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The effective use of cancer chemotherapy requires a thorough understanding of the principles of neoplastic cell growth kinetics, basic pharmacologic mechanisms of drug action, pharmacokinetic and pharmacodynamic variability, and mechanisms of drug resistance. Recent scientific advances in the field of molecular oncology have led to the identification of large numbers of potential targets for novel anticancer therapies. This has resulted in a tremendous expansion of the drug development pipeline, and in the present era, the diversity of clinically useful novel anticancer therapeutic agents is growing at an unprecedented rate. However, the great enthusiasm that surrounds these new agents must be tempered by the challenges they present in optimizing their clinical use and in rationally integrating them with existing anticancer therapies. This discussion focuses on the basic principles underlying the development of modern combination chemotherapy, and it is followed by a description of the major classes of chemotherapeutic drugs and their mechanisms of action.

In 2008, it was estimated that head and neck cancers comprised ­2% to 3% of all cancers in the United States and accounted for 1% to 2% of all cancer deaths. This total includes 22,900 cases of oral cavity cancer, 12,250 cases of laryngeal cancer, and 12,410 cases of pharyngeal cancer. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

Despite the widespread perception that herbal products are safe because they are “natural,” few products have been subjected to rigorous research.

The authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.

This chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy). Recent relevant techniques of radiation oncology, such as conformal and stereotactic radiation therapy, also will be presented. These topics are not covered in great tech­nical detail. It is hoped that a basic understanding of radiation treatment will benefit those practicing in other disciplines of cancer management. This chapter does not address the principles of radiobiology, which guide radiation oncologists in determining issues of treatment time, dose, and fractionation or in combining radiation with sensitizers, protectors, and chemotherapy or hormones.

When caring for patients with a new cancer diagnosis, oncology nurses generally have clear and distinct plans to assist each patient through the phases of diagnosis and treatment. Nurses provide guidance, support, and well-defined patient education regarding the planned treatment, as well as anticipatory guidance regarding management of side effects and emotional responses to diagnosis and treatment.

Surgical oncology, as its name suggests, is the specific application of surgical principles to the oncologic setting. These principles have been derived by adapting standard surgical approaches to the unique situations that arise when treating cancer patients.

Hospice care continues to be underutilized. Indeed, owing to untimely referrals, many patients who begin hospice care unfortunately die shortly thereafter, having never received the full benefits provided by hospice. In her excellent article, Dr. Prince-Paul provides a case example that demonstrates the familiar multifaceted issues faced by cancer patients nearing end of life and discusses how hospice care could be of tremendous benefit to the patient, family, and professional.

Ms. D is a 45-year-old woman with ovarian cancer and hepatic metastatic disease. She has received multimodal treatment over the past 5 years. Ms. D lives in her own home, is divorced, and is a single parent of two adolescent children. Her mother is her primary caregiver and also has a deteriorating health condition.

Change is in the air-and I don’t just mean the arrival of spring. The current national focus on health care is clearly evident from many quarters, including policy makers, health care institutions, and clinical staff. In addition to the discussion on health care coverage, there is an increasing emphasis on patient-centered care. As a result, we have before us a unique opportunity to assure the inclusion of survivorship and end-of-life care as formal parts of the health care continuum.

Champions Biotechnology has obtained royalty rights to Concordia Pharmaceuticals’ Salirasib (farsnesyl thiosalicylic acid), an RAS antagonist.

Oncolytics will start a U.S. phase II trial on Reolysin (reovirus serotype 3) and chemotherapy for NSCLC. Oncolytics said that Reolysin, in combination with certain chemotherapeutics, results in more efficient and synergistic anti-cancer activity than when each agent is used on its own.

Thoracic CT scans in cancer patients require careful inspection in order to pinpoint previously undetected lesions, according to a study by Canadian radiologists. Jean-Charles Vinet, MD, and colleagues found that PET/CT detected an additional 20% of lesions from the supraclavicular notch to the adrenals that were not found on chest CT alone.

Not long ago, our approach to treating difficult metastatic tumors was to “spray and pray.” We knew that chemotherapy and other traditional treatment approaches could cause great damage and had a limited chance of successfully destroying the entire tumor. At the time, a proven safer and more effective option did not exist, and patients were desperately in need of treatment. Fortunately, as our knowledge of the complexities of advanced liver tumors has grown, so has our ability to develop treatments that target and treat tumors while avoiding harmful side effects to normal tissue.

John C. Hayes Editorial DirectorShalmali Pal News EditorAnne Landry, Ronald Piana Feature EditorsTerri Gelfand Managing EditorLisa Katz Creative DirectorNancy Bitteker Group Creative DirectorCarolyn Harrington Art DirectorBarbara Boughton, Catherine Donnelly, Jordana Bieze Foster, Caroline Helwick, Susan London, June Skinner, Kathlyn Stone, Steven Wagner Contributing WritersAndrew Barkus Group Production ManagerAmy Birnbach Associate PublisherChrissy Sheehan Advertising CoordinatorCara H. Glynn Senior Editorial DirectorKathy Mischak Group PublisherBeth Scholz Senior Vice President, Oncology and RadiologyBeatrix Eriksen Vice President, Research Marketing, and CirculationAmy Erdman Director of ResearchColleen Tricarico Circulation Manager

Henry ElkingtonCEO, UBM Medica Ltd, UKPatrick McAleenanCFO, UBM Medica Ltd, UKSally ShanklandCEO, UBM Medica USASteve ResnickVP, Finance Director, USAJulia MurphyVP, Director of Human Resources, USAPamela L. Moore, PhDEVP, Content & Strategy, USAMorgan KelseyVP, Technology, USA

The American Society for RadiationOncology will host a connectathonat its headquarters in Fairfax, Va. inSeptember.

ONCOLOGY’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.

In the past decade, core biopsy has largely replaced fine-needle aspiration for breast tissue evaluation. The latter technique’s inability to distinguish between invasive cancer and in situ cases and a general unease among pathologists not trained in cytopathology (in interpreting cells rather than tissue) are two of the main reasons that FNA has fallen out of favor (Diagnostic Cytopathology online, November 19, 2008).

ONCOLOGY will not consider articles that are sponsored directly or indirectly by a commercial entity (eg, a pharmaceutical company or public relations firm). Financial Disclosure statements are published for all authors and reviewers.

George Bernard Shaw once said “Youth is wasted on the young.” But for Sharon Murphy, MD, youth is in the hands of exactly the right people. As a medical student, Dr. Murphy was considering a career in internal medicine; doing rounds on the adult wards changed her mind.

The National Comprehensive Cancer Network (NCCN) has announced the addition of a survivorship section to the NCCN Clinical Practice Guidelines in Oncology for colon and rectal cancers, as well as other key updates in colorectal cancer. The NCCN also recently updated its guidelines for breast cancer and breast cancer risk reduction. These changes reflect leading developments in the treatment of cancer patients and represent the standard of clinical policy in oncology in both community and academic settings.

The entry of new technology into medical practice is complex. New technology in radiation oncology includes advances in imaging (including anatomic and molecular/functional imaging) and radiation therapy planning and delivery involving intensity-modulated radiation therapy (IMRT), stereotactic radiation therapy (SRT), and therapy with particles such as protons and carbon ions.

The recommendation to minimize sun exposure to prevent skin cancer has produced a pandemic of vitamin D deficiency. Vitamin D has generated considerable interest in the past decade, as accumulating evidence from both retrospective and prospective epidemiologic studies suggests an association between vitamin D deficiency and increased risk of autoimmune, infectious, and cardiovascular diseases, as well as cancer.

Cancer drugs and indications newly approved by the US Food and Drug Administration, May 2007 – February 2009

Celator Pharmaceuticals and the Leukemia & Lymphoma Society have partnered for the phase II development of CPX-351 (cytarabine:daunorubicin), a liposome injection for treatment of adults with acute myeloid leukemia.