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There is concern and growing evidence that the supply of medical oncologists in the United States will be insufficient to meet the needs of future patients. With an aging population and increasing complexity of cancer therapies, it is clear there will be more patients and that they will live longer and require expert care. It is equally clear that the number of specialists trained in cancer medicine is not growing fast enough to meet projected needs, so new models of care will need to be designed and implemented. Innovation in practice models will require the integration of non-physician practitioners (nurse practitioners and physician assistants) into multidisciplinary teams, broader use of technology to allow virtual consultations and the secure exchange of vital health information, increased utilization of community services, and public acceptance.

The number of cancer patients and cancer survivors continues to increase rapidly amid predictions of a shortfall in physicians to care for them. In addition, newer cancer therapies have become increasingly complex and resource-intensive, compounding the impending workforce shortage. Simultaneously, the growing understanding of the biologic heterogeneity of cancer and the development of pharmacogenomics have opened up the possibility of personalized approaches to cancer diagnosis and treatment. Such personalization has been promulgated as a means of decreasing the cost of drug development, improving the efficacy of treatments, and reducing treatment toxicity. Although there have been notable successes, the fulfillment of these promises has been inconsistent. Providing care for future cancer patients will require the development of innovative delivery models. Moreover, new approaches to clinical research design, to the assessment of therapeutic value, and to the approval of and reimbursement for diagnostics and treatments are needed.

Recent studies have shed new light on the role of histology in predicting sensitivity to therapeutic agents such as pemetrexed (Alimta) or bevacizumab (Avastin). Whereas during the past 30 years, the only useful histologic consideration was the absence or presence of a “non” before “small-cell lung cancer,” two US Food and Drug Administration (FDA)-approved drugs now have histologic restrictions. In this issue of ONCOLOGY, Selvaggi and Scagliotti provide an interesting review on how an old tool such as histology has recently emerged as a new criterion for treatment decisions in metastatic non–small-cell lung cancer (NSCLC). However, recent experience with tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) demonstrate that we need to move beyond histology to improve outcomes for patients with advanced NSCLC.

Exploring the Clinical Decisions of US Community-Based Oncologists and Hematologists in the Management of Multiple Myeloma and Follicular LymphomaSupported by educational grants from Celgene Corporation, Cephalon Inc, and Millennium Pharmaceuticals Inc

An update of a long-term denosumab (Xgeva) trial offers another bisphosphonate as an alternative to zoledronic acid (Zometa) that is more convenient, less toxic, and more effective in bone metastases. But oncologists need to perform an oral exam of patients with bone metastases before placing them on denosumab.

Results from the GINECO group study demonstrate Afinitor’s ability to buy more time for patients while Xgeva makes everyday life less painful.

Our experts comment on the recent IOM report: Dietary Reference Intakes for Calcium and Vitamin D.

A new hybrid technology emerged at radiology’s mega conference in Chicago earlier this month, one that may dislodge decade-old PET/CT from its prominent berth for the diagnosis and monitoring of cancer patients. This new modality combines the positron-imaging component of PET/CT with oncology’s premier anatomic modality, MR, opening the door to cancer images with unprecedented clarity and clinical value.

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Experimental drugs from ImmunoGen, Seattle Genetics, and S*BIO advance therapeutic options in multiple myeloma, anaplastic large-cell lymphoma, and relapsed lymphoma.

Thank you for registering to Cancernetwork.com, the online home of Consultant and Consultant for Pediatricians.. Click here to download your online copy of Achieving Success and Balance nowAchieving Success and Balance Yes, It Can Be Done. A Physician's Guide to Having It All.Stressed out? Looking for solutions for efficiency and balance? We can help. This guide brings you the best of Physicians Practice articles and columns on avoiding burnout and relieving stress, boosting efficiency and increasing revenue, and finding the best way to achieve balance and success.

More oncologists in the past few years have opted to consolidate with other practices in their area or sought employment at hospitals. Results from an ongoing survey highlights the ups and down of cancer care, with most professionals reporting they are happy with their chosen specialty.

ASCO recently released updated guidelines on the use of adjuvant endocrine therapy in hormone-receptor-positive breast cancer. While the guidelines focus on all postmenopausal women, those who are age 75 and older require special consideration. Unfortunately, meaningful data to help healthcare providers make treatment decisions for these patients are scarce, according to Peter Ravdin, MD, PhD, an executive committee member and scientific program planning member of SABCS 2010.

The effectiveness of RT in the palliative setting is sometimes overlooked; however, RT can provide excellent palliation for patients whose disease becomes refractory to other modalities.

Despite being heralded as a major public health breakthrough, the HPV vaccine has seen its fair share of controversy. Most recently, 24 U.S. states tried to pass a bill to make the vaccine mandatory for school-age girls. But the bill did not make it past the introductory stages in all but one state for the reasons, both scientific and cultural, that have plagued the HPV vaccine from the start: The vaccine fails to protect against 30% of the strains of HPV that cause cervical cancer; there is not enough known about possible adverse events; vaccination may lull young women into a false sense of security, leading to risky sexual behavior.Legal researchers, led by Dan Kahan, JD, from Yale Law School in New Haven, Conn., conducted a study to assess the factors that influence the perceptions of the risks and benefits of the HPV vaccine among the general public. They surveyed 1,538 U.S. adults and found that two factors influenced how their respondents viewed the HPV vaccination: biased assimilation and cultural credibility. “Biased assimilation refers to the tendency of individuals selectively to credit and dismiss information in a manner that confirms their prior beliefs,” the authors explained. With regard to cultural credibility, “the results of this [study] suggest that polarization grows where culturally diverse subjects see the argument they are disposed to accept being made by the advocate whose values they share, and the argument they are predisposed to reject being made by the advocate whose values they repudiate”( Law Hum Behav online, January 14, 2010).Individuals who have cultural values that favor authority and individualism perceive the vaccine as risky while individuals with cultural values that favor gender equality and pro-community/government involvement in basic healthcare are more likely to see the vaccine as low risk and high benefit.The authors suggested that policymakers avoid creating the impression that a scientific debate trumps cultural standards, and consider cultural norms and biases. 

Though there are no data yet on their efficacy, oleander extracts are promoted to treat cancer, AIDS, and congestive heart failure, and are being investigated in clinical trials.

With the new direction in research and clinical trials, treating patients who most benefit from treatment with minimal toxicity will continue to be the mainstay of personalized cancer therapy.

Bevacizumab has become a standard of care for first line therapy in a subgroup of advanced NSCLC patients. With the advent of other effective therapies in bevacizumab-eligible patients and the ongoing development and testing of biomarkers for cytotoxic agents, it remains to be seen whether continued use of bevacizumab will be justified in the absence of predictive biomarkers.

Despite the fact that bevacizumab and cetuximab are both in an advanced stage of clinical development for use in treatment for unresectable NSCLC (with bevacizumab already licensed for the use in clinical practice), several unanswered questions regarding these drugs remain. A number of ongoing trials have been specifically addressed to answer them, however, the first priority should be to personalize treatment, through clinical or biological markers, in order to better select patients who could benefit from targeted therapy with decreased toxicity.

Moreover, today’s new economic reality has forced policymakers to scrutinize every branch of medicine to cut costs. Not surprisingly, oncology has taken center stage in this debate.

Pathologies such as infections, or even tumors, crop up from time to time in patients examined for entirely unrelated issues. These "incidental findings"can put doctors-and patients-in a tight spot. How do they proceed with the patient, knowing that many of the asymptomatic signs of disease may never lead to clinical problems, or may simply be false positives?

Researchers in the radiation oncology department at UCLA’s Jonsson Comprehensive Cancer Center have received a $14 million grant to develop countermeasures that will help treat damage caused by radiological or nuclear threats such as a dirty bomb attack, with possible applications to radiotherapy-induced damage.

Rosetta Genomics, which has a test to identify tissues of origin for metastatic cancers with an unknown primary, just won back the rights to market its own test in the US. But it's expected to post a loss this year. If it can find missing cancers, why isn't Rosetta rolling in cash?

Dear Colleague: Targeted therapies and personalized medicine have become two major buzzwords in cancer care. But as breast cancer specialists, we have incorporated both into our practice for some time. For instance, tamoxifen is a targeted therapy, although we didn’t necessarily call it by that name. When it comes to personalized medicine, one of our goals has been to find better prognostic and predictive factors: Can we identify which patients will benefit from a specific therapy? Can we pinpoint those patients who can safely avoid chemotherapy? The 2010 San Antonio Breast Cancer Symposium (SABCS) offers all breast cancer specialists the chance to explore the wealth of data that we have amassed over the years. Join Oncology NEWS International for onsite reports from SABCS 2010 as we bring you a bird’s eye view of the research, trials, scientific advances, and controversies that are changing the way breast cancer is managed and treated. Check back here daily during the meeting and watch your inbox for our exciting reports from the SABCS 2010.

ONCOLOGYNURSE EDITIONApril 2011Volume 25 • Number 4Subscribe  |  Publication Services  |   ArchivesONCOLOGY's Nurse Edition publishes articles related to practical management issues in the care of patients with neoplastic disease. Through the Nurse Edition, ONCOLOGY aims to provide readers with useful insights into all aspects of patient management, with an emphasis on information and tools that can be applied to daily practice and patient education.