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In this article (the first of a two-part interview), Linda L. Emanuel, MD, PhD, discusses bioethics. Part I highlights end-of-life care and physician-assisted suicide, while part II, which will appear in an upcoming issue of ONI, focuses on organizational ethics and future issues in bioethics.

NEW ORLEANS-Transperitoneal laparoscopic radical prostatectomy achieves negative surgical margins comparable to those achieved with the open retropubic approach, according to a study from University of Massachusetts Medical School

ATLANTA-Health care personnel exposed to HIV should be evaluated within hours (rather than days) after their exposure and should be tested for HIV at baseline (ie, to establish infection status at the time of exposure), according to the latest HIV postexposure prophylaxis (PEP) guidelines from the US Public Health Service [MMWR 50:(RR11):1-42, 2001].

SAN DIEGO--Anxiety and other symptoms of distress that occur during radiotherapy and chemotherapy sessions were found to be reduced when patients were exposed to octaphonic sound, according to Sook Kim, RN, BSN, a nurse clinician and charge nurse at M.D. Anderson Cancer Center’s Ambulatory Treatment Center.

ST. LOUIS, Missouri-United States Attorney General John Ashcroft "is putting a spoke in the wheel" of end-of-life care, said Karen Stanley, RN, MSN, AOCN, FAAN. In a decision designed to prevent the implementation of Oregon’s Death

MINNEAPOLIS-Give Life Twice. That’s the message behind a new National Marrow Donor Program (NMDP) pilot project designed to increase the number of minority umbilical cord blood units listed on the NMDP Registry. Patients of minority race and ethnicity are less likely than Caucasians to find a matched donor in the Registry, the NMDP said in a press release. The NMDP’s goal is to collect 2,000 units of cord blood from African-American, Hispanic/Latino, and Asian/Pacific Islander donors.

SAN FRANCISCO-Chemotherapy given concomitantly with radiotherapy improves disease-free survival rates in patients with stages III and IV oropharynx carcinoma, according to final results of the 94-01 GORTEC study. The findings were presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO plenary 2).

A federal judge in Oregon has temporarily blocked Attorney General John Ashcroft’s ability to prosecute Oregon physicians who use controlled substances to help a patient in pain end his or her life. Mr. Ashcroft’s announcement in early

MIAMI BEACH-Trastuzumab (Herceptin), the monoclonal antibody that blocks HER-2, has been chemically linked to the maytansinoid DM1, a powerful cytotoxic agent that attacks tubulin, resulting in a conjugate that is dramatically more effective

WASHINGTON-President Bush moved quickly to appoint a new director of the National Cancer Institute, naming Andrew C. von Eschenbach, MD, a professor of urology at The University of Texas M.D. Anderson Cancer Center and a cancer survivor.

RESEARCH TRIANGLE, North Carolina-Five academic research centers will join the National Institute of Environmental Health Sciences (NIEHS) to form a consortium to study how genes interact with the environment to cause cancer and other

SAN DIEGO--Nursing staff at Fox Chase Cancer Center are investigating the factors that put cancer patients at risk for hospital readmission, said Carolyn Weaver, RN, MSN, AOCN, a clinical nurse specialist and patient education coordinator

ROCKVILLE, Maryland-The Association of Community Cancer Centers (ACCC) has launched a new website (www.accc-cancer.org/publicpolicy) dedicated to regulatory and legislative issues affecting patients with cancer. The website will assist in the education of patients and their families about public policy that affects cancer care.

BETHESDA, Maryland-Two National Institutes of Health (NIH) units will jointly fund the design and construction of three new synchrotron beamlines as a way to increase x-ray crystallography studies of proteins.

SEATTLE-Researchers at the Fred Hutchinson Cancer Research Center have discovered a chemical compound that reverses a process called silencing, in which genes or chromosomal regions are shut off (Proc Natl Acad Sci 98:15113-

Cancer researchers can almost feel the ground rumble beneath their feet as they walk through their clinics and laboratories. A veritable explosion of information has radically altered the way we think about cancer, and has introduced new concepts

Barton, Loprinzi, and Gostout provide a comprehensive, accurate, and multidisciplinary review of the management of menopausal symptoms in patients with a previous diagnosis of cancer. The article is clearly enhanced by the authorship of individuals from different backgrounds, each of whom bring a valuable perspective to the subject. Additional attention to several issues would, however, make interpretation of the data on this subject, and hence, the management of patients with these problems, more clear.

More women, and especially more premenopausal women, are surviving their cancer diagnosis. However, due to their therapy, these women may become symptomatic from iatrogenic ovarian failure. For some, the use of hormone replacement therapy (HRT) is contraindicated because it may affect the course of their disease. Other women and their physicians may feel uncomfortable with the use of hormones because research is inconclusive regarding long-term survival or disease recurrence. Women who experience a cessation of menses due to adjuvant therapy for breast cancer are more likely than women undergoing a natural menopause to experience severe hot flashes, night sweats, and fatigue.[1] However, nonhormonal interventions appear to benefit many of these women[2] and should be used to decrease their symptoms. Barton, Loprinzi, and Gostout address these concerns in their excellent review and offer recommendations for pharmacologic and nonpharmacologic interventions.

The study of cancer in specific populations can offer clues useful in determining the extrinsic and intrinsic factors influencing cancer in all populations. Extrinsic factors are sometimes called "environmental" in the broadest sense of the word. They are modifiable or mutable. Intrinsic factors are more inherent to the individual. They are almost always genetic and are immutable or unchangeable. Targeting research on specific populations is and should be a significant ethical issue.

Health disparities among populations within the United States are well documented. In order to eliminate these disparities, we must further understand their sources. Are they the result of the unequal distribution of resources, racism, or inherent characteristics of ethnically or "racially" defined groups? How we define and discuss "race" has major scientific and moral consequences. In this issue, Leslie Klein Hoffman asks two major questions as they pertain to research on ethnic or "racially" defined groups. When is genetic research on a population appropriate? How should researchers define a given population? These questions are timely, and it is both humbling and instructive that the answers to these questions remain unclear.

This paper by Abi-Rached and Neugut provides an overview of the diagnosis and treatment of gallbladder carcinoma, a rare, yet frustratingly difficult disease to manage [1]. Overall, we agree with the risk factors described in this review. We would add that, in addition to chronic cholecystitis, porcelain gallbladder, and retained gallbladder (secondary to cholecystostomy), cholecysto-enteric fistulas have also been associated with a higher incidence of gallbladder carcinoma [2,3] Patients with ulcerative colitis are known to be at higher risk for cholangiocarcinoma, and there is also some evidence that these patients have an increased risk of gallbladder cancer.

Immune deficiency in cancer patients is well documented, and tumor cells have developed a variety of cellular and molecular mechanisms to avoid antitumor immune responses. These mechanisms include defective presentation of tumor antigens on the cell surface and/or an inability of the host to effectively recognize these cells and target them for destruction. Tumor-induced defects are known to occur in all major branches of the immune system. The continuous administration of vascular endothelial growth factor (VEGF), a factor produced by most solid tumors, inhibits the functional maturation of dendritic cells, significantly decreases T-cell to B-cell ratios in the peripheral lymphoid organs, and induces rapid and dramatic thymic atrophy in tumor-bearing animals. VEGF is abundantly expressed by a large percentage of solid tumors, and defective antigen presentation, T-cell defects, and premature thymic atrophy are known to occur in cancer patients and tumor-bearing animals. This review will encompass the major mechanisms responsible for tumor evasion of immune surveillance and highlight a role for VEGF as a principal contributor to tumor-associated immune deficiencies. [ONCOLOGY 16(Suppl 1):11-18, 2002]

Every 3 years, the National Cancer Institute (NCI) asks cancer researchers, advisory groups, and advocacy organizations to recommend important areas to which it should devote additional resources. NCI defines such "extraordinary opportunities for investment" as "broad-based, overarching areas of scientific pursuit that hold tremendous promise for significantly expanding our understanding of cancer."This is the first in a series of interviews exploring the progress and promise of NCI’s six current extraordinary opportunities: genes and the environment, cancer imaging, defining the signature of cancer cells, molecular targets of prevention and treatment, research on tobacco and tobacco-related cancers, and cancer communications.

Patients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]

The effect of a patient’s race or ethnicity on cancer incidence and mortality rates remains a neglected area of cancer research. However, with cancer statistics differing among various populations, research on racial and ethnic groups could provide clues to cancer trends.

ROCHESTER, Minnesota-Fluorouracil (5-FU)-based chemotherapy after surgery can be given safely to selected elderly patients with stage II/III colon cancer, and these patients derive the same benefits from the treatment as do their younger counterparts, according to results of a pooled analysis of seven clinical trials.

HOUSTON-The Intercultural Cancer Council (ICC) promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its associated territories. With this issue, ONI launches a regular column devoted to intercultural facts about cancer, based on information from the ICC and other sources.

ROCKVILLE, Maryland-The Food and Drug Administration has approved Viread (tenofovir disoproxil fumarate, Gilead Sciences, Inc.) for the treatment of HIV-1 infection in combination with other antiretroviral agents. Viread, a nucleotide analog, remains in cells longer than other antiretrovirals, which enables a dosage of 300 mg taken once a day in tablet form.

NEW YORK-Researchers reported in the September 27 Nature that a surgeon on one side of the Atlantic removed the gallbladder of a patient on the other side, but the clinical usefulness of this long-distance, robot-assisted laparoscopic surgery is uncertain.

BETHESDA, Maryland-Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) have begun enrolling 21 volunteers in a phase I trial of a new plasmid DNA-based HIV vaccine (VRC4302). The randomized, controlled, double-blinded, dose-escalation study will examine the vaccine’s toxicity, dose, and immune response. It will be conducted on the National Institutes of Health campus.