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Dr. Richard Schilsky, Dr. Edward Pan, Pam Kedziera

A mature 70-patient report by Chau T. Dang, MD, et al, on cardiac safetyof dose-dense AC (doxorubicin and cyclophosphamide, 60/600 mg/m2 X4) followed by Taxol with Herceptinfor 52 weeks in HER2-positivepatients, has concluded that theregimen is feasible; 3 of 70 patients (4%) had cessation oftrastuzumab because of asymptomaticLVEF decline, about 6 monthsinto the treatment period.

A second interimefficacy analysis of BCIRG 006 indicatessimilar survival benefit but significantlyless toxicity with a regimen oftrastuzumab (Herceptin) plus docetaxel(Taxotere), compared with trastuzumabplus doxorubicin.

As oncology professionals, we all look forward to seeing our successfully treated patients come in for their follow-up visits. In a busy day filled with making complex medical decisions, delivering bad news, managing symptoms, and dealing with insurance companies, it is a real highlight. These individuals are among the over 10 million cancer survivors in the United States and represent 3.5% of the population. However, along with these optimistic results come new challenges for survivors that require ongoing medical care and psychosocial support. Survivors face lifetime health risks that are dependent on the cancer, treatment exposures, genetic predispositions, comorbid health conditions, and lifestyle behaviors.

The risk of cancer increases with age, and as the US population rapidly ages, the number of older adults seeking treatment for cancer is also increasing dramatically. However, this growing population of older adults has been underrepresented in clinical trials that set the standards for oncology care. In addition, most clinical trials conducted to date have not addressed the problems that accompany aging, including reduced physiologic reserve, changes in drug pharmacokinetics, and the impact of comorbid medical conditions and polypharmacy on treatment tolerance. As a result, there are variations in treatment patterns between older and younger adults and few evidence-based guidelines accounting for the changes in physiology or pharmacokinetics that occur with aging. This article examines the demographics of cancer and aging, the barriers to enrollment of older adults on clinical trials, and approaches for future trials to address the needs of the older patient.

The risk of cancer increases with age, and as the US population rapidly ages, the number of older adults seeking treatment for cancer is also increasing dramatically. However, this growing population of older adults has been underrepresented in clinical trials that set the standards for oncology care. In addition, most clinical trials conducted to date have not addressed the problems that accompany aging, including reduced physiologic reserve, changes in drug pharmacokinetics, and the impact of comorbid medical conditions and polypharmacy on treatment tolerance. As a result, there are variations in treatment patterns between older and younger adults and few evidence-based guidelines accounting for the changes in physiology or pharmacokinetics that occur with aging. This article examines the demographics of cancer and aging, the barriers to enrollment of older adults on clinical trials, and approaches for future trials to address the needs of the older patient.

The risk of cancer increases with age, and as the US population rapidly ages, the number of older adults seeking treatment for cancer is also increasing dramatically. However, this growing population of older adults has been underrepresented in clinical trials that set the standards for oncology care. In addition, most clinical trials conducted to date have not addressed the problems that accompany aging, including reduced physiologic reserve, changes in drug pharmacokinetics, and the impact of comorbid medical conditions and polypharmacy on treatment tolerance. As a result, there are variations in treatment patterns between older and younger adults and few evidence-based guidelines accounting for the changes in physiology or pharmacokinetics that occur with aging. This article examines the demographics of cancer and aging, the barriers to enrollment of older adults on clinical trials, and approaches for future trials to address the needs of the older patient.

Mr. CH is a 71-year-old retired naval officer who works full time as an aerospace engineer. He began experiencing increasing lethargy and malaise in August 2000 at the age of 65. He was finding it difficult to concentrate and became tired by the end of the day. An evaluation by his primary care physician revealed anemia and iron deficiency. CH received a trial of iron and erythropoietin with no substantial improvement. His anemia progressed; he required his first red blood cell transfusion in September 2001. He was referred to a hematologist at a regional comprehensive cancer center.

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About 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.

Adding rituximab (Rituxan) to CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) significantly improves the time to treatment failure and overall survival in elderly patients with previously untreated advanced-stage follicular lymphoma (FL)

Total cancer deaths decreased in the United States for the second consecutive year in 2004, a drop of 3,014 deaths from the toll recorded in 2003. The number of deaths in 2003 declined 369 from the total in 2002.

As government pressure to reduce healthcare spending increases, gaps in Medicare coverage for participation in clinical trials is a potential barrier that could compromise the ability to conduct valuable medical research.

Accelerated partial breast irradiation (APBI) may be an effective and well-tolerated alternative to standard radiotherapy in early-stage breast cancer, and partial breast irradiation with interstitial brachytherapy also appears feasible in women who have had a recurrence after previous breast radiotherapy

Infusion of bone-marrow-derived mesenchymal stem cells (MSCs) appears to be a promising treatment for severe, steroid-resistant graft-vs-host disease (GVHD)

Four years of follow-up have confirmed that the front-line combination of all-trans-retinoic acid, or ATRA (tretinoin, Vesanoid), and arsenic trioxide (Trisenox) is beneficial for the treatment of patients with newly diagnosed acute promyelocytic leukemia (APL)

A phase III trial has shown that using arsenic trioxide (Trisenox) after standard first-line chemotherapy for acute promyelocytic leukemia (APL) significantly improves event-free survival and provides better overall survival, compared to standard therapy alone.

Over the past several years, new structures known as Regional Health Information Organizations, or RHIOs, have begun to appear on the healthcare scene.

An online survey of the impact of cancer on the careers and working environment of patients revealed strong support from employers, with 75% to 79% granting time off for doctor's appointments and allowing flexible work schedules and tele-commuting.

In the clinical practice setting, almost a quarter of women treated for breast cancer stop tamoxifen within 1 year, a rate twice as high as indicated by previous studies.

This challenging supplement to ONCOLOGY is based on the proceedings of a closed expert symposium, and provides an overview of our current knowledge on primary cutaneous T-cell lymphomas (CTCL). The complete spectrum from genetics to clinical practice is covered.

Deaths from liver cancer increased over the past year in both men and women, reported the American Liver Foundation, a national nonprofit organization that provides education, advocacy, and research on behalf of the 30 million Americans affected by liver disease. This is despite recent news focusing on the overall decline in the number of deaths due to most cancers.

The National Comprehensive Cancer Network (NCCN) recently announced updates to the NCCN Antiemesis Guidelines. The NCCN Clinical Practice Guidelines in Oncology are used extensively by managed care companies and by Medicare as the basis for coverage policies. The guidelines have a new recommendation for breakthrough treatment—Nabilone (Cesamet, Valeant)—for chemotherapy-induced nausea/vomiting.

Congress adjourned and retreated from the nation's capital in early December without passing 9 of the 11 fiscal year (FY) 2007 appropriations bills, including that of the Department of Health and Human Services.

A mind-body technique known as self-hypnotic relaxation performed during certain medical procedures significantly reduces pain, anxiety, drug use, and complications.

A striking black-and-white photograph (see Figure) of nursing student Katherine Wilson, a nonsmoker who lived 5 years with small-cell lung cancer before dying in 2005 at age 28, won the Best of the United States first prize in the 2006 Lilly Oncology on Canvas: Expressions of a Cancer Journey International Art Competition and Exhibition. The US competition finale was held at the Metropolitan Pavilion, New York, with Lilly President and COO John C. Lechleiter, PhD, presenting the top three US finalists with their awards.

In first-line therapy of chronic lymphocytic leukemia (CLL), alemtuzumab (Campath) has superior efficacy to the standard treatment, oral chlorambucil, with manageable toxicity, according to results of the CAM307 trial.

Genta Incorporated announced that it has received notice that its New Drug Application for the use of Genasense (oblimersen) plus chemotherapy in patients with relapsed/refractory chronic lymphocytic leukemia (CLL)