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As genome-wide association studies (GWAS) have opened the door to systematic discovery of genetic factors for complex diseases, including cancers, the clinical utility of the findings remains to be determined. This is elegantly discussed in the article in this issue of ONCOLOGY by Stadler et al. The authors rightfully caution against the use of “personal genomic tests” based on cancer GWAS results for personal cancer risk prediction.

Genome-wide association studies (GWAS) have emerged as a new approach for investigating the genetic basis of complex diseases. In oncology, genome-wide studies of nearly all common malignancies have been performed and more than 100 genetic variants associated with increased risks have been identified. GWAS approaches are powerful research tools that are revealing novel pathways important in carcinogenesis and promise to further enhance our understanding of the basis of inherited cancer susceptibility. However, “personal genomic tests” based on cancer GWAS results that are currently being offered by for-profit commercial companies for cancer risk prediction have unproven clinical utility and may risk false conveyance of reassurance or alarm.

Breast cancer is predominantly a disease of older women. Many of these older patients with breast cancer have low-risk disease owing to low proliferation indices, positive hormone receptors, node-negativity, or p53-negative and HER-2 (human epidermal growth factor 2)-negative tumors.[1,2] They do well without chemotherapy and will receive adjuvant hormonal therapy with tamoxifen or an aromatase inhibitor. Yet there are older women who do not have these favorable tumor characteristics and so are potential candidates for chemotherapy. The review by Muss points out this issue, highlighting benefits of chemotherapy and describing appropriate treatment regimens for these patients.

Although increasing age is the major risk factor for breast cancer incidence and mortality, when adjusted for disease stage, breast cancer mortality is similar among younger vs older patients. Importantly, about 90% of older women with breast cancer present with early-stage disease. The biologic characteristics of breast tumors in older patients suggest they would derive benefit from adjuvant therapy, particularly endocrine therapy, but older women are still frequently undertreated, resulting in poorer survival. Studies suggest that focusing on comorbidity rather than “chronologic age” as a surrogate for life-expectancy is a key aspect of adjuvant decision-making for older patients. Morbidity and mortality from cancer in vulnerable patients with poorer health can be accurately predicted by the Comprehensive Geriatric Assessment (CGA), which evaluates comorbidities, functional status, cognition, social support, psychological state, nutritional status, and polypharmacy. Use of the CGA and newer versions of this tool can lead to interventions that maintain function and improve quality of life in older patients with breast cancer.

Vitamin E is a fat-soluble vitamin found in green leafy vegetables, whole grains, nuts and seeds, wheat germ, eggs, and in oils derived from soybeans, almonds, safflower, and sunflower. It is also an antioxidant and is said to confer protection against Alzheimer’s, Parkinson’s, cardiovascular disease, arthritis, and cancer. Although observational data suggest a correlation between high intake of foods rich in vitamin E and lowered risk of cancer, randomized trials using vitamin E supplements failed to validate those findings; some studies suggest that vitamin E supplementation can actually increase all-cause mortality.

Dr. Hy Muss is a well recognized expert in the treatment of elderly women with breast cancer, and his article “Adjuvant Chemotherapy of Breast Cancer in the Older Woman” is an extremely important addition to the limited existing literature on this topic. As he points out, nearly half of all breast cancer diagnoses occur in women over 65 years of age. As the total number of women in that demographic increases with the aging of our population, medical oncologists will be faced with a growing number of elderly breast cancer patients, for whom evidence-based recommendations on treatment are needed. As any medical oncologist who sits face-to-face with these older women knows, it is not acceptable to simply tell the patient that there are inadequate data to guide recommendations for adjuvant chemotherapy in her age group, though this is what the EBCTCG (Early Breast Cancer Trialists Collaborative Group) overview has concluded.

They are nearly microscopic, yet ganged together they can pack a big punch. They are microbeads embedded with radioisotopes and infused into body parts containing cancer tumors. The idea is to surround and destroy the tumor. The problem is making sure the microbeads stay put. SPECT/CT can provide the information to make it work.

Stay tuned on this page for our upcoming coverage of the American Society of Clinical Oncology meeting 2010 focusing of hematologic malignancies.

ASCO: Annual Meeting '10 Our on-site coverage of the American Society of Clinical Oncology's annual meeting: Five internationally regarded oncologists give exclusive interviews and expert perspective reports of the highlights of this year’s meeting…

Watch this page for ONCOLOGY’s on-site coverage of the annual meeting: Internationally regarded oncologists give exclusive interviews and expert perspective reports of the highlights of this year's meeting

In this exclusive CancerNetwork Blog podcast, nationally regarded healthcare specialist, Marty Neltner, talks about, among other things, how to bring value into an oncology practice.

Go back to the Eisenhower years and amid the gray flannel suits, rabid McCarthyism, and dread over nuclear war you’ll find rays of hope in the battle against cancer. Looking back from the 60s, it was easy to believe that this hope was unfounded, an unwarranted faith engendered by the conquest of polio. But it may have been that science simply was not ready.

As a psychiatrist who has cancer, I have developed a deep understanding of the ways in which our training can help us help patients who find themselves forced to deal with the complicated emotional aspects that accompany this disease. My hope is that my insights will help psychiatrists as they wrestle with the problems that plague their patients who are coping with this difficult disease.

Radiologists have come to expect rising demand for CT, which is why anecdotal reports of sudden and dramatic falls in CT volumes have sent a shudder through the community. All the more alarming is that the rumored drop-offs are coming at the request of patients who want nothing to do with CT because they fear its radiation will someday cause cancer. Instead they reportedly are demanding ultrasound or MRI because neither has ionizing radiation -- never mind that neither is indicated, nor, particularly in the case of ultrasound, has much chance of providing useful information.

Sentara Healthcare, located in Hampton Roads, VA is seeking an Experience RN for a Unit Manager Position on an Oncology Unit. This full-time position is located at Sentara Norfolk General Hospital, the region’s first Magnet Hospital. This level one trauma/teaching hospital is located in Norfolk, VA. The Hematology/Oncology Unit (HOU) is an 18-bed, self-contained unit providing a wide range of oncology services to a variety of diverse patient populations including the newly diagnosed through end of life, with specialties in chemotherapy and peripheral blood stem cell transplant.

The AACR and ACCC elect new leaders. Read more about the latest accolades and appointments in the cancer care community.

In today’s contentious debate over how to best deliver cost-effective, value-added healthcare, insurers have become the villain du jour, taking a backseat only to Wall Street fat cats.

Whole-body MRI should be the go-to imaging modality for detecting bone metastases in asymptomatic patients.

Eli Lilly has joined SNM’s Clinical Trials Network, a collaborative effort designed to address the need for validated imaging biomarkers for streamlining the development and registration of investigational therapeutics.

Patients who receive chemotherapy after surgery for gastric cancer have a higher rate of survival compared to those patients who have surgery alone.

The p90 ribosomal S6 kinase protein contributes to tumor cell proliferation and survival, the genetic disease Carney complex, and cardiac hypertrophy.

Coverage in most countries is universal, but limited resources can sometimes hinder how much coverage a person can expect.

Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.

Kilbridge correctly points out that comparative effectiveness research (CER) does not require cost data. It should also be pointed out, however, that the composition of the quality-adjusted life-year (QALY) gain of one intervention over another-whether the QALY gain is achieved mainly in the dimension of longevity or in the dimension of quality of life-has real consequences in terms of comparative costs of the interventions. Basically, a longevity increase entails additional consumption costs and additional labor earnings, essentially negative costs, during the extended life that should be included in the “cost” of an intervention.[1-3] Because labor earnings tend to be negligible relative to consumption costs toward the end of one’s life, due to sickness or retirement, failure to incorporate consumption costs and labor earnings into the comparative costs of two interventions generates a bias in favor of the intervention with the larger longevity effect.

Turmeric, a perennial herb prevalent in South Asia, is ubiquitous in Asian and Middle Eastern cooking. It is also used in Ayurveda and traditional Chinese medicine to treat inflammation, burns, and disorders of the digestive system.

Recently, the American Recovery and Reinvestment Act (ARRA) set aside $1.1 billion for comparative effectiveness research (CER) to investigate what healthcare strategies and interventions offer the greatest benefits to individual patients and the population as a whole. The Institute of Medicine has identified CER in cancer care as a high priority research focus for ARRA funding. The ability to measure quality of life will be central to CER in oncology because survival and disease-free survival do not adequately capture outcomes important to policy makers, physicians, and patients. There are two ways to measure quality of life: descriptive health status and patient preference weights (utilities). However, only patient preference weights can be incorporated into the economic analysis of medical resources and be used in the calculation of quality-adjusted life-years (QALYs). Some of the advantages and limitations inherent in measuring quality of life with descriptive health status and patient preference weights are discussed. Both types of measurements face health literacy barriers to their application in underserved populations, an important concern for CER in all medical fields.

In this issue of Oncology, Dr. Kilbridge details the incorporation of nontraditional outcome measures in the evaluation of cancer therapies-the importance of which is underscored by the passage of the sweeping healthcare reform bill that will alter the landscape of healthcare delivery for years to come.