Authors

Psychological Outcomes Associated With Anemia-Related Fatigue in Cancer Patients

This article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors.

UFT and Its Metabolites Inhibit Cancer-Induced Angiogenesis via a VEGF - Related Pathway

Treatment with UFT for spontaneous lung metastasis of murine renal carcinoma (RENCA) after resection of the primary tumor has resulted in significant prolongation of the life span of tumor-bearing animals. UFT inhibited the growth of metastatic nodules in the lung, apparently via decreased density of microvessels in the metastatic foci. Subsequent experiments used dorsal air sac assay to directly trace newly forming microvessels.

Early Engagement in Physical Activity and Exercise Is Key in Managing Cancer Cachexia

Despite consensus on the diagnosis and staging of cancer anorexia/cachexia syndrome, there is currently no accepted standard of care, and affected patients remain widely undertreated.

UFT/Leucovorin Plus Weekly Paclitaxel in the Treatment of Solid Tumors

The palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) derivative combined with oral leucovorin plus weekly intravenous paclitaxel.

Hodgkin Lymphoma

This management guide covers the risk factors, screening, diagnosis, staging, and treatment of Hodgkin lymphoma.

Nursing Challenges of Caring for Patients with HIV-Related Malignancies

Moran provides a comprehensive overview of the myriad nursing challenges posed by patients who have a dual diagnosis of HIV disease and cancer. At least two factors make it imperative for nurses to become increasingly proficient in the care of patients with HIV-related malignancies. First, it is now estimated that 1 in every 250 people in this country is infected with HIV, with the largest increases occurring in heterosexual men and women.[1] Second, patients with HIV disease are being seen in virtually all health-care settings, and many dedicated oncology and HIV/AIDS services are now being mainstreamed into general medical services. Thus, nurses who may have had little experience with this patient population in the past are now much more likely to encounter these patients.

Development and Characterization of Darbepoetin Alfa

Studies on human erythropoietin (EPO) demonstrated that there is a direct relationship between the sialic acid-containing carbohydrate content of the molecule and its serum half-life and in vivo biological activity, but an

QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic Status

The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate

Advantages of Every-3-Week Dosing of Erythropoietic Agents to Manage Chemotherapy-Induced Anemia

Patients receiving chemotherapy for cancer often develop anemia, which can contribute to increased morbidity and reduced quality of life.[1] It is important for clinicians to be aware of current clinical studies in the treatment of chemotherapy-induced anemia. In patients with nonmyeloid malignancies, chemotherapy-induced anemia can be successfully treated using erythropoiesis-stimulating agents (ESAs). The application of these agents has evolved from more frequent to less frequent administration and from weight-based to single, fixed doses. Emerging data show that ESAs can be given safely on the same day as chemotherapy without loss of efficacy,[2] and that these agents may be administered as infrequently as every 3 weeks.[3,4] The every-3-week schedule is convenient and may reduce the burden on patients and their caregivers by reducing the number of visits to the clinic.

Phase II Study of Docetaxel and Irinotecan in Metastatic or Recurrent Esophageal Cancer: A Preliminary Report

The outcomes for patients with metastatic or recurrent esophagealcancer are dismal, with 1-year survival rates of approximately 20%. Inthis phase II study, we studied the combination of docetaxel (Taxotere)and irinotecan (CPT-11, Camptosar) in patients with metastatic orrecurrent esophageal cancer. Eligible patients included those withhistologic or cytologic diagnosis of adenocarcinoma or squamouscancer of the esophagus or gastroesophageal junction who had receivedno previous chemotherapy for metastatic esophageal cancer. Previouschemotherapy in the neoadjuvant or adjuvant setting was allowed.Patients received irinotecan at 160 mg/m2 over 90 minutes followed bydocetaxel at 60 mg/m2 intravenously over 1 hour, with chemotherapycycles repeated every 21 days. Patients were reevaluated every twocycles. Of a planned 40 patients, 15 were enrolled, with 14 patientsevaluable for toxicity and 10 evaluable for response and survival. Thecombination of docetaxel and irinotecan resulted in a response rate of30%. An additional 40% achieved stable disease. The median survivalwas 130 days, with three patients still alive at the time of this analysis.The toxicities included 71% incidence of grade 4 hematologic toxicities,with 43% febrile neutropenia. One patient died of cecal perforationafter one cycle. There was no evidence of pharmacokinetic interaction,as systemic clearance of both drugs was similar to that seen after singleagentadministration. In conclusion, the regimen of docetaxel andirinotecan is active in metastatic or recurrent esophageal cancer.However, this combination chemotherapy regimen has an unacceptablerate of febrile neutropenia. This regimen needs to be modified toreduce the incidence of febrile neutropenia.

Diagnostic Dilemma: Dermatology

A 49-year-old Caucasian man presented with progressing erythematous plaques on the face and neck in December 2007. He was treated with topical steroids, presumably for dermatitis, without improvement.

Putting Lung Cancer Clinical Trials Into Perspective

Ganti and colleagues have provided a comprehensive overview on recent presentations involving lung cancer.

Pregnancy After Breast Cancer: From Psychosocial Issues Through Conception

Women face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following

Supportive Management of the Patient With Pancreatic Cancer:

The oncology nurse attends not only to the physiologic needs of the patient with pancreatic cancer but also to the educational, economic, logistic, and psychosocial factors that impact on quality of care. Managing patient care

Commentary (Lohr): Diagnosis of Venous Thromboembolic Disease in Cancer Patients

This article nicely describes concernsabout the underdiagnosisof deep vein thrombosis(DVT) and superficial vein thrombosisin patients with malignancy. Theincidence of these conditions in thissetting has been demonstrated to beas high as 51% in postmortem studies,as opposed to the clinically recognized15% rate. The articlereinforces the need for better diagnostictools than are currently availablein clinical practice. It alsostresses the need for a high clinicalsuspicion. Duplex ultrasound shouldbe used as a first step, and othermodalities listed in the article needto be used when appropriate.

Paclitaxel as First-Line Treatment for Metastatic Breast Cancer

When administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard

Hypersensitivity Reactions to Oxaliplatin: Incidence and Management

Oxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.

Coming to Grips With Hand-Foot Syndrome

Hand-foot syndrome is a localized cutaneous side effect associatedwith the administration of several chemotherapeutic agents, includingthe oral fluoropyrimidine capecitabine (Xeloda). It is never life-threateningbut can develop into a painful and debilitating condition thatinterferes with patients' normal daily activities and quality of life. Severalsymptomatic/prophylactic treatments have been used to alleviatehand-foot syndrome, but as yet there is insufficient prospective clinicalevidence to support their use. The only proven method of managinghand-foot syndrome is treatment modification (interruption and/or dosereduction), and this strategy is recommended for patients receivingcapecitabine. Retrospective analysis of safety data from two largephase III trials investigating capecitabine as first-line therapy in patientswith colorectal cancer confirms that this strategy is effective inthe management of hand-foot syndrome and does not impair the efficacyof capecitabine. This finding is supported by studies evaluatingcapecitabine in metastatic breast cancer. Notably, the incidence andmanagement of hand-foot syndrome are similar when capecitabine isadministered in the metastatic and adjuvant settings, as monotherapy,or in combination with docetaxel (Taxotere). It is important that patientslearn to recognize the symptoms of hand-foot syndrome, so thatprompt symptomatic treatment and treatment modification strategiescan be implemented.

Fertility Preservation in Young Adult Patients With Cancer

This article will outline key information needed and practical ways that clinicians can integrate fertility preservation discussions and guidelines into their day-to-day practice.

Novel Therapeutic Avenues in Myeloma: Changing the Treatment Paradigm

Our better understanding of the complex interaction of multiple myeloma (MM) cells with their bone marrow microenvironment and the signaling pathways that are dysregulated in this process has resulted in a dramatic increase in the therapeutic agents available for this disease. A number of these new agents have demonstrated significant activity in patients with MM. Over the past 5 years, three drugs have received approval from the US Food and Drug Administration for therapy in MM—bortezomib, thalidomide, and lenalidomide. To date, the choice of therapy for MM is not individualized according to the biologic characteristics of the disease, but future studies should enable us to identify patients who may benefit most from certain therapeutic interventions, and thus develop individualized therapy for MM. In this review, we will present some of the treatment algorithms currently developed for patients with MM and focus on established advances in therapy, specifically with thalidomide, bortezomib, and lenalidomide. We will also discuss some of the emerging novel therapeutic agents showing promise in phase I/II clinical trials in MM.

State of the Art in Umbilical Cord Transplantation

Every day thousands of babies are born in hospitals across America. These births offer opportunities to cure patients of leukemia and other life-threatening diseases. The opportunities lie in the routinely disposed placentas and umbilical cords.

28 Enhancing the Interpretation of Real-World Quality of Life (QoL) in Patients With Hormone Receptor– Positive/Human Epidermal Growth Factor Receptor 2–Negative (HR+/HER2-) Advanced Breast Cancer (ABC) Enrolled in the POLARIS Trial

Commentary (Zhong/Lynn): Some Elements of Prognosis in Terminal Cancer

The claim that physicians make substantial, systematically optimistic errors in prognostication undergirds the article by Lamont and Christakis. This claim seems to contrast with our experience in the Study to Understand Prognoses and Preferences for

Genetics of Colorectal Cancer

Approximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. Familial adenomatous polyposis is an autosomal dominant syndrome classically presenting with hundreds to thousands of adenomatous colorectal polyps that are caused by mutations in the APC gene.

Commentary (Zujewski): Current Status of Endocrine Therapy for Metastatic Breast Cancer

Endocrine therapy has been shown to be effective therapy for women with all stages of breast cancer, and the nonsteroidal antiestrogen tamoxifen is being evaluated as a potential preventive agent for this disease. Kimmick and Muss review the use of endocrine therapy for the treatment of patients with metastatic breast cancer. They discuss the basis for endocrine therapy and potential mechanisms of endocrine resistance, currently available and new agents, as well as new areas of investigation. I would like to highlight a few practical points regarding the use of endocrine therapy in the treatment of patients with metastatic breast cancer and some key areas of research.

The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric Cancer

Gastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

The optimal management of patients with an elevated post-prostatectomy prostate-specific antigen (PSA) level remains to be determined. In the pre-PSA era, many patients received immediate adjuvant radiation therapy on

Clinical Trials and NCI Resources for Cancer in HIV-Positive Patients

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

Resection of Pulmonary Metastases: a Mechanical Solution for a Biological Problem

Isolated pulmonary metastases (PM) represent a unique manifestation of the myriad presentations of systemic spread from a primary neoplasm.

ACR Appropriateness Criteria® Nonsurgical Treatment for Locally Advanced Non–Small-Cell Lung Cancer: Good Performance Status/Definitive Intent

The treatment of inoperable stage III non–small-cell lung cancer (NSCLC) remains a challenge due to high rates of distant metastasis, local recurrence, and toxicity associated with definitive therapy.