Authors

Mammography in One's 40s: Considering the Arguments

Ann Kelsall is a medical writer who reported on the NIH Consensus Development Panel meeting for Oncology News International. Here she considers, from the woman's perspective, the panel's arguments against mammography screening for women ages 40 to 49.

Clinical Trials in Ovarian Cancer, Part 2

The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.

Management of Sleep-Wake Disturbances Comorbid With Cancer

In both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.

Trouble Sleeping During Breast Cancer Adjuvant Chemotherapy Treatments

The patient, “TB,” is a 44-year-old Caucasian, married woman with three daughters, 21, 18, and 10 years of age.

Phase I Study of Docetaxel and Concomitant Chest Radiation

Data from the Radiation Therapy Oncology Groupand Eastern Cooperative Oncology Group indicate that increased survival

What Is the Indication for Sorafenib in Hepatocellular Carcinoma? A Clinical Challenge

In this review article we will discuss the current data on, and future role of, sorafenib in the treatment of hepatocellular carcinoma beyond Child-Pugh A cirrhosis, in conjunction with local therapy, and in a transplant setting.

Managing Painful Surface Wounds

Gina, age 9, and Rosemary, age 66. They had different cancers, but developed similar skin ulcers over their entire bodies. Gina's wounds were open to air for 4 weeks. Her pain was severe. Two weeks after starting wound care, Gina allowed us to take pictures of her wounds. We promised to teach doctors and nurses how to care for her wounds. Unfortunately, Gina died. The pictures were lost. A year later, Rosemary was admitted with a similar skin condition and allowed us to photograph the progression of her wound care. Our promise to Gina is now kept. Here we describe the wound care plan necessary to relieve the pain and discomfort of partial-thickness wounds from dermatological conditions in oncology patients.

Lower Genital Tract Neoplasia in Women With HIV Infection

Although overall death rates from the acquired immune deficiency syndrome (AIDS) are declining rapidly, the incidence of human immunodeficiency virus (HIV) in women continues to climb, and HIV-associated gynecologic disease is also likely toincrease over the next decade. In this paper on lower genital tract neoplasia in women with HIV infection, Abercrombie and Korn review some of the many studies documenting the increased incidence of cervical human papillomavirus (HPV) and HPV-asso-ciated disease in this population. The clinical importance of these studies is underscored by recent data from New York City, where the incidence of invasive cervical cancer increased significantly from 1990 to 1995 in HIV-positive women, compared to the general popu-lation of 25- to 49-year-old women.[1]

HPV Blood Test Could Predict Prognosis in Head and Neck Cancer

Head and neck cancer patients who have a human papillomavirus (HPV) infection detectable with a blood-based biomarker have a better prognosis compared with HPV-negative patients.

Caring for the Life You Saved

We may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.

COUNTERPOINT: Primary Debulking Surgery vs Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer

In a Significant Percentage of Patients, Neoadjuvant Therapy Yields Equivalent Survival, With Better Quality of Life and Lower Costs

Prophylactic Cranial Irradiation in Small-Cell Lung Cancer: Is It Ever Indicated?

Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]

Docetaxel/Doxorubicin/Cyclophosphamide in the Treatment of Metastic Breast Cancer

A pilot phase II study examined the feasibility of 75 mg/m² of docetaxel (Taxotere) in combination with 50 mg/m²of doxorubicin and 500 mg/m² of cyclophosphamide (Cytoxan, Neosar) in the first-line treatment of metastatic breast cancer. This study was designed to evaluate the efficacy and toxicity of the docetaxel/doxorubicin/cyclophosphamide combination both alone and as induction before high-dose chemotherapy, supplemented by autologous peripheral blood stem-cell transplantation.

Initiating Exercise Interventions to Promote Wellness in Cancer Patients and Survivors

This article includes a succinct review of current research into exercise in the cancer setting and a discussion of the American College of Sports Medicine exercise recommendations for cancer survivors. Common acute, long-term, and late effects of cancer and its treatment are also described in the context of ways in which these side effects impact the ability to exercise.

Gemcitabine/Epirubicin/Paclitaxel Trials in Advanced Breast Cancer

Numerous trials have shown that the pharmacokinetic interferences of epirubicin (Ellence)/paclitaxel (Taxol) combinations produce less pharmacodynamic effect than doxorubicin/paclitaxel regimens. Paclitaxel is more easily

Clinical Trial Simulation of a 200-µg Fixed Dose of Darbepoetin Alfa in Chemotherapy-Induced Anemia

Our objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic

Specialty Nutrition: New Approaches and Novel Ingredients

Specialty nutrition for patients with cancer is anexciting area in research. It is well known thatpatients with cancer experience many nutritionalproblems during the course of their disease-in particularanorexia and weight loss.[1,2] Specialty nutritioncan impact nutritional status directly by improvingweight and lean body mass, or indirectly by improvingcommon symptoms often associated with cancerand cancer therapies.

18 Vepdegestrant, a PROteolysis TArgeting Chimera (PROTAC) Estrogen Receptor (ER) Degrader, Plus Palbociclib in ER-Positive/Human Epidermal Growth Factor Receptor 2 (HER2)–Negative Advanced Breast Cancer: Phase 1b Cohort

Nonsteroidal and Steroidal Aromatase Inhibitors in Breast Cancer

Anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are members of the third generation of aromatase inhibitors that has now replaced aminoglutethimide (Cytadren), the progestins, and tamoxifen

Improving Adherence to Endocrine Therapies: The Role of Advanced Practice Nurses

With the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.

A Phase 2 Study of Docetaxel and Capecitabine in Advanced Squamous Cell Carcinoma of the Head and Neck

This study explores the efficacy and safety of combining docetaxel and capecitabine for treating recurrent or metastatic head and neck cancer.

NCI's Cancer Information Systems-Bringing Medical Knowledge to Clinicians

The National Cancer Institute's computerized information systems have been designed to help physicians cope with the information explosion by translating the medical literature into usable forms. Systems developed by the

Novel TKI Plus Chemo Dramatically Shrank Advanced Head & Neck Tumors

AZD1775, a small-molecule, WEE1-targeting TKI, significantly shrunk tumors when administered in combination with cisplatin and docetaxel in a phase I trial.

Challenges of IP Chemotherapy for Ovarian Cancer

Ms. Hydzik's article on intraperitoneal chemotherapy (IPC) for the treatment of ovarian cancer provides the rationale for IPC, presents the supporting evidence, and describes nursing management of these patients through the Memorial Sloan-Kettering Cancer Center experience.

Facing Forward: Meeting the Rehabilitation Needs of Cancer Surviviors

The 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.

Prechemotherapy Assessment of Neutropenic Risk

Chemotherapy-induced febrile neutropenia (FN) predisposes patients to life-threatening infections and typically requires hospitalization. The goal was to investigate whether a risk assessment tool aligned with national guidelines could help identify patients at risk of FN and reduce FN-related hospitalizations. Beginning in October 2004, oncology nurses applied the new risk assessment tool to all patients initiating chemotherapy or a new regimen. Patients at risk for FN received prophylactic colony-stimulating factor. Charts for 189 patients receiving chemotherapy in fiscal year 2005 (FY05) were compared with charts of 155 patients receiving chemotherapy in FY04, before the tool was implemented. The incidence of FN-related hospitalization declined by 78%, from 9.7% in FY04 to 2.1% in FY05 (P = .003). Total hospital days decreased from 117 to 24. Routine systematic evaluation by oncology nurses improves recognition of patients at risk of FN and substantially reduces FN-related hospitalization.

Chemotherapeutic Agents and Their Uses, Dosages, and Toxicities

This list of chemotherapeutic agents covers the cancers each drug is used for, as well as the recommended dosage and possible toxicities of the therapy.

Disparities in Cancer Care Among Racial and Ethnic Minorities

Eliminating cancer disparities-not only for racial/minority groups but for all underserved populations-must be a priority for those involved in cancer care. For individual practitioners, the first step in addressing disparities is accomplished through understanding the possibility that disparities exist in varying depth and complexity for each racial or ethnic minority patient.

Obesity and Cancer: The Risks, Science, and Potential Management Strategies

Overweight and obesity increase the risk of developing several cancers.Once cancer develops, individuals may be at increased risk of recurrenceand poorer survival if they are overweight or obese. A statisticallysignificant association between overweight or obesity and breast cancerrecurrence or survival has been observed in the majority of populationbasedcase series; however, adiposity has been shown to have less of aneffect on prognosis in the clinical trial setting. Weight gain after breastcancer diagnosis may also be associated with decreased prognosis. Newevidence suggests that overweight/obesity vs normal weight may increasethe risk of poor prognosis among resected colon cancer patients and therisk of chemical recurrence in prostate cancer patients. Furthermore, obesecancer patients are at increased risk for developing problems followingsurgery, including wound complication, lymphedema, second cancers,and the chronic diseases affecting obese individuals without cancer suchas cardiovascular disease and diabetes. Mechanisms proposed to explainthe association between obesity and reduced prognosis include adiposetissue-induced increased concentrations of estrogens and testosterone,insulin, bioavailable insulin-like growth factors, leptin, and cytokines.Additional proposed mechanisms include reduced immune functioning,chemotherapy dosing, and differences in diet and physical activityin obese and nonobese patients. There have been no randomized clinicaltrials testing the effect of weight loss on recurrence or survival inoverweight or obese cancer patients, however. In the absence of clinicaltrial data, normal weight, overweight, and obese patients should beadvised to avoid weight gain through the cancer treatment process. Inaddition, weight loss is probably safe, and perhaps helpful, for overweightand obese cancer survivors who are otherwise healthy.

The Future of NSCLC: Molecular Profiles Guiding Treatment Decisions

The authors of "ALK-Targeted Therapy for Lung Cancer: Ready for Prime Time," in this issue of ONCOLOGY, address the newest developments in the field of targeted therapies for advanced non–small-cell lung cancer (NSCLC).