Palliative and Supportive Care

Acute myeloid leukemia (AML) is a disease of the elderly, with the majority of patients diagnosed in their 6th and 7th decade of life. Older patients with AML are less likely to achieve complete remission after induction chemotherapy, and they suffer from higher rates of leukemia relapse compared to younger cohorts. Suboptimal outcomes are the result of adverse biologic characteristics of leukemia in the elderly, as well as the presence of medical comorbidities and patient or physician preferences as to initiating treatment. In addition, there is a distinct lack of randomized, prospective data to guide management decisions for the treatment of AML in the elderly. Patients who are over age 75, with poor performance status, multiple comorbidities, or poor prognostic features, should be considered for a clinical trial or palliative therapy. Elderly patients who are candidates for standard induction chemotherapy and achieve complete remission are unlikely to benefit from intensive postremission therapy and should be referred to a clinical trial when possible. Further prospective trials are needed to identify a tolerable, effective treatment regimen for older patients with AML.

As the Centers for Medicare & Medicaid Services(CMS) moves toward a payment system linked toquality performance, it is important that the oncologycommunity participates in the ongoing debateover how to define best quality care and how todeliver it.

The frequency and duration of chemotherapy-induced oral mucositis may be significantly improved by either prophylactic chlorhexidine or by cryotherapy, according to the results of a randomized, double-blind, placebo-controlled study presented at the 31st Congress of the European Society for Medical Oncology (ESMO) (abstract 988 O).

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.

In the past decade numerous advances have been made in the arena of cancer treatment. Evolving scientific discoveries related to molecular targets and cellular signaling have led to an increased understanding of how to develop novel therapeutic cancer agents.

Epidermal growth factor receptor inhibitors and other protein kinase inhibitors are novel agents that have recently been incorporated into the treatment of many solid malignancies. They specifically target the aberrant proteins in cancer cells and thus have fewer associated toxicities. These agents represent a welcome change in cancer treatment, as standard chemotherapy regimens entail numerous toxicities that may disqualify patients from continued administration or cause dose reductions or early discontinuation because of poor tolerance. Among the most common toxicities related to epidermal growth factor receptor inhibitors and multitargeted agents are cutaneous reactions that can lead to noncompliance and affect patients' sense of well-being. Oncology nurses play a key role in providing patient education, instituting preventive measures, and assuring early detection and intervention for patients on targeted therapies.

Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.

a brief overview of the dosing and administration guidelines for the various targeted therapy agents discussed in this supplement to the ONCOLOGY Nurse Edition. Please consult the manufacturer's package insert for more information.

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

The US Food and Drug Administration (FDA) has approved Amgen's Vectibix (panitumumab) for the treatment of patients with colorectal cancer that has metastasized following standard chemotherapy.

Virtual reality interventions that provide a distracting, immersive environment may make chemotherapy treatments more tolerable for cancer patients

The US Food and Drug Administration (FDA) has approved Schering-Plough Corporation's Noxafil (posaconazole) Oral Suspension for the prevention of invasive Aspergillus and Candida infections in patients age 13 years and older at high risk of developing these infections.

A research-based psychosocial intervention especially geared to the needs of children whose parents have cancer is of great benefit, offering emotional support at a time when their fears can be overwhelming

Methylphenidate (Ritalin) effectively reduces fatigue in men with prostate cancer; however, careful monitoring is essential because the psychostimulant can also elevate blood pressure and pulse rates

Members of the Oncologic Drugs Advisory Committee (ODAC) unanimously recommended that the Food and Drug Administration grant accelerated approval to Fragmin (dalteparin sodium, Pfizer) for the extended treatment of symptomatic venous thromboembolism (VTE), proximal deep vein thrombosis (DVT), and/or pulmonary embolism (PE) to reduce the recurrence of VTE in patients with cancer.

Amgen recently announced the launch of the darbepoetin alfa (Aranesp)-prefilled SureClick autoinjector for patients with chemotherapy-induced anemia and anemia associated with chronic kidney disease in the United States.

Study results suggest that 80,000 units of epoetin alfa (Epogen, Procrit) administered once every 2 weeks demonstrated comparable changes in hemoglobin levels and safety in treating chemotherapy-related anemia in patients with nonmyeloid malignancies compared to 40,000 units of epoetin alfa once weekly, the current recommended dosage.

Cephalon, Inc, announced that it has received approval from the US Food and Drug Administration (FDA) to market fentanyl buccal tablets (Fentora [C-II]) for the management of breakthrough pain in patients with cancer who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain.

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

Cancer causes pain as it invades bone, compresses nerves, produces obstructive symptoms in the pulmonary, gastrointestinal, and genitourinary systems, and distends involved visceral organs. This manuscript reviews progress in cancer pain management during the past 2 decades. Since the 1980s, we have seen (1) genuine advances in research on the biology of pain, (2) new approaches to the treatment of cancer pain, and (3) important changes in the health-care system to ensure that pain is appropriately assessed and managed. Currently, clinicians have the appropriate diagnostic and therapeutic tools to ensure that the vast majority of patients with cancer pain can be comfortable during their illness. Nevertheless, too many patients with terminal malignancies continue to die in pain in nations around the globe. An effective strategy to make alleviating pain a major health-care priority remains the primary challenge to effectively palliating patients with cancer pain.

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

The European Commission (EC) has granted approval for Novartis' Exjade (deferasirox) to treat patients with transfusional iron overload in all 25 member states of the European Union (EU). Exjade, available in the United States, is an oral iron chelator that provides continuous chelation coverage with a single daily dose.

Optimal mucositis management requires a good assessment tool; an oral care protocol that includes cleaning, flossing, rinsing, and lip care; cryotherapy where appropriate; and pain management

Wyeth Pharmaceuticals and Progenics Pharmaceuticals, Inc. (Tarrytown, New York) have begun a phase II clinical trial to evaluate once-daily dosing of oral methylnaltrexone, a peripheral mu opioid-receptor antagonist designed to reverse the effect of opioids on opioid receptors outside the central nervous system, thus reducing opioid-induced constipation. The trial is designed to identify the dose(s) of methylnaltrexone to be taken forward into the phase III studies.

The field of integrative oncology represents the synthesis of mainstream cancer treatment and rational, databased complementary therapies. These therapies are used not to treat cancer, but to reduce physical and emotional symptoms using noninvasive, nonpharmacologic modalities such as massage and music therapies, acupuncture, meditation, and other mind-body therapies, fitness programs, and the like.

The high prevalence of pain in the cancer population underscores why pain management is integral to comprehensive cancer care. How well pain is controlled can have a profound effect on the cancer experience for both patient and family. The goals of pain assessment are to prevent pain if possible, and to identify pain immediately should it occur. This can be facilitated by standardized screening of all cancer patients for pain, on a routine basis, across care settings. A comprehensive assessment of pain follows if a patient reports pain that is not being adequately managed. Oncology nurses play a huge role in pain assessment and management throughout the course of a patient's disease. A basic understanding of the types of pain seen in the cancer population as well as inferred neurophysiologic pain mechanisms and temporal patterns of pain can help focus the pain assessment. This in turn will lead to targeted pain management strategies