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Surviving the Stresses of Clinical Oncology by Improving CommunicationOncologists grapple with an element of psychological stress that relatesto the suffering their patients experience. Although this stress maynot be unique to oncology, it is profound. When these stresses becomeoverwhelming, they lead to physician burnout. It is important to understandwhat makes an oncologist feel successful, what coping strategieshelp combat burnout, and what adds to the process of renewal. Thedoctor-patient relationship plays an important role for many oncologistsin this regard, and communication skills are increasingly recognizedfor their importance in this arena. We outline several clinical scenariosthat pose particular challenges to oncologists. These include breakingbad news and the patient’s response to hearing bad news, transitions incare and offering end-of-life care, participation in investigational studies,error disclosure, complementary and alternative medicine, spirituality,family discussions, and cross-cultural issues. By highlighting therelevant psychosocial issues, we offer insight into, and tools for, anenriched dialogue between patient and oncologist. The doctor-patientrelationship can be viewed as the ultimate buffer for dealing with thehassles encountered in clinical oncology.
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Smoking Cessation: Recent Developments in Behavioral and Pharmacologic InterventionsSmoking kills more than 430,000 people each year in the United States and is currently estimated to be responsible for 30.5% of all cancer-related deaths in our society. The majority of these deaths could be prevented,
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Breast Cancer Following Radiation for Hodgkin Lymphoma: Clinical Scenarios and Risk-Reducing StrategiesWe review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma.
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Multimodality Therapy for High-Risk Endometrial Cancer: Balancing the Courses While Keeping All Options on the TableAs advances in treatment strategies continue to focus on individualization of therapy, the identification of disease subsets is crucial to strategizing optimal therapeutic approaches.
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The Role of Bisphosphonates in the Adjuvant Setting for Breast CancerBone health is a critical issue in the management of women with breast cancer. Many women who develop breast cancer are postmenopausal, which already predisposes them to osteoporosis. Systemic treatments for breast cancer, including chemotherapy and endocrine therapy, decrease circulating levels of estrogen in both pre- and postmenopausal women, further accelerating the natural process of bone loss. The primary concern in breast cancer patients is that this accelerated bone loss, known as cancer treatment–induced bone loss (CTIBL), will lead to an increase in fractures, chronic pain, and loss of mobility. Bisphosphonates are highly effective at slowing the rate of bone loss in postmenopausal women with osteoporosis and at preventing skeletal-related events in women with metastatic breast cancer. Many studies are now focusing on the role of bisphosphonates in preventing CTIBL in the adjuvant setting. Both oral and intravenous bisphosphonates have shown promising activity in preventing CTIBL in patients receiving chemotherapy or hormonal therapy. In addition, emerging data indicate that the use of bisphosphonates in the adjuvant setting may prevent disease recurrence and prolong survival. Data from a number of ongoing trials will further elucidate the role of bisphosphonates in the adjuvant setting over the next few years.
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Vinorelbine and Carboplatin in the Treatment of Advanced Non-Small-Cell Lung CancerRandomized trials in patients with advanced non-small-cell lung cancer (NSCLC) have demonstrated that the combination of vinorelbine (Navelbine) and cisplatin
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Complexities of Adjuvant Endocrine Therapy in Young Premenopausal WomenYounger women with breast cancer present important management challenges due in part to differences in both tumor biology and individual patient factors. In his article, Peppercorn provides a comprehensive overview of these issues with a particular focus on questions surrounding systemic therapy options.
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Using Germline Testing to Inform Treatment Decisions in Breast CancerAhead of the ASCO Annual Meeting, we discuss the use of germline testing and PARP inhibitors in patients with breast cancer with Jennifer K. Litton, MD.
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What’s New in Genetic Testing for Cancer Susceptibility?The dilemma for clinicians is how best to understand and manage this rapidly growing body of information to improve patient care. With millions of genetic variants of potential clinical significance and thousands of genes associated with rare but well-established genetic conditions, the complexities of genetic data management clearly will require improved computerized clinical decision support tools, as opposed to continued reliance on traditional rote, memory-based medicine.
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QOL Research Helps Physicians Tailor Cancer TreatmentConcerns over the rising costs of health care in the United States have recently focused attention on the young discipline of health services research.
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Improved Metastatic Uterine Papillary Serous Cancer Outcome With Treatment of Mast Cell Activation SyndromeA 71-year-old woman not on hormone replacement therapy presented with uterine bleeding. Dilation and curettage revealed complex hyperplasia with atypia, focal clear-cell features, and endocervicitis. Endometrial intraepithelial carcinoma was suspected.
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Diagnostic Dilemma: GI DiseaseThis photograph is from an upper gastrointestinal endoscopy on a 15-year-old male. He has a history of a total colectomy and is being evaluated for iron deficiency anemia. He denies abdominal pain, weight loss, and melena. He notes occasional bright red blood on the toilet paper but denies hematochezia.
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Obesity and Breast CancerIn this review, we describe the evidence linking obesity to breast cancer recurrence, discuss the potential biological mechanisms through which weight could impact breast cancer prognosis, and review the weight-loss intervention studies that have been performed in breast cancer populations to date.
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Current Management of Menopausal Symptoms in Cancer PatientsMore women, and especially more premenopausal women, are surviving their cancer diagnosis. However, due to their therapy, these women may become symptomatic from iatrogenic ovarian failure. For some, the use of hormone replacement therapy (HRT) is contraindicated because it may affect the course of their disease. Other women and their physicians may feel uncomfortable with the use of hormones because research is inconclusive regarding long-term survival or disease recurrence. Women who experience a cessation of menses due to adjuvant therapy for breast cancer are more likely than women undergoing a natural menopause to experience severe hot flashes, night sweats, and fatigue.[1] However, nonhormonal interventions appear to benefit many of these women[2] and should be used to decrease their symptoms. Barton, Loprinzi, and Gostout address these concerns in their excellent review and offer recommendations for pharmacologic and nonpharmacologic interventions.
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Screening for Prostate Cancer With PSA Testing: Current Status and Future DirectionsThis article will present a detailed review of the body of evidence regarding the PSA assay, with reflections on the resulting future of prostate cancer screening.
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The Current Clinical Value of the DCIS ScoreThe DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making.
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Should Response to Preoperative Therapy Guide Local Management in Node-Positive Breast Cancer?Current data challenge the statement that recommendations for postmastectomy radiotherapy should be based on the highest clinical or pathologic stage. Instead, data suggest that in a majority of patients, the pathologic stage after neoadjuvant chemotherapy carries more prognostic value.
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Using Targeted Inhibitors in the Management of Chronic Lymphocytic Leukemia: Are We There Yet?Several critical issues need to be addressed during the next several years if we are to reach the true potential of new agents like ibrutinib, idelalisib, venetoclax, ofatumumab, and obinutuzumab-which conceivably could ultimately cure CLL.
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Approaching Use of CDK4/6 Inhibitors in Metastatic HR+, HER2- Breast CancerAn otherwise healthy 58-year-old woman with a history of breast cancer presents to the clinic with newly diagnosed metastatic disease; eventual abdominal CT showed a mass in the transverse colon with ascites and peritoneal nodularity. What is the best initial systemic treatment for her?
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Human Papillomavirus and Head and Neck CancerAs outlined by Leslie Kim and colleagues in this issue of ONCOLOGY,[1] almost 650,000 new cases of head and neck cancer are identified and approximately 350,000 individuals die from this disease worldwide each year. Most cancers of the head and neck are squamous cell carcinomas and originate from one of five major sites: oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx. Traditionally, tobacco smoking and alcohol consumption have been considered to be the main risk factors for head and neck squamous cell carcinoma (HNSCC) and, thus far, most prevention strategies and public health messages have focused on these two factors. However, as described in the review by Kim et al., there is increasing evidence that, independent of tobacco and alcohol exposure, oral human papillomavirus (HPV) infection is a major risk factor for a specific subset of HNSCCs. We agree with the authors that this is an important public health concern, especially given the increasing prevalence of HPV infection in the US and Western Europe and our limited knowledge about the natural history of oral HPV infection. Here we summarize the role of HPV in HNSCC and discuss clinical implications.
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Challenges of Rural Cancer Care in the United StatesRural cancer patients often face substantial barriers to receiving optimal treatment, including availability of cancer care providers, distance to services, lack of public transportation, financial barriers, and limited access to clinical trials. However, a number of promising approaches may address some of these challenges.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen 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
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Polypharmacy, Aging, and CancerPolypharmacy, defined as concurrent use of several drugs, is not uncommon in the elderly and increases their risk of adverse drug reactions and interactions.[1] Besides adverse drug reactions and drug-drug interactions, other clinical sequelae of polypharmacy include nonadherence, increased risk of hospitalizations, and medication errors.
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The Integration of Palliative Care and Oncology: the EvidenceThis article will review the overlap between palliative care and oncology and discuss the available evidence that true integration of palliative and oncology care provides patients with optimal oncology care.
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Determining the Role of the Gut Microbiome in Melanoma Treated With Anti–PD-1 ICIsPatients who responded to anti–PD-1 therapy and experienced prolonged progression-free survival had a much greater diversity of gut bacteria.
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Targeted Therapy: Its Status and Promise in Selected Solid Tumors Part IIThis second article in our two-part series on targeted therapies in solid tumors covers the emergence of targeted therapies for the treatment of two common malignancies: lung cancer and breast cancer.
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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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Current and Emerging Treatments for Brain MetastasesConventional methods for treating brain metastasis, such as surgery, WBRT, and SRS, each compete with and complement one another. A plethora of recent studies have helped define and expand the utility of these tools.
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Testicular CancerThis testicular cancer management guide covers the diagnosis, staging, and treatment of germ-cell tumors and seminoma.
