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Cancer-related thrombocytopenia is a clinical problem. Unfortunately, the qualitative nature and quantitative extent of the problem has been poorly defined to date. Without knowing these two parameters, the risk/benefit ratio of any management option for cancer-related thrombocytopenia is impossible to calculate accurately. Drs. Goodnough and DiPersio have done an excellent job of delineating many of the potential risks of managing the problems associated with platelet transfusions.

Drs. Goodnough and DiPersio present an authoritative and informative discussion of the management of thrombocytopenia in the cancer patient, emphasizing the risks of platelet transfusions, the safety of a platelet count threshold of < 10,000/µL for prophylactic transfusions, and issues related to the optimal type of platelet product and dose of platelets. The authors make the important point that although the risk of transmission of viral infections has decreased markedly due to the addition of nucleic acid testing for hepatitis C and human immunodeficiency virus (HIV),[1] sepsis due to bacterial contamination remains a serious risk, particularly for the neutropenic patient.[2] The fever and chills that occur within 6 hours after a platelet transfusion usually are associated with nonhemolytic febrile transfusion reactions, but the more dangerous possibility of bacterial sepsis from contamination should be considered, particularly in the neutropenic patient, and treated empirically until bacterial cultures prove otherwise.

Dr. Nemunaitis gives a scholarly and informative historical review of antineoplastic viral therapy using recombinant DNA biotechnologies. The field predates the polymerase chain reaction and restriction enzymes; it has its roots in observations by Jenner and experiments that are over 100 years old.

Approximately 30 years passed between the first description of a paraneoplastic neurologic disorder[1] and the demonstration of an immunologic pathogenesis for one of these syndromes.[2] In the almost 4 decades since, the paraneoplastic neurologic disorders have been subjected to study far out of proportion to their clinical prevalence. These disorders stimulate clinical research because (1) paraneoplastic neurologic syndromes are frequently the presentation of a malignancy, (2) they may bode well for a more favorable tumor prognosis,[3,4] and most importantly, (3) they yield insight into the workings of malignancy and the pathogenesis of neurologic disorders, particularly neurologic degenerations.

William Pirl and Jeffrey Mello present an informative overview of the psychological impact of prostate cancer. They also provide a practical framework for distress management, as promulgated by the National Comprehensive Cancer Network (NCCN).

During the HIV epidemic in the 1980s, more than half of the hemophiliac patients living in many countries, including the United States, France, Denmark, and Japan, became infected with HIV as a result of blood transfusions with contaminated blood or blood products.[1,2] Since the clotting factor needed to treat hemophiliacs was manufactured by pooling plasma from thousands of donors, even one HIV-infected donor could contaminate the entire supply, infecting hundreds.

The authors challenge the notion that men with prostate cancer exhibit little psychological difficulty. In fact, we do not know much about actual distress rates in men with prostate cancer because few studies have directly measured distress in this population. Likewise, we do not know if the distress experienced by prostate cancer patients is qualitatively different from that of other cancer patients. By assuming that all men with prostate cancer "do well," we, as clinicians and researchers, may fail to ask patients important questions.

Drs. Goodnough and DiPersio should be commended for contributing such a well-written, well-referenced, objective, and authoritative review of issues in the management of cancer-related thrombocytopenia. Their article focuses primarily on platelet transfusion risks, rational transfusion thresholds, and potential novel pharmaceutical triumphs. The general lack of large-scale, definitive clinical trials in this field is appreciated and emphasized throughout. Much to my disappointment, the authors seem to have passed on the opportunity to provide the oncology community with any form of evidence-based (or evidence-lacking, as the case may be) and practical guideline for the treatment of thrombocytopenia.

Over the past decade, interest has been growing in the quality of life of men with prostate cancer. Traditionally considered a group with few psychological complications, 10% to 20% of men with prostate cancer are found to have clinically significant levels of psychological distress. This article reviews the prevalence of psychiatric symptomatology among prostate cancer patients, the psychological challenges of coping with the disease, and general guidelines for treatment. [ONCOLOGY 16:1448-1467, 2002]

The use of live viruses for the treatment of cancer has been extensively studied in several preclinical and clinical models, as discussed in Nemunaitis’ thorough historical review of the subject.

Pirl and Mello carefully review the current state of knowledge about the psychological complications of prostate cancer. Their discussion is worth reading, particularly by those who treat patients with the disease. To put this knowledge in context for the general reader, we should give some thought to what this review illustrates about all patients with a serious life-threatening illness.

LOS ANGELES-A retrospective study indicates that 18F-fluorodeoxyglu-cose (FDG)-PET may be a good tool for predicting osteosarcoma patients’ response to chemotherapy, said Christiane Franzius, MD, and colleagues from the Department of Nuclear Medicine, University of Munster, Germany.

WASHINGTON-The human body has strong immune defenses against cells of foreign species. For example, cells that produce a sugar known as galactose-alpha(1,3)galactose, found in many mammalian species but not in humans, trigger a hyperacute response in humans that destroys the great majority of the interloper cells. Cancer cells, however, which also contain many molecules not found in normal cells, nonetheless often elude the immune system’s defenses.

BETHESDA, Maryland-Calling his initial months as director of the National Cancer Institute (NCI) "absolutely exhilarating," Andrew C. von Eschen-bach, MD, described three interrelated themes that will guide his leadership of the Institute. The three, he said at a meeting of the National Cancer Advisory Board (NCAB), are patient centricity, a more active leadership by NCI in the National Cancer Program, and collaborations and partnerships beyond the Institute’s usual sphere of activities.

One of the national health objectives for 2010 is to reduce the prevalence of cigarette smoking among adults to £ 12% (objective 27.la). To assess progress toward this objective, the Centers for Disease Control and Prevention (CDC) analyzed

The US Food and Drug Administration (FDA) has approved granisetron (Kytril) for the prevention and treatment of postoperative nausea and vomiting. The approval was based on the results of recent clinical trials.

WASHINGTON-Most Americans worry about developing cancer and being overweight, but few of them recognize that excessive pounds are a risk factor for some common cancers, according to a new survey commissioned by the American Institute for Cancer Research (AICR). Of those polled, 61% said they were either very or somewhat concerned about receiving a diagnosis of cancer. Yet when asked to name major risk factors for cancer other than smoking, only 6% listed overweight or obesity.

Steven Grunberg, one of the pioneer clinical investigators in the development of modern antiemetics, describes various approaches to the management of this important complication of cytotoxic chemotherapy. Dr. Grunberg describes the use of phenothiazines and antidopaminergic agents as antiemetics, the discovery that steroids could serve as effective adjuvant antiemetic agents, and the development of the serotonin (5-HT3)-receptor antagonists. Thus, we have compazine, metoclopromide, decadron, and a set of 5-HT3 antagonists-ondansetron (Zofran), dolasetron (Anzemet), and granisetron (Kytril)-in our therapeutic armamentarium.

A new partnership between the National Institutes of Health and five major drug companies will provide a total of $6 million to several cancer centers to find ways to increase accrual to early clinical trials. The five pharmaceutical firms involved in the

BETHESDA, Maryland-Calling his initial months as director of the National Cancer Institute (NCI) "absolutely exhilarating," Andrew C. von Eschen-bach, MD, described three interrelated themes that will guide his leadership of the Institute. The three, he said at a meeting of the National Cancer Advisory Board (NCAB), are patient centricity, a more active leadership by NCI in the National Cancer Program, and collaborations and partnerships beyond the Institute’s usual sphere of activities.

BARCELONA, Spain-A new anti-HIV agent from Roche and Trimeris, Inc has a unique mode of action that suggests it will be active in HIV infections that have developed resistance to other antiretroviral agents and can be combined with other agents without substantially increasing toxicity.

EVANSTON, Illinois-Patients with low literacy have often been excluded from assessments of self-reported health outcomes, but that may change thanks to a new multimedia tool called the Talking Touchscreen.

ORLANDO-The routine use of ductal lavage in a high-risk breast surgical oncology practice will identify many patients who may benefit substantially from chemoprevention with tamoxifen (Nolvadex), and may detect rare contralateral breast cancers missed by traditional methods, according to a report at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 193).

NIAGARA-ON-THE-LAKE, On-tario, Canada-With the increasing success in the treatment of childhood leukemia and other cancers, possible long-term problems need to be addressed, said Sue Kaste, DO, St. Jude Children’s Research Hospital.

ORLANDO-Uncircumcised men are at increased risk of HIV infection. A new study presented at the 100th Annual Meeting of the American Urological Association (abstract 111) suggests that this is due to high numbers of HIV target cells in the foreskin. Carlos R. Estrada, MD, of Rush-Presbyterian-St. Luke’s Medical Center, Chicago, and his colleagues evaluated 8 pediatric and 6 adult foreskins with and without a history of HIV-1 infection. Cervical biopsy tissue served as a control.

WASHINGTON-The next 2 decades will see an increasing shortage of nurses if current trends continue, according to a report by the Health Resources and Services Administration. The report points to a worsening shortfall as nurses retire and too few new people enter the field. In the year 2000, there were an estimated 1.89 million registered nurses in the United States, while the demand for nurses was 2 million, a gap of 6%.

ROCKVILLE, Maryland-The US Food and Drug Administration has announced a major new initiative to revise its regulations governing pharmaceutical manufacturing and product quality. Focused on the agency’s current Good Manufacturing Practice (cGMP) program, the new effort seeks to improve public health promotion and protection. It will apply to veterinary and human drugs, including vaccines and other human biological drug products.

NIAGARA-ON-THE-LAKE, Ontario, Canada-Survivors of childhood brain tumors appear to have a high risk for non-neurological late effects such as endocrine disorders, according to a report (abstract 7) presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute.

ORLANDO-A promising approach in vector vaccine development is the use of a combination of vaccination strategies that enhance T-cell responses for specific tumor-associated antigens, said Jeffrey Schlom, PhD, chief of the Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institutes, Bethesda, Maryland.

WASHINGTON-The imaging methods presently used to detect, diagnose, and stage breast tumors have significant flaws, as shown by the roughly 75% of breast biopsies that return normal results. These "completely unnecessary" procedures impose "huge costs" and "unnecessary trauma," said Craig S. Levin, PhD, assistant professor of radiology, University of California, San Diego, and the Department of Nuclear Medicine, San Diego VA Medical Center.