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Oncologists would be well advised to consider their obligations to the patient, as well as other stakeholders, and be prepared to resolve potential conflicts that go beyond the focus of their clinical training.

Further prospective clinical trials in very elderly patients with DLBCL are clearly needed. Complementing the growing need for such trials, an evolving clinical trial infrastructure, geriatric oncology support, and novel therapeutics are making such studies feasible in the current era.

Elderly patients may have several such comorbidities, but their impact on normal life is minimal-and so most of these patients may receive a curative treatment such as R-CHOP. Very elderly patients have more comorbidities with greater impact, with the result that some of their vital organs exhibit functional deficiency.

In this review, we critically analyze clinical trials that were specifically designed for the very elderly, and we discuss the challenges encountered by investigators who are conducting studies in this patient population. We conclude by proposing an algorithm to help clinicians determine the optimal therapeutic strategy for treatment of DLBCL in very elderly patients.

It is hard to realize that an elderly patient's visit to you is likely the only trip outside his or her apartment for the week and the only contact with someone other than family or an aide. Doctor visits sometimes become the elderly's primary contact with the larger world.

Costs of care continue to rise; new cancer drugs are more expensive than ever before, and more patients are being treated with these drugs. While patients and claims datasets consistently report an association between financial burden and quality of care, the impact on traditional disease-related outcomes-survival, for example-have not been assessed.

In this article, we have chosen to focus on three ethical challenges that we believe practicing oncologists might commonly encounter with their patients. The ethical dilemmas are presented in a case-based approach in the hope of better joining the ethical theory to clinical practice.

Cancer Network presents exclusive coverage from the American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium. Check out the stories below for write-ups of the most important information to come out of this year's event.

New data suggest that surveillance of patients with small kidney tumors may be a safe alternative to surgery, especially in older patients or those with comorbid conditions.

As often as not, the decision whether to treat or deny treatment to any elderly patient with cancer is a result of an oncologist’s impression of the individual person’s ability to benefit from and withstand the side effects of therapy. And that decision is usually based on a clinical assessment that is far more intuitive than it is scientific.

Localized prostate cancer treatment with surgery or radiation results in similar long-term side effects, such as erectile dysfunction and urinary incontinence.

My suggestion, as unrealistic as it is, would be to encourage the creation and maintenance of parallel groups of quality measures: one set to satisfy the reportable measures of quality that affect reimbursements and pay for performance, and a second set that would be developed by and adapted to each institution to measure and drive improvements in those things we felt were true measures of high quality care.

The reality is that new biological agents are often priced like a Ferrari, and patients who are covered under a pharmacy benefit are required to fork over not a fixed copay but a percentage of the pill’s cost, each and every month ‘til eternity or death, whichever comes first.

The same week that bevacizumab (Avastin) received a new indication for the treatment of metastatic colorectal cancer, results from two phase III trials involving the drug were presented at the American Society of Clinical Oncology 2013 Gastrointestinal Cancers Symposium (ASCO GI) held January 24–26 in San Francisco.

By Cary A. Presant, MD, FACP1, Linda Bosserman, MD, FACP1, Wendy McNatt1, Brandon Emilio11Wilshire Oncology Medical Group, La Verne, California

Cancer Network presents exclusive coverage from the American Society of Clinical Oncology (ASCO) 2013 Genitourinary Cancers Symposium. Check out the stories below for write-ups of the most important information to come out of this year's event.

The mTOR inhibitor everolimus (Afinitor) has been found to significantly reduce the size of angiomyolipomas, the slow-growing benign tumors commonly associated with tuberous sclerosis complex (TSC) and sporadic lymphangioleiomyomatosis, according to the results of the phase III EXIST-2 study.

Such a systematic review of the current status of mTOR inhibitors in the treatment of breast cancer demonstrates holes in our knowledge of the role of the tumor, the host, and metabolic factors in breast cancer progression.

Efforts to identify clinical biomarkers of response or resistance to mTOR inhibitors are ongoing. This review will summarize results of preclinical and clinical studies as well as ongoing clinical trials with mTOR or dual PI3K/mTOR inhibitors.

Reading the contents of the NCI Cancer Bulletin in recent years, I have become increasingly concerned by what I perceive as an irrational, pervasive, and persistent editorial bias against cancer screening.

The annual report to the nation on the status of cancer in the United States, published Monday, shows cancer death rates overall continue to decline. The number of people who die as a result of their cancer has been steadily declining since the 1990s, and over the 9-year period between 2000 and 2009, the report shows a 1.8% decrease in death rates per year among men and a 1.4% decrease among women.

There has been a decline in overall cancer screening among the US population. Only colorectal cancer screening rates met current screening goals. Cancer survivors specifically met current national screening goals with the exception of cervical cancer screening.

Without naming drugs, because there are several that fall into this category, has anyone else noticed that many of the new cancer drugs show an infinitesimal improvement in progression-free survival or overall survival?

Much study has been done on how to promote the most important attribute physicians must have in order to fulfill their sworn duty: that of professionalism. For practicing physicians such frustrations as the insurance bureaucracy and the pressure to generate visits can erode that duty.

In this interview we discuss what patients expect from their cancer treatment with Deborah Schrag, MD, MPH, associate professor at Harvard Medical School. Dr. Schrag recently published a study that aimed to discover how patients with advanced cancer understand the purpose of their chemotherapy treatment.

As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign.

Find out how your compensation, bonuses, and benefits compare to your peers. Data exclusive to Cancer Network.

The Come Home project will demonstrate that community oncology practices can aggressively manage the symptoms and complications of cancer and its treatment-and at the same time can save money by limiting the use of expensive sites of service like hospitals and emergency departments.

Initiating discussions about end-of-life care with patients with incurable cancers early in their disease was associated with a decrease in late-stage aggressive cancer treatments such as chemotherapy or acute care, and with an increase in the use of hospice care at the end of life.