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Managing Central Venous CathetersOver 5 million central venous catheters are inserted annually in the United States. Yet the ‘ideal’ access device does not exist. A host of issues preclude optimizing central line care.
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Unmet Needs During Extended SurvivorshipThe needs and challenges of cancer survivors and their family members do not vanish once treatment has been completed, although their follow-up care is often not addressed sufficiently.
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Treatment of Complications After Breast-Conservation TherapyOver the past 2 decades, breast-conservation therapy with lumpectomyand whole-breast radiotherapy has become a standard option for themajority of women with newly diagnosed breast cancer. Long-term localcontrol is achieved in approximately 85% of patients, and the therapy isgenerally well tolerated. There can, however, be long-term effects on thebreast and other nearby tissues that may range from asymptomaticfindings on examination to severe, debilitating problems. Infection, fatnecrosis, and severe musculoskeletal problems such as osteoradionecrosisor soft-tissue necrosis are uncommon, affecting less than 5% ofpatients. However, changes in range of motion, mild-to-moderate musculoskeletalpain, and arm and breast edema are much more common.As more women choose breast-conservation therapy for management oftheir breast cancer, physicians will encounter these problems, as well asin-breast tumor recurrence, with greater frequency. This review willfocus on the incidence, contributing factors, and management of thelate problems of infection, fat necrosis, musculoskeletal complications,and local recurrence following breast-conservation therapy.
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Lymph Node–Positive Prostate Cancer: The Benefit of Local TherapyAlthough high-level evidence is lacking, the existing literature indicates that select men with lymph node–positive prostate cancer benefit from local therapy.
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Is Axillary Dissection Always Indicated in Invasive Breast Cancer?In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as
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Metabolic Abnormalities in an Adult Survivor of Pediatric CraniopharyngiomaAdult survivors of childhood craniopharyngiomas, the second most common type of childhood brain tumor, face many challenges, including multiple life-threatening metabolic abnormalities. Serious metabolic deficits can result from injury to the pituitary gland or hypothalamus.
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Gastric CancerThis comprehensive guide for oncologists covers the diagnosis, staging, treatment, and management of gastric cancer.
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Tailoring Treatment for Multiple Myeloma Patients With Relapsed and Refractory DiseaseResponses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
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Local Therapy for Breast Cancer in the Molecular Era: Relevant or Relic?This article reviews the current status of local therapy for breast cancer and the likely impact of evolving molecular data on the present paradigm.
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Facing Forward: Meeting the Rehabilitation Needs of Cancer SurviviorsThe 5-year survival rate of cancer patients in the United States is about 66%, and today there are approximately 12 million cancer survivors in the US.
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Cancer Management Chapter 21: Bone sarcomasBone sarcomas are extremely rare neoplasms, which precludes determination of their true incidence. In 2009, approximately 2,570 new cases of cancer of the bones and joints will be diagnosed in the United States, and some 1,470 patients will succumb to the disease. Population-based tumor registries seldom separate bone sarcomas into various histologic types.
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Xerostomia: Diagnosis and ManagementXerostomia, or dry mouth, is a common complaint that may be caused by several conditions, which include side effects of a wide variety of drugs, such as antidepressants, therapeutic radiation to the head and neck,
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Cardiotoxicity of Targeted Agents in Oncology: A Medical Oncology PerspectiveWithout question, targeted therapies have revolutionized the treatment of cancer across histologies.
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Planning Treatment for Women With Recurrent Epithelial Ovarian CancerIt is important to help patients with recurrent ovarian cancer recognize and acknowledge when further therapy is likely to be futile. For some patients this might occur very early in their disease course, while for others it may be after many years of treatment.
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Implementing Survivorship Care Plans Within an Electronic Health RecordSurvivorship care is “a distinct phase of care for cancer survivors that includes four components: (1) prevention and detection of new cancer or recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment; and (4) coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.”
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Commentary (Kuban): Prostate-Specific Antigen as a Marker of Disease Activity in Prostate CancerThe authors present an excellent review of prostate-specific antigen (PSA), bringing us up to date on the large body of information that has been collected since this marker came into clinical use in the mid-1980s. It is hard to believe that we have had this tool for nearly 20 years. Much has been learned.
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The Role of Statins in Cancer Prevention and TreatmentStatins inhibit the activity of the rate-limiting enzyme in the cholesterolbiosynthetic pathway, HMG-CoA reductase, and are widely prescribedfor lowering plasma lipid levels. Several statins have antitumor effects inexperimental models, and observational studies suggest that this anticanceractivity in the laboratory may translate into effective treatments and/orpreventive strategies for certain human cancers. This paper reviews thelaboratory and clinical evidence that statins have anticancer activity, discussesthe possible mechanisms by which tumor growth may be inhibitedby this class of drugs, and outlines strategies for the evaluation of theseagents in the prevention and treatment of human cancers.
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CLL Workshop Emphasizes Engaging Conversations on Shared Treatment PlanningBoth clinicians and patients should have as much information as possible to participate in shared decision-making for CLL care, says Jacob D. Soumerai, MD.
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Follow-Up Care and Screening for Cancer SurvivorsIn this interview we discuss follow-up care and screening for second primary cancers in cancer survivors.
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Toxicity of CNS Prophylaxis for Childhood LeukemiaLong-term neurotoxicity associated with central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), primarily involving physical growth and cognitive development, is an ongoing
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At the Crossroads: The Intersection of the Internet and Clinical OncologyThe Internet is rapidly becoming a third party in the doctor-patient relationship. The World Wide Web, electronic mail (e-mail), and discussion groups have dramatically increased the quantity of medical and health
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Patient Expectations About Their Cancer TreatmentIn this interview we discuss what patients expect from their cancer treatment with Deborah Schrag, MD, MPH, associate professor at Harvard Medical School. Dr. Schrag recently published a study that aimed to discover how patients with advanced cancer understand the purpose of their chemotherapy treatment.
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Nursing Strategies for Patients on Oral ChemotherapyOncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-
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Postoperative Radiation Therapy for Rectal Cancer Combined With UFT/LeucovorinPostoperative combined-modality therapy with fluorouracil (5-FU) and radiation therapy is accepted practice for high-risk rectal cancer. Postoperative pelvic radiotherapy alone may improve pelvic control, but is not associated with an improvement in survival.
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Percutaneous Ablation of Kidney Tumors in Nonsurgical CandidatesAlthough resection currently remains the standard of care for renalcarcinoma, the search for less invasive treatments has led to alternativesurgical approaches. Even less invasive, and appropriate for manygroups of patients, is percutaneous radiofrequency ablation, which inducestumor necrosis via lethal hyperthermia. Multiple series of renaltumors treated with percutaneous ablation in vivo and left in situ havebeen published; these series reveal that for small renal tumors,radiofrequency ablation results in complete necrosis at imaging in 79%to 100% of cases. Because current results come from tumors left in situwith short postablation follow-up, long-term results are necessary tocompare outcomes to surgical standards. Complication rates are lowerthan those following partial nephrectomy. Future reports will shed lighton the long-term outcomes of percutaneous ablation and the relativeadvantages and disadvantages of various technologies for thermal ablation.
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Integrative Medicine: Not Just GarnishWe still have much to do to fully understand the potential of complementary therapies as important elements in cancer treatment and health. Mind-body and body-based interventions may be able to improve health and prevent disease as effectively as pharmacologic agents-without the toxicities associated with pharmacologics, and as adjuncts to pharmacologic therapies they may help to maximize health and diminish disease with less toxicity.
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The Patient With Cancer CachexiaMany cancer patients experience cachexia. In collaboration with an interdisciplinary team including dietitians, oncology nurses are well positioned to implement proactive, multimodality interventions that improve clinical outcomes and quality of life for these patients.
