to its editorial advisory team, Editor-in-Chief Steven Rosen, MD, announced. The new deputy editors represent a spectrum of interests, including genitourinary and breast tumors, surgical oncology, and radiation oncology. Monica Bertagnolli, MD, Derek Raghavan, MD, PhD; Andrew D. Seidman, MD; Joel Tepper, MD, a radiation oncologist and professor at the University of North Carolina School of Medicine. He is a former president and chairman of the board for ASTRO and currently sits on the board of directors for ASCO.

Since the passage of the Medicare Modernization Act of 2003, community cancer centers around the country have been struggling to balance the delivery of optimum care with an ever-tightening reimbursement climate. Cancer Care & Economics (CC&E) talked with the Association of Community Cancer Centers (ACCC) Manager of Provider Economics & Public Policy, Matthew Farber, MA, about the challenges of the upcoming year.

A new formulation of Emend has entered oncology's antiemetic armamentarium. Emend (fosaprepitant dimeglumine, Merck) for Injection received US Food and Drug Administration approval in late January for use in combination with other antiemetic agents for the prevention of acute and delayed nausea and vomiting associated with initial and repeated courses of moderate- or high-emetogenic chemotherapies, including high-dose cisplatin.

If therapeutic agents are documented to be more effective than standard therapies in the advanced breast cancer setting, they will also be effective in the adjuvant setting. This renders randomized phase III adjuvant trials unnecessary in many cases, and means that undue delays in moving new agents up-front are costing lives

Exelixis, Inc. and Bristol-Myers Squibb Company will collaborate to co-develop and co-commercialize Exelixis' compound XL139, a small molecule inhibitor of the hedgehog pathway, in the United States.

Palliative care for patients and their families across the cancer disease trajectory-from diagnosis, through survivorship, to end of life-is essential for quality cancer care. In their excellent article, Ferrell and Virani emphasize the important role of oncology nurses in providing palliative care, and they present the National Consensus Project (NCP) Guidelines[1] and the National Quality Forum (NQF)[2] preferred practices as a roadmap for all oncology nurses to use in their practice.

US Food and Drug Administration (FDA) has accepted Cephalon's supplemental New Drug Application (sNDA) for fentanyl buccal tablets (Fentora) for the management of breakthrough pain in opioid-tolerant patients with chronic pain.

Patients with cancer have significant needs for palliative care, including pain and symptom management and psychosocial and spiritual support. The experience of cancer has an impact on family caregivers as well, and palliative care needs exist from diagnosis through survivorship and end-of-life care. Oncology nurses have opportunities to integrate palliative care into disease-focused care.

Despite the high prevalence of brain metastases in patients with metastatic lung cancer, these patients have been excluded from enrollment in clinical trials of new therapeutic drugs. The reasons for exclusion have centered on concerns that the blood-brain barrier may impede drug delivery into brain metastases, that brain metastases confer a dismal survival for metastatic lung cancer patients, and that brain metastases carry risk for cerebrovascular hemorrhage. A focused, updated review of these issues, however, clearly shows that these particular concerns are unwarranted. An extensive review of clinical trials on the efficacy of chemotheraputic agents against lung cancer brain metastases is also provided. This collective information describes an area in need of therapeutic development and supports an initiative to evaluate novel targeted therapies for lung cancer brain metastases.

Pain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.

Mounting evidence suggests that a 2007 Medicare coverage decision has severely curtailed the use of ESAs for chemotherapy-induced anemia.

A 68-year-old man with a history of small-cell lung cancer with bony metastases was admitted with diarrhea. The patient had completed chemotherapy one week earlier with cisplatin and etoposide, along with radiation therapy, and irinotecan (Camptosar). The patient was found to be neutropenic.

Sunitinib malate (Sutent, SU011248) is an oral multitargeted tyrosine kinase inhibitor used for treatment of renal cell carcinoma and gastrointestinal stromal tumor. We report a case of a patient who developed Guillain-Barré syndrome after initial treatment with sunitinib, with recurrent symptoms upon reintroducing the drug. This is the first report of such an effect. The literature on chemotherapy-induced Guillain-Barré syndrome is also reviewed. Oncology providers should be aware of this rare but potentially serious possible adverse effect of sunitinib.

Radiation therapy (RT) is an important treatment modality for multiple thoracic malignancies. Incidental irradiation of the lungs, which are particularly susceptible to injury, is unavoidable and often dose-limiting. The most radiosensitive subunit of the lung is the alveolar/capillary complex, and RT-induced lung injury is often described as diffuse alveolar damage. Reactive oxygen species generated by RT are directly toxic to parenchymal cells and initiate a cascade of molecular events that alter the cytokine milieu of the microenvironment, creating a self-sustaining cycle of inflammation and chronic oxidative stress. Replacement of normal lung parenchyma by fibrosis is the culminating event. Depending on the dose and volume of lung irradiated, acute radiation pneumonitis may develop, characterized by dry cough and dyspnea. Fibrosis of the lung, which can also cause dyspnea, is the late complication. Imaging studies and pulmonary function tests can be used to quantify the extent of lung injury. While strict dose-volume constraints to minimize the risk of injury are difficult to impose, substantial data support some general guidelines. New modalities such as intensity-modulated radiation therapy and stereotactic body radiation therapy provide new treatment options but also pose new challenges in safely delivering thoracic RT.

A new oral kinase inhibitor that targets the transforming growth factor-beta (TGF-b) receptor reduced radiation-induced lung injury in a preclinical model

New drugs on the horizon could reduce the adverse effects of radiation to the lung, allowing higher doses for lung cancer patients, according to studies presented at the 49th ASTRO annual meeting.

Angiogenesis is a critical requirement for malignant growth, invasion, and metastases. Agents interfering with angiogenesis have shown efficacy in the treatment of a number of solid tumors, such as metastatic colorectal cancer, non–small-cell lung cancer, and renal cell cancer, and are being studied in many more. Each of the three agents currently approved by the US Food and Drug Administration-bevacizumab (Avastin), sunitinib (Sutent), and sorafenib (Nexavar)-offer challenges to nurses, in terms of assessment and management of toxicity, and to their patients as well: learning and integrating self-care strategies, such as self-assessment and self-administration (for sorafenib and sunitinib). This article reviews the recommended dosing, drug interactions, potential side effects, and management strategies for these three agents. Other agents that have antiangiogenesis properties, such as the epidermal growth factor inhibitors, the mTOR inhibitors, bortezomib, and thalidomide will not be addressed.

The controversial new Medicare policy restricting the use of erythropoiesis-stimulating agents (ESAs)—Medicare's single largest drug expense—continues to stir intense debate.

The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) have released an updated joint guideline on the use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat chemotherapy-related anemia.

Phase II trials planned for oral methylnaltrexone for chronic pain

2007: A tumultuous year for erythropoietic-stimulating agents

The increased approval of anticancer agents has led to unprecedented results, with improved quality of life and longer survival times, resulting in millions of individuals living with a diagnosis of cancer. Whereas these novel medical, surgical, and radiation regimens, or combinations thereof, are largely responsible for these remarkable achievements, a new, unexpected constellation of side effects has emerged. Most notably, cutaneous toxicities have gained considerable attention, due to their high frequency and visibility, the relative effectiveness of anti–skin toxicity interventions, and the otherwise decreasing incidence of systemic or hematopoietic adverse events. Optimal care dictates that dermatologic toxicities must be addressed in a timely and effective fashion, in order to minimize associated physical and psychosocial discomfort, and to ensure consistent antineoplastic therapy. Notwithstanding the critical importance of treatment-related toxicities, dermatologic conditions may also precede, coincide, or follow the diagnosis of cancer. This review provides a basis for the understanding of dermatologic events in the oncology setting, in order to promote attentive care to cutaneous health in cancer patients and survivors.

ImClone Systems Incorporated and Bristol-Myers Squibb Company announced that a phase III study of cetuximab (Erbitux) in combination with platinum-based chemotherapy (vinorelbine plus cisplatin) met its primary endpoint of increasing overall survival compared with chemotherapy alone in patients with advanced non–small-cell lung cancer (NSCLC).