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A 31-year-old man presented in May 2007 with generalized painful, ulcerated, and necrotic papules and plaques worsening for the last few months. He had been diagnosed with mycosis fungoides in October 2005. Treatments included topical corticosteroids and psoralen with ultraviolet A light therapy (PUVA), with the latter being discontinued because of the development of blisters. For the last 6 months, he had been treated with oral bexarotene (Targretin), with initial improvement of his skin lesions.

Palliative care for patients and their families across the cancer disease trajectory-from diagnosis, through survivorship, to end of life-is essential for quality cancer care. In their excellent article, Ferrell and Virani emphasize the important role of oncology nurses in providing palliative care, and they present the National Consensus Project (NCP) Guidelines[1] and the National Quality Forum (NQF)[2] preferred practices as a roadmap for all oncology nurses to use in their practice.

Patients with cancer have significant needs for palliative care, including pain and symptom management and psychosocial and spiritual support. The experience of cancer has an impact on family caregivers as well, and palliative care needs exist from diagnosis through survivorship and end-of-life care. Oncology nurses have opportunities to integrate palliative care into disease-focused care.

Pain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.

Imagine my surprise to unwrap my Sunday paper one day last month and find inside a clever advertising pamphlet and a card good for a free tin of Camel Snus (pronounced "snoose"), R.J. Reynolds' new flavored spitless chewing tobacco.

Steven Rosen, MD, Genevieve Teuton Professor of Medicine at the Feinberg School of Medicine, Northwestern University, and director of the Robert H. Lurie Comprehensive Cancer Center, has agreed to accept the position of Editor-in-Chief for Oncology News International (ONI).

Soaring expenditures must be contained or they will end up sinking the healthcare system, Allen S. Lichter, MD, CEO of ASCO, said during a featured appearance at the Radiological Society of North America meeting (see photograph below). Among the changes that could help attack the problem is mandatory insurance coverage for all citizens, Dr. Lichter said. He also cast doubt on the ability of one currently popular approach, consumer-driven, high-deductible healthcare plans, to solve the system's problems.

The first interim results from the first study of dasatinib (Sprycel) as induction therapy of Ph+ acute lymphoblastic leukemia (ALL) show complete and early hematologic responses with good overall compliance

A cutting-edge prognostic tool called MammaPrint, developed by Agendia, a laboratory located in The Netherlands, uses molecular technology to predict whether breast cancer will metastasize, helping clinicians make more accurate management decisions for their patients.

Use of accelerated partial breast irradiation (APBI) with multicatheter brachytherapy to treat resected early-stage breast cancer is associated with good early outcomes in terms of local control, adverse effects, and cosmesis

Pharmion Corporation announced final data from a randomized, double-blind, placebo-controlled phase III trial demonstrating that the addition of thalidomide (Thalomid) to standard treatment improves survival by 17.6 months in patients over age 75 newly diagnosed with multiple myeloma compared to standard treatment, consisting of melphalan and prednisone (MP) alone.

Pain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.

Strides made in the treatment of metastatic breast cancer (MBC) appear to prolong survival in some settings, but the cost in terms of quality of life (QOL) remains a concern. The previous four E-Updates in this series on metastatic breast cancer have focused on the various treatment options, including chemotherapy, anti-HER2 targeted therapy, antiangiogenic therapy, and hormonal therapy. In this E-Update, we turn to the role of supportive measures in the treatment of cancer, specifically as these measures relate to quality of life. These measures include the use of erythropoiesis-stimulating agents (ESA) and bisphosphonates, management of fatigue and pain, and psychological care.

FDA has approved a supplemental New Drug Application for Nexavar (sorafenib) tablets for the treatment of patients with unresectable heptocellular carcinoma. Nexavar (Bayer Healthcare Pharmaceuticals and Onyx Pharmaceuticals) is the first approved systemic therapy for liver cancer and the only one shown to significantly improve overall survival.

Celgene to acquire Pharmion

Compared with older men, younger men have a similarly high rate of biochemical control of localized prostate cancer when treated with brachytherapy and should therefore be offered this treatment option

Cancer patients receiving chemotherapy have not noticed a restriction in their access to treatment following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003

Radioactive microsphere therapy is gaining in popularity among specialists who deal with both primary and metastatic solid tumors in the liver (see images on page 1 and "On the cover" box below). During the past 2 years, sessions dedicated to this therapeutic approach have been held in meetings of all major related specialties: interventional radiology, radiology, radiation oncology, surgical oncology, hepatobiliary surgery, nuclear medicine, and medical oncology.

A New England Journal of Medicine review article is highlighting the cancer risks of computed tomography at the same time that hundreds of scientific presentations and new product announcements at the 2007 RSNA meeting are fueling the continued growth of multislice CT.

America's clinical trial pipeline is drying up, with fewer safe and effective new cancer drugs reaching the market. Some experts contend that FDA's control of the drug approval process hinders the development of new products.

In 1998, the American Cancer Society (ACS) set a challenge goal for the United States to lower cancer incidence by 25% between 1992 and 2015. At about the midpoint (2004), overall cancer incidence rates had declined at a rate of about 0.6% per year, about half the pace needed to achieve the 25% goal by 2015

West Clinic has opened West Clinic International Shanghai in collaboration with Shanghai Kanglian Hospital.

For decades, initial therapy for chronic lymphocytic leukemia (CLL) consisted of alkylators such as chlorambucil (Leukeran). The introduction of nucleoside analogs such as fludarabine and monoclonal antibodies such as rituximab (Rituxan) markedly changed the initial therapy of CLL, particularly in the United States. Fludarabine and combination regimens such as fludarabine/cyclophosphamide (FC) have achieved higher complete response (CR) rates and progression-free survival (PFS) than chlorambucil in previously untreated CLL, but long-term overall survival has not improved, due to concurrent improvement in salvage therapy of relapsed CLL patients. Upfront chemoimmunotherapy regimens such as fludarabine/rituximab (FR) and fludarabine/cyclophosphamide/rituximab (FCR) have similarly improved CR rates and PFS in previously untreated CLL patients, but it is unclear whether overall survival is improved. Advances in cytogenetic analysis and other biologic prognostic factors have greatly enhanced clinicians' ability to risk-stratify newly diagnosed CLL patients, and knowledge of such prognostic factors is necessary to properly interpret results of clinical treatment studies. The choice of initial therapy for an individual patient should depend upon the patient's age and medical condition, cytogenetic and other prognostic factors, and whether the goal of therapy is maximization of CR and PFS or palliation of symptoms with minimal toxicity.

By the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.

US Food and Drug Administration (FDA) has approved a supplemental New Drug Application for sorafenib (Nexavar) tablets for the treatment of patients with unresectable hepatocellular carcinoma (HCC).

By the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.

Angiogenesis is a critical requirement for malignant growth, invasion, and metastases. Agents interfering with angiogenesis have shown efficacy in the treatment of a number of solid tumors, such as metastatic colorectal cancer, non–small-cell lung cancer, and renal cell cancer, and are being studied in many more. Each of the three agents currently approved by the US Food and Drug Administration-bevacizumab (Avastin), sunitinib (Sutent), and sorafenib (Nexavar)-offer challenges to nurses, in terms of assessment and management of toxicity, and to their patients as well: learning and integrating self-care strategies, such as self-assessment and self-administration (for sorafenib and sunitinib). This article reviews the recommended dosing, drug interactions, potential side effects, and management strategies for these three agents. Other agents that have antiangiogenesis properties, such as the epidermal growth factor inhibitors, the mTOR inhibitors, bortezomib, and thalidomide will not be addressed.

Hematopoietic stem cell (HSC) transplantation may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. In some clinical settings, transplantation represents the only curative option. The feasibility and efficacy of this approach in older patients are undefined, since this population has been excluded from nearly all clinical trials. Advances in supportive care, HSC harvesting, and safer conditioning regimens have made this therapy available to patients well into their 6th and 7th decades of life. Recent evidence suggests that elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.