ONCOLOGY Vol 16 No 9 | Oncology

Oxaliplatin Approved for Use in Advanced Colorectal Cancer

September 01, 2002

Sanofi-Synthelabo recently announced that its platinum-based drug oxaliplatin (Eloxatin) has been approved by the US Food and Drug Administration (FDA) for use in combination with infusional fluorouracil (5-FU)/leucovorin in advanced colorectal cancer patients whose disease has recurred or progressed after bolus 5-FU/leucovorin plus irinotecan (CPT-11, Camptosar) therapy. The FDA approval is based on the response rate and improved time to tumor progression observed in an ongoing trial. Data that demonstrate a clinical benefit, such as improvement in disease-related symptoms or an increase in survival are not yet available.

Oncologists Oppose Stark Bill

September 01, 2002

Depending on what the Senate does in September, there is a slight chance Congress could act on the Medicare Market Acquisition Drug Price Act (H.R. 5167). Introduced by Rep. Pete Stark (D-Calif) in July, the bill would change the way Medicare reimburses oncologists for the oncology drugs they purchase to administer to patients in the office. Even the American Society of Clinical Oncology (ASCO) agrees change in the reimbursement format is necessary. Nevertheless, Paul A. Bunn, Jr, MD, president of ASCO, says, "Under this bill, reductions in Medicare reimbursement would make it very difficult for many doctors to continue providing high-quality treatment to people with cancer."

Management of Anemia in Patients With Cancer

September 03, 2002

Since our first "Quality of Life in Current Oncology Practice and Research" symposium was held at St. Mary Medical Center in Long Beach, California in February 1989, and published in ONCOLOGY in May 1990, there has been a marked increase in the use of quality of life measures to determine the outcomes of interventions in clinical oncology. Measuring the effects of anemia treatment with quality of life tools is a fine example of the importance of these tools to gauge the impact and clinical significance of interventions. It is, therefore, both timely and relevant that we dedicate our fifth symposium to the management of anemia in patients with cancer.

ASTRO Names New Honorary Members

September 01, 2002

Officials from the American Society for Therapeutic Radiology and Oncology (ASTRO) have announced that Ann Barrett, md, of the University of East Anglia in the United Kingdom, and John J. Curry, of the American College of Radiology, have

Bayer and Us Too! Collaborate on Support for Advanced Prostate Cancer Patients

September 01, 2002

The Bayer Corporation recently announced that it has teamed up with Us Too! International to offer Continuous Care, a program for advanced prostate cancer patients using the leuprolide acetate implant (Viadur). The program provides appointment reminders, education, support materials, and valuable health coupons.

Irinotecan and Other Agents in Lung Carcinoma

September 02, 2002

The 4th Investigators’ Workshop sponsored by The University of Texas M. D. Anderson Cancer Center was held on July 25-29, 2001, in Colorado Springs, Colorado. The purpose of these annual workshops has been to review the latest data on new agents, with a particular focus on the broadly used agent irinotecan (CPT-11, Camptosar).

New Drug Regimen Shows Clear Benefit in the Treatment of Advanced Colorectal Cancer

September 01, 2002

Patients with advanced colorectal cancer who received the FOLFOX4 regimen (fluorouracil [5-FU], leucovorin, oxaliplatin [Eloxatin]) responded significantly better to treatment, had fewer severe side effects, and lived months longer than did patients

FDA Approves Darbepoetin Alfa for Anemia Associated With Chemotherapy

September 01, 2002

The US Food and Drug Administration (FDA) has approved darbepoetin alfa (Aranesp) for the treatment of chemotherapy-induced anemia in patients with nonmyeloid malignancies. Darbepoetin alfa is a recombinant erythropoietic protein that requires fewer injections than previous treatments used for this indication. The agent maintains its level in the blood approximately three times longer than epoetin alfa (Epogen, Procrit), thus giving health-care providers the ability to treat anemia related to chemotherapy with less-frequent dosing than the current standard of care.

The Molecular Basis of Cancer, 2nd Edition

September 05, 2002

Edited by John Mendolsohn, MD, Peter M. Howley, MD, Mark A. Israel, MD, and Lance A. Liotta, MD, PhD, The Molecular Basis of Cancer is designed for students, researchers, and physicians in a variety of disciplines. It does not provide a detailed description of the clinical manifestations of human neoplasia. There is, instead, an extensive presentation of the scientific basis of cancer development and therapy. The book includes the contributions of 61 authors, virtually all of whom are recognized experts in their respective fields, from throughout the United States and Europe. The references are comprehensive and relatively current, given the lag time in going to press. The book will certainly benefit both basic scientists and clinicians alike.

Zoledronic Acid Effective as Treatment for Bone Complications in Prostate Cancer Patients

September 01, 2002

The bisphosphonate zoledronic acid (Zometa) is effective in the treatment of skeletal-related events from bone metastases in prostate cancer patients, according to data presented at the 97th annual meeting of the American Urological Association. Patients with advanced prostate cancer are at high risk for bone complications, including bone pain, pathologic fractures, need for radiation or surgery to bone, and spinal cord compression. This study marks the first time a bisphosphonate has demonstrated efficacy in the treatment of bone metastases in this patient population.

Role of Octreotide in Cancer and Therapy-Related Complications

September 01, 2002

Octreotide (Sandostatin), a somatostatin analog, has a wide range of uses in the management of cancer patients. It is a unique molecule that specifically binds to somatostatin receptor subtype 2. This property of activating the receptor can result in a multitude of physiologic actions (for example, inhibition of synthesis and release of peptides in endocrine and neoplastic cells, antiangiogenesis, antisecretory effect in the gastrointestinal mucosa, anticholecystokinin activity retarding gallbladder motility, and reduction in splanchnic blood flow). In addition, in vitro experiments confirm that octreotide has cytostatic activity against a variety of malignancies. Octreotide is now widely used in the treatment of hormonal syndromes that result from a variety of neuroendocrine and endocrine neoplasms. Its dramatic effect in controlling malignant carcinoid syndrome and hormone-induced diarrhea (for example, from gastrinoma and VIPoma) has been well documented. However, the chronic use of octreotide can result in steatorrhea and gallstone formation.

Commonly Used Quality of Life and Symptom Measurement Scales

September 03, 2002

On the following pages are examples of commonly used scales for evaluating quality of life and symptoms associated with anemia in patients with cancer. Please note that some of the scales are copyrighted (and marked as such herein) and may not be reproduced in anyway without the express written consent of the copyright holders.

Negative ‘Update’ Means Lower Medicare Reimbursement for Oncologists in 2003

September 01, 2002

Medicare’s proposed fee-schedule changes for calendar year 2003 would result in a 3% cut in average payments to oncologists. That reduction is due to an expected 4.4% negative "update" to all physician fees in 2003. The total relative value of the CPT codes used most often by oncologists will actually go up 1% in 2003 because of some positive changes Medicare wants to make in the "practice expense" portion of the relative value formula. However, that increase will not be nearly enough to offset the negative 4.4% update. The negative update could have been worse had Medicare not proposed to change the way it figures a "productivity" element in the Medicare Economic Index (MEI). A measure of inflation in physician inputs, the MEI is itself one of the determinants of the annual Medicare fee update-the higher the MEI, the higher the annual update, or the lower the decrease. The change being proposed by the Centers for Medicare & Medicaid Services raises the estimated 2003 MEI update from 2.3% to 3.0%. Without the productivity change, the update would have been a negative 5.1%. These figures are all preliminary. They will be finalized when Medicare releases a final 2003 fee schedule, probably in late October.

Medical Management of Carcinoid Neoplasms: Present and Future Considerations

September 01, 2002

Much progress in the diagnosis and management of well-differentiated neuroendocrine malignancies is evident over the past 2 decades. Initial medical intervention using somatostatin analogs such as octreotide acetate in the immediate and sustained release formulations (Sandostatin and Sandostatin LAR Depot) is standard for the symptomatic stage IV patient.[1,2] Somatostatin analogs provide effective hormonal suppression for carcinoid neoplasm, pancreatic islet cell malignancies, and pituitary adenomas.

Multiple Myeloma: Role of Allogeneic Transplantation

September 01, 2002

In this article, Pandit and Vesole present a focused overview of allogeneic transplantation for multiple myeloma. Additionally, this article addresses the challenges of allogeneic transplantation, including continued relapse and treatment-related toxicity and mortality.

Current Role of Irinotecan in the Treatment of Non-Small-Cell Lung Cancer

September 01, 2002

The comprehensive review by Dr. Karen Kelly meticulously outlines the rationale for the study of irinotecan in non-small-cell lung cancer (NSCLC), summarizes results of trials of this agent as monotherapy and as a component of doublet and triplet regimens in previously untreated NSCLC patients, and then reviews its role in previously treated NSCLC patients.

Radiation-Induced Enteritis: Incidence, Mechanisms, and Management

September 01, 2002

Diarrhea is a common problem in patients receiving pelvic irradiation with concurrent chemotherapy. Virtually all patients develop diarrhea of varying severity during the course of the treatment. The incidence and severity of diarrhea vary with the chemotherapy type and dose, radiotherapy field size, daily fraction size, and total dose of radiation given. Diarrhea (any grade) occurs in 30% to 87% of patients receiving chemotherapy and in 20% to 49% of patients receiving pelvic radiotherapy. The incidence of severe and life-threatening (grade 3/4) diarrhea ranges from 20% to 40% in patients receiving combined chemoradiotherapy.

Multiple Myeloma: Role of Allogeneic Transplantation

September 01, 2002

Multiple myeloma is a multistep malignancy, starting with an indolent phase (monoclonal gammopathy of unknown significance [MGUS] or smoldering myeloma), progressing to overt myeloma (which is typically restricted to the bone marrow), and

Current Clinical Trials of Flavopiridol

September 01, 2002

Flavopiridol [2-(2-chlorophenyl 5 ,7-dihydroxy-8-[cis-(3-hydroxy-1-methyl-4-piperidinyl)-4H-1-benzopyran-4-one, hydrochloride] is a semisynthetic flavone with a novel structure compared with that of polyhydroxylated flavones, such as quercetin and genistein.[1] It is derived from rohitukine, an alkaloid isolated from the stem bark of Dysoxylum binectariferum, a plant indigenous to India.[2] Originally synthesized and supplied by Hoechst India Limited, flavopiridol is provided to the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) by Aventis Pharmaceuticals, Inc.

Update on Adjuvant Interferon Therapy for High-Risk Melanoma

September 01, 2002

Two of the most important predictors of relapse (and, therefore, survival) in patients with melanoma are the Breslow thickness of the primary melanoma and regional lymph node involvement. Patients with melanomas greater than 4 mm in thickness have approximately a 50% risk of recurrence, and those with lymph node involvement have a 50% to 85% risk of recurrence depending on the number of lymph nodes involved. Thus, a group of patients can be identified who are at high risk of death from melanoma and are, therefore, appropriate candidates for postsurgical adjuvant therapy.

Antiangiogenesis as a Mechanism for the Antitumor Effects of Octreotide

September 01, 2002

Octreotide acetate (Sandostatin), a somatostatin receptor subtype 2 (sst 2)-preferring somatostatin analog, inhibits angiogenesis in a dose-dependent fashion in the chicken chorioallantoic membrane model (CAM) and in the human placental vein angiogenesis model (HPVAM).[1,2] To explain these antiangiogenic effects, sst 2 gene expression in normal (resting) full-thickness human placental vein segments was compared to tissue-matched counterparts that initiated an angiogenic response in culture. Using polymerase chain reaction (PCR) techniques, the sst 2 gene was found to be uniquely up-regulated in the angiogenic vessels, but not present in the tissue-matched resting (nonproliferative) vein segments.

Long-Acting Octreotide LAR Depot in the Treatment of Advanced Hepatocellular Carcinoma

September 01, 2002

Hepatocellular carcinoma (HCC) is the third most frequent cause of cancer death worldwide, causing 549,000 deaths in 2000-10% of all cancer deaths. There are strong etiologic associations with hepatitis C, hepatitis B, alcohol, other causes of cirrhosis, and dietary aflatoxins. The US incidence of HCC is 2.4/100,000 persons/year and rising due to the increased prevalence of hepatitis C.[1] After the current cohort of patients infected with the chronic hepatitis C virus passes, there will likely be a continued increase in the US incidence of HCC due to increasing rates of obesity-related nonalcoholic steatohepatitis, which causes many cases of "cryptogenic cirrhosis."

Resection of Liver Metastases: State of the Art

September 01, 2002

Surgery has evolved to become the standard of care for a defined subset of patients with hepatic colorectal metastases. Hepatic resections are now well-controlled procedures, with several centers reporting very low perioperative mortality rates.

Resection of Liver Metastases: State of the Art

September 01, 2002

In this article, Ravikumar and Gallos nicely summarize the current understanding of liver resection for metastases. My comments here will be limited to resection of colorectal metastases, as this is the most common and best characterized of the procedures described.

Current Role of Irinotecan in the Treatment of Non-Small-Cell Lung Cancer

September 01, 2002

Dr. Kelly has provided a complete, well-written review of the current status and evolving role of irinotecan (CPT-11, Camptosar) as a cytotoxic agent for patients with non-small-cell lung cancer (NSCLC). Her review clearly demonstrates the value of irinotecan in this patient population and further supports the continued development of this agent in concert with other chemotherapeutic agents, biologically targeted agents, surgery, and/or radiotherapy.

Role of Octreotide in Pancreatic Cancer

September 01, 2002

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. Of the 28,000 patients diagnosed each year, more than 95% will die of pancreatic cancer. Therefore, the focus of therapy for most patients is palliative care. In fact, the most active single-agent therapy for advanced disease-gemcitabine (Gemzar)-was first compared to fluorouracil (5-FU) with relief of disease symptoms as a primary end point. However, the survival with gemcitabine remains approximately 6 months for advanced disease, and no new agent, either alone or in combination, has exceeded this time frame in phase III study.

Is There a Role for Octreotide in the Treatment of Hormone-Refractory Prostate Cancer?

September 01, 2002

Normal and hyperplastic prostate glandular epithelium does not express somatostatin receptors. Neuroendocrine prostatic cells contain bioactive secretory products such as chromogranin A, serotonin, and neuron-specific enolase. The stromal smooth muscle cells around glandular epithelium and ganglion cells of the prostatic plexus are positive for somatostatin subtype 2 receptors (sst 2).[1] In prostate cancer, however, there is nonhomogeneous distribution of sst 1. In the peritumoral veins of prostate cancer, sst 2 receptors were found by Reubi et al in 14 of 27 samples.[2]

Current Status of Gastroenteropancreatic Tumor Management

September 01, 2002

Gastroenteropancreatic tumors, although relatively rare, present management problems that may last many years, in comparison with the usually more aggressive adenocarcinomas whose management may encompass a far briefer span of time. In general, 50% of such tumors are insulinomas, while gastrinomas comprise 25%, and nonfunctional tumors 20% VIPomas and glucagonomas are the predominant lesions of the remaining 5%. Clinical diagnosis is usually made on the presence of the classical symptom complex. In uncertain circumstances or covert presentations, the critical diagnostic biochemical test is plasma chromogranin A as well as measurement of the specific peptide.

Iron and the Anemia of Chronic Disease

September 03, 2002

The anemia of chronic disease traditionally is defined as a hypoproliferative anemia of no apparent cause that occurs in association with an inflammatory, infectious, or neoplastic disorder, and resolves when the underlying disorder is corrected. Disordered iron metabolism as manifested by a low serum iron, decreased serum transferrin, decreased transferrin saturation, increased serum ferritin, increased reticuloendothelial iron stores, increased erythrocyte-free protoporphyrin, and reduced iron absorption, is a characteristic feature of the anemia of chronic disease and has been thought to be a major factor contributing to the syndrome.

Diagnosis and Management of Aplastic Anemia and Myelodysplastic Syndrome

September 03, 2002

The bone marrow failure states, aplastic anemia and myelodysplastic syndrome, are characterized by reticulocytopenic anemia, with variable neutropenia and thrombocytopenia. The bone marrow biopsy is very hypocellular in aplastic anemia, but it is usually hypercellular in myelodysplastic syndrome.

Systematic Review of Controlled Trials on Erythropoietin to Support Evidence-Based Guidelines

September 03, 2002

To support evidence-based clinical guidelines on erythropoietin use for anemia in oncology, we conducted systematic reviews of controlled trials on four patient groups. These were patients with treatment-related anemia; patients with disease-related anemia; patients transplanted with allogeneic hematopoietic stem cells; and those transplanted with autologous hematopoietic stem cells.

Resection of Liver Metastases: State of the Art

September 01, 2002

In this article, we present current surgical perspectives on the management of liver metastases, with a focus on state-of-the-art resection, by drawing on clinical data provided in the medical literature. Metastases from

What Evidence Supports Use of Erythropoietin as a Novel Neurotherapeutic?

September 03, 2002

In its hormonal role, erythropoietin is produced by the kidney in response to hypoxic stress and signals the bone marrow to increase the number of circulating erythrocytes. It has become clear in recent years, however, that erythropoietin and its receptor are members of a cytokine superfamily that mediates diverse functions in nonhematopoietic tissues. Nonhormonal erythropoietin actions include a critical role in the development, maintenance, protection, and repair of the central nervous system (CNS).

Recombinant Human Erythropoietin in Cancer-Related Anemia

September 03, 2002

The clinical development of recombinant human erythropoietin (rHuEPO) has had a remarkable impact on the clinical practice of oncology. A decade ago, randomized, placebo-controlled trials in anemic cancer patients demonstrated that rHuEPO resulted in an improvement in hemoglobin and hematocrit, a reduction in transfusion requirements, and improvement in quality-of-life (QOL) end points. Based on these trials, recombinant erythropoietin was approved for the treatment of anemia in patients with nonmyeloid malignancies in whom the anemia was caused by the effect of chemotherapy.

Current Role of Irinotecan in the Treatment of Non-Small-Cell Lung Cancer

September 01, 2002

Lung cancer remains the primary cause of cancer-related death in both men and women in the United States. Chemotherapy has been shown to provide a survival benefit in patients with advanced non-small-cell lung cancer (NSCLC), and current regimens have produced median survivals of approximately 8 months and 1-year survival rates of 30% to 35% in patients with stage IIIB and IV disease. Nevertheless, there remains room for improvement. Irinotecan (CPT-11, Camptosar) has demonstrated efficacy in the treatment of small-cell lung cancer (SCLC). It also appears to have promising activity in advanced NSCLC, producing overall response rates of up to 32%. Combinations of irinotecan and cisplatin or carboplatin (Paraplatin) have resulted in overall response rates of 25% to 56% in phase II and III studies in patients with advanced disease, with median survivals ranging from 9 to 13 months and 1-year survival rates of 33% to 58%. Current irinotecan-based doublet and triplet regimens appear to produce promising response rates with manageable toxicities. In addition, irinotecan has demonstrated potential as a radiosensitizing agent and is currently being evaluated in several trials of combined-modality therapy in patients with locally advanced NSCLC. Early trials of irinotecan in combination with cisplatin or carboplatin along with radiation therapy have reported overall response rates of 60% to 67%. The approach appears to have potential and warrants further study. [ONCOLOGY 16:1153-1168, 2002]

When Is it Justified to Treat Symptoms? Measuring Symptom Burden

September 03, 2002

Symptom burden is certainly not a new concept in the literature on disease and treatment, but recent developments in our understanding of how to measure symptoms and their impact make it possible to cast symptom burden as a reasonable summary measure of both disease- and treatment-outcome status. We discuss the use of symptom burden as an alternative to quality-of-life measures or as a supplement to these measures.

Overcoming Barriers to Erythropoietic Therapy

September 03, 2002

Barriers to use of erythropoietic therapy in cancer patients include nonresponse in a sizable proportion, resultant lowering of cost-effectiveness, and inconvenience. Darbepoetin alfa represents the outcome of efforts to develop agents with improved erythropoietic potency.

Camptothecin and Taxane Regimens for Small-Cell Lung Cancer

September 02, 2002

For more than 2 decades, combination chemotherapy has been the standard treatment for patients with small-cell lung cancer. Despite high initial response rates in both extensive- and limited-stage disease, long-term survival

The Potential for Anemia Treatment to Improve Survival in Cancer Patients

September 03, 2002

One of the most fundamental challenges to multicellular life is the delivery of sufficient oxygen and metabolic substrate to all cells and the rapid elimination of acid formed during cellular respiration. Thus it is logical to wonder whether anemia, by compromising these pathways, might contribute to the progression of cancer.

Blood Substitutes: How Close to a Solution?

September 03, 2002

The term "blood substitute" is commonly misused when "red cell substitute" is meant. The ideal red cell substitute should deliver oxygen (O2), require no compatibility testing, cause few side effects, have prolonged storage qualities, persist in the circulation, and be available at reasonable cost. While no drug with all of these qualities is on the near horizon, several early generation red cell substitutes are approaching submission for licensure, at least for limited indications.

Anemia in Cancer Patients: Significance, Epidemiology, and Current Therapy

September 03, 2002

Anemia in cancer patients is associated with a decline in energy levels, activity levels, and quality of life, and these variables improve when hemoglobin levels rise. Importantly, the impact of improved hemoglobin levels on response to chemotherapy, radiation therapy, and survival time is under study.

Erythropoietic Agents as Neurotherapeutic Agents: What Barriers Exist?

September 03, 2002

Erythropoietin is the primary physiological regulator of erythropoiesis, and it exerts its effect by binding to cell surface receptors. It has recently been shown that both erythropoietin and its receptor are found in the human cerebral cortex, and that, in vitro, the cytokine is synthesized by astrocytes and neurons, has neuroprotective activity, and is up-regulated following hypoxic stimuli. In animal models, exogenous recombinant human erythropoietin has been reported to be beneficial in treating experimental global and focal cerebral ischemia and reducing nervous system inflammation

Targeted Therapy in Non-Small-Cell Lung Cancer

September 02, 2002

Although treatment of advanced non-small-cell lung cancer has been improved with the availability of such new agents as the taxanes, topoisomerase inhibitors, vinorelbine (Navelbine), and gemcitabine (Gemzar), platinum-

Topoisomerase I-Based Nonplatinum Combinations in Non-Small-Cell Lung Cancer

September 02, 2002

Lung cancer is the leading cause of cancer-related death in males and females in the United States. Most patients have advanced disease at diagnosis. Chemotherapy is the treatment of choice for patients with good performance

Irinotecan Plus Cisplatin in Small-Cell Lung Cancer

September 02, 2002

The DNA topoisomerase inhibitor irinotecan (CPT-11, Camptosar) is being evaluated as a novel chemotherapeutic agent for small-cell lung cancer that may complement other agents and treatment modalities. Combination

Assessing Quality of Life in Research and Clinical Practice

September 03, 2002

There is a growing recognition in oncology of the importance of maintaining or improving patients’ quality of life (QOL) throughout the disease course. With this goal in mind, many clinical trials in oncology now seek to evaluate QOL end points.

Multiple Myeloma:Role of Allogeneic Transplantation

September 01, 2002

An estimated 14,600 new cases of multiple myeloma will be diagnosed in the United States in 2002. Multiple myeloma remains an incurable disease despite significant improvements in complete response rates and overall

Commentary (Droller): Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer

September 01, 2002

This second installment on prostate specific antigen (PSA) as a marker of disease activity and cancer cell viability in prostate cancer focuses on its role in monitoring the effects of a variety of therapies at different stages of the disease. In addition, the authors propose guidelines for studying the efficacy of new treatments in this setting.

Commentary (Crawford): Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer

September 01, 2002

As a tumor marker, prostate specific antigen (PSA) has revolutionized the detection and management of adenocarcinoma of the prostate. From its discovery in the early 1970s to its application in the 1980s and finally widespread use in the 1990s, PSA has profoundly affected the way in which we treat prostate cancer. Many researchers in basic science and clinical practice have helped to create the PSA story, and the authors of this manuscript have made major contributions to our understanding of PSA as a tumor marker.

Update on Adjuvant Interferon Therapy for High-Risk Melanoma

September 01, 2002

Despite more than 2 decades of active clinical study, the use of interferon as adjuvant therapy for high-risk melanoma remains controversial. The controversy has centered on dose, schedule, and toxicity of treatment. Agarwala and Kirkwood superbly summarize the clinical studies to date and highlight many of the salient issues relevant to clinicians.

Practitioners’ Practical Model for Managing Cancer-Related Anemia

September 03, 2002

Anemia is the most common hematologic abnormality seen in patients with cancer. Anemia is associated with debilitating symptoms and poorer health-related quality of life and may result in less than optimal disease/treatment outcomes.

Update on Adjuvant Interferon Therapy for High-Risk Melanoma

September 01, 2002

Melanoma is almost 100% curable when diagnosed early, but when metastatic to distant organs, it is associated with a poor survival. The interferons have shown the most promise in the treatment of melanoma and interferon

Physical Function in Men and Women With Cancer

September 03, 2002

Fatigue is an extraordinarily common consequence of cancer and its treatment. Fatigue can result in diminished cognitive and physical functional capacity and may be the result of multiple causes.

Clinical Presentation and Management of Hemolytic Anemias

September 03, 2002

The hallmark of hemolysis is shortened red blood cell survival in the peripheral blood. Hemolysis results in anemia only when bone marrow cannot keep up with the rate of red cell destruction. Even though anemia is very commonly observed in most cancer patients, hemolytic anemias are rather rare.

The Effects of Anemia and Anemia Treatment on the Quality of Life of People With Cancer

September 03, 2002

Anemia, common in people with cancer, can be due to the disease itself or to the associated therapy. Fatigue, the most prevalent of all symptoms experienced by cancer patients, is the primary symptom of anemia. Caused by many factors, fatigue, regardless of etiology, has an adverse impact on health-related quality of life.