ONCOLOGY Vol 9 No 12

The incidence of invasive breast cancer among women age 65 years or older is twice that among those age 35 to 44 years,

University of Pittsburgh Cancer Institute (UPCI) investigators have begun vaccinating people with advanced melanoma using molecules that are overexpressed in melanoma cells.

In the United States, efforts to reduce mortality from breast cancer focus primarily on secondary prevention (ie, early detection

Combinations of the new agent, Taxotere (docetaxel), and Navelbine (vinorelbine), and Taxotere plus Adriamycin (doxorubicin) have both demonstrated activity in the treatment of metastatic breast cancer, according to research presented

Forty years of research have had a tremendous impact on the treatmentof leukemia in both children and adult's, according to a panel

A new technique for enriching progenitor blood cells and purging tumor cells before reinfusing the progentitor cells into cancer patients offers significant advantages over bone marrow for transplantation, according to investigators at Stanford University.

As oncology professionals, what initially drew us into this field was some mix of the mystery and intrigue of cancer with the

Human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2)both cause AIDS. Following the licensure of combination HIV-l/HIV-2

While it would seem obvious that dose intensity is an important determinant of treatment outcome in aggressive lymphomas, actually there are very few prospective data to support this hypothesis. Circumstantial evidence derived from retrospective analyses suggests that dose intensity is of clinical significance.

Gaynor and Fisher provide a literature review and analysis of the significance of dose intensity in determining treatment outcome in patients with intermediate-grade non-Hodgkin's lymphoma (NHL). Since most of the patients in the studies reviewed had diffuse large-cell lymphoma or its variants, that is the term that will be used in the remainder of this commentary. In their analysis, Gaynor and Fisher reach the conclusion that in the dose range tolerable without extraordinary supportive measures, increasing dose intensity has no demonstrable benefit.

We commend the authors for an earnest, if tentative and incomplete, acknowledgment that information on discrimination in the initial or continued employment of cancer patients and survivors after enactment of the Americans with Disabilities Act (ADA) needs to be gathered and reported. This subject requires the type of in-depth study with which oncologists are familiar and which characterized follow-up of employment discrimination prior to enactment of the ADA [1-3].

Mark Rothstein and colleagues have tackled a difficult and sensitive subject: the existence of, and reasons for, employment discrimination against cancer victims. Employment discrimination in any chronic disease is not uncommon, but may be even more widespread in cancer patients, whose treatment is very lengthy, often physically or mentally debilitating, and usually exceedingly expensive. Because improved therapeutic approaches to the treatment of cancer have led to increased rates of survival, there will be more and more survivors in our society in the future. In pediatric cancer, therapeutic advances continue to increase the survival rate, which now is estimated at about 70% overall [1]. Thus, the potential for increasingly greater numbers of employable cancer survivors is high. And with children, although representing only 1% of all cancers, the actual number of person-years saved will be exceedingly high [1]. Adult cancers are diagnosed at more advanced age and in many cases the patient is near retirement age. Nevertheless, the issue of employability and job discrimination is very important to resolve.

The comprehensive review by Drs. Gaynor and Fischer details the historical and prospective data on conventional doxorubicin-based chemotherapy in advanced-stage intermediate grade lymphoma. However, it does not address the question of dose intensity in the era of growth-factor and stem-cell support. As the authors carefully document, modest increases in the dose intensity of conventional agents has translated into little objective gain in curative outcome. The pivotal Intergroup study [1] has emphasized the value of prospective compararative trials and has established CHOP (cyclophosphamide, doxorubicin HCl, Oncovin, and prednisone) as the gold standard of conventional chemotherapy.

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.