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Cost Considerations in the Management of Cancer in the Older PatientThis paper provides an overview of several prominent articles and empirical studies on supportive care and cancer-related costs faced by older cancer patients. It focuses primarily on individuals 65 years of age and over and reviews several types of cancer.
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Commentary (Moller): Surgical Staging in Endometrial CancerEndometrial cancer is the mostcommon gynecologic malignancyaffecting women in theUnited States. In 1988, the InternationalFederation of Gynecology andObstetrics shifted from a clinical stagingprotocol to one based on surgicalfactors, making surgical staging theaccepted treatment approach to endometrialcancers, with excellentsurvival compared to other gynecologicmalignancies. The manuscript byKirby et al brings to light the controversiessurrounding the surgical evaluationof endometrial cancers. Althoughsurgical staging has been shown to haveboth prognostic and therapeutic benefit,major problems in the United Statescontinue to result in suboptimal treatmentof patients with endometrial cancer.These problems include the lack ofan accepted surgical protocol (in termsof adequacy of lymph node sampling)and incomplete surgical staging secondaryto patient factors or the lack ofreferral to specialty-trained gynecologiconcologists.
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Update on Malignant MesotheliomaMesotheliomas are uncommon in the United States, with an incidenceof about 3,000 new cases per year (or a risk of about 11 per million Americansper year). Incidence and mortality, however, are probably underestimated.Most are associated with asbestos, although some have arisen inports of prior radiation, and a reported association with simian virus (SV)40remains controversial. About 85% of mesotheliomas arise in the pleura,about 9% in the peritoneum, and a small percentage in the pericardiumor tunica vaginalis testis. The histology of about half of mesotheliomas isepithelial (tubular papillary), with the remainder sarcomatous or mixed.Multicystic mesotheliomas and well-differentiated papillary mesotheliomasare associated with long survival in the absence of treatmentand should be excluded from clinical trials intended for the usual rapidlylethal histologic variants of the disease. The median survival isunder a year, although longer median survivals for selected patients,particularly those with epithelial histology, have been reported in somecombined-modality studies. Recent randomized trials have shown significantimprovement in time to progression and survival for the additionof new antifolates to platinum-based chemotherapy.
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Commentary (Basen-Engquist/Cohen): Quality of Life in Low-Grade Non-Hodgkin’s LymphomaCancer treatment often has debilitating effects on the patients who receive it. Chemotherapy regimens can produce toxicities, such as gastrointestinal disturbances, hematologic deficiencies, fatigue, and neurotoxicity. Patients typically undergo these chemotherapy regimens to increase their disease-free survival time. Given that these therapies can negatively affect a patient’s quality of life (QOL), treatments need to provide clear curative potential and/or survival benefits to offset detrimental effects on QOL.
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Ovarian CancerDespite the fact that it is highly curable if diagnosed early, ovarian cancer causes more mortality in American women each year than all other gynecologic malignancies combined.
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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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ASCO 2017: Updates on HER2-Positive Breast Cancer TreatmentThis video highlights the latest studies presented at the 2017 ASCO Annual Meeting on the treatment of HER2-positive breast cancer.
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Caring for Patients at Risk for Hereditary Colorectal CancerAbout 6% of colorectal cancers are caused by genetic mutations associated with hereditary colorectal cancer syndromes. The most common hereditary cancer syndromes nurses are likely to encounter include hereditary nonpolyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MYH polyposis. Current colorectal cancer recommendations for risk management, screening, and surveillance are complex and based on level of colorectal cancer risk and whether an individual carries a genetic mutation associated with a hereditary colorectal cancer syndrome. Caring for patients with hereditary colorectal cancer syndromes requires nurses to understand how to identify individuals and families at risk for hereditary colorectal cancer, refer to appropriate resources, and provide accurate information regarding screening, surveillance, and management. Nurses play a critical role in assessing colorectal cancer risk, obtaining an accurate family history of cancer, and providing information concerning appropriate cancer screening and surveillance.
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Commentary (Broaddus/Lu): Gynecologic Manifestations of Hereditary Nonpolyposis Colorectal CancerTraditionally, most hereditarynonpolyposis colorectal cancer(HNPCC) syndrome patientshave been identified and cared for bygastroenterologists, colorectal surgeons,and gastrointestinal medicaloncologists. Hence, the realization thatgynecologic tumors actually play amajor role in HNPCC has come relativelylate. Consequently, much of theclinical and basic science focus ofresearch in HNPCC has concentratedon colorectal cancer.
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Quality of Life Among Long-Term Cancer SurvivorsThanks to advances in cancer diagnosis and treatment, there are now more than 10 million cancer survivors in the United States. Successful treatment of cancer has resulted in increased demands on survivors and has had diverse effects on the quality of life (QOL) of patients and their families. A model of QOL encompassing dimensions of physical, psychological, social, and spiritual well-being has been applied to illustrate the multidimensional needs of cancer survivors and the necessity of comprehensive care extending over the long term. Data from a recent survey of members of the National Coalition of Cancer Survivorship (NCCS) is presented, along with a summary of issues compiled by the NCCS that merit future attention. [ONCOLOGY 11(4):565-571, 1997]
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Progress and Prospects in Vaccine Therapy for Gynecologic CancersTherapeutic and prophylactic vaccines that harness the potential of the immune system against a number of gynecologic cancers are now being developed. The therapeutic vaccines coerce the cellular components of the
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Are Cancer Patients Subject to Employment Discrimination?We sought to determine whether patients undergoing treatment for cancer had experienced discrimination in employment and, if so, how that discrimination was manifested. We also sought to determine what variables affected the rate of discrimination, including age, gender, occupation, and employer size.
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Altered Fractionation for Head and Neck CancerA conventional course of radiation for squamous cell carcinoma in the United States is generally 70 Gy in 7 weeks, with a once-daily dose of 1.8 to 2 Gy. This schedule has a modest success rate in curing head and neck cancer. The
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Cervical Cancer Screening Guideline UpdateIn light of the recent FDA approval of HPV testing for women as a screening method for cervical cancer, we discuss changing guidelines with two experts.
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Karen Kelly, MD, Discusses When to Start ImmunotherapyKaren Kelly, MD, sat down to discuss her presentation on when to start immunotherapy in a real world, patient setting.
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Dermatologic Challenges in Cancer Patients and SurvivorsThe 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.
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Problem-Related Distress in Cancer Patients Drives Requests for Help: A Prospective StudyThe Moores UCSD Cancer Center has implemented the use of an innovative instrument for screening cancer patients at first visit to assist them with distress due to cancer-related problems. This 36-question screening instrument addresses physical, practical, social, psychological and spiritual problems. Patients are asked to rate the severity of each problem on a scale of 1 to 5, and to circle "Yes" if they would like staff assistance. Data from a prospective study of the first 2,071 patients to complete this questionnaire has been entered into a database and analyzed to identify common patient problems, demographics, and trends. The five most common causes of problem-related distress were fatigue, sleeping, finances, pain, and controlling my fear and worry about the future. The five most common problems for which patients circled "Yes" to ask for assistance were understanding my treatment options, fatigue, sleeping, pain, and finances. Compared to the entire population, patients who circled "Yes" on a particular problem, demonstrated a robust increase in problem-related distress.
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Management of a Superior Sulcus (Pancoast) TumorThe patient is a 74-year-old gentleman who presented with a visual disturbance and right shoulder pain. On routine chest x-ray, he was found to have a right apical lung mass.
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Precision Medicine in NSCLC The Power of Molecular TestingPersonalized therapy for non–small cell lung cancer has evolved significantly with the advent of comprehensive molecular testing.
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The Recklitis et al Article ReviewedThe psychological challenges of cancer can become more evident when treatment is complete. The focus on survival and acute symptom management fades and is supplanted by a re-focus on living with the after-effects of diagnosis and treatment. As well described by Drs. Recklitis, Varela and Bober, worry, anxiety, depression, fatigue, and sexual difficulties are some of the most common and yet sometimes intangible issues faced by survivors.
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Counseling Women at High Risk of Ovarian or Endometrial CancerPatient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.
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Preserving Fertility inYoung Women DiagnosedWith Breast CancerIn the US, breast cancer is the most common invasive cancer in women, with more than 200,000 diagnosed with the disease each year.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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The Use of Serum hCG as a Marker of Tumor Progression and of the Response of Metastatic Urothelial Cancer to Systemic ChemotherapyA 55-year-old woman with a history of metastatic melanoma in remission for 8 years presented to the emergency department with gross hematuria. A CT scan, ordered because the patient was in menopause, demonstrated a bladder tumor.
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Management Strategies in Acute Lymphoblastic LeukemiaThis review will cover the key elements of modern acute lymphoblastic leukemia treatment regimens, focusing primarily on front-line treatment and concluding with a brief discussion of the management of relapsed disease.
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Radiofrequency Ablation in Lung Cancer: Promising Results in Safety and EfficacyOnly about 15% of patients diagnosed with lung carcinoma eachyear are surgical candidates, either due to advanced disease orcomorbidities. The past decade has seen the emergence of minimallyinvasive therapies using thermal energy sources: radiofrequency,cryoablation, focused ultrasound, laser, and microwave; radiofrequencyablation (RFA) is the best developed of these. Radiofrequency ablationis safe and technically highly successful in terms of initial ablation.Long-term local control or complete necrosis rates drop considerablywhen tumors are larger than 3 cm, although repeat ablations can beperformed. Patients with lung metastases tend to fare better with RFlung ablation than those with primary lung carcinoma in terms of localcontrol, but it is unclear if this is related to smaller tumor size at time oftreatment, lesion size uniformity, and sphericity with lung metastases,or to differences in patterns of pathologic spread of disease. The effectsof RFA on quality of life, particularly dyspnea and pain, as well aslong-term outcome studies are generally lacking. Even so, the resultsregarding RF lung ablation are comparable to other therapies currentlyavailable, particularly for the conventionally unresectable or high-risklung cancer population. With refinements in technology, patient selection,clinical applications, and methods of follow-up, RFA will continueto flourish as a potentially viable stand-alone or complementarytherapy for both primary and secondary lung malignancies in standardand high-risk populations.
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Evidence grows for value of high-field MRI in prostate cancer Rx strategyVIENNA-Image-guided intensity-modulated radiotherapy, high-intensity focused ultrasound, and cryotherapy are increasing the curative treatment options for men with prostate cancer. The problem is how to determine which patients are most suitable for these therapies.
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Promoting Smoking Cessation Among Cancer Patients: A Behavioral ModelThe smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its
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Management of DeliriumMs. B is a 44-year-old married African-American female who was diagnosed with locally advanced right breast cancer in 2002. Immunohistochemistry in the original tumor was estrogen- and progesterone-receptor-negative, HER2-positive. Her past medical history is significant for hypertension and miscarriage in 1995.
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New Biomarkers in Prostate CancerIn this article, we review recent advances in the discovery of prostate cancer biomarkers, their integration into clinical practice, and implications for improving clinical management of the disease.
