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Payne, Coyne, and Smith present a concise review of the surprisingly meager literature regarding costs of end-of-life cancer care, an issue with substantial ethical and financial implications. They present evidence that improved coordination of care holds the potential to lower costs, or at least to offer better services at the same cost. The authors are to be commended for pursuing more rigorous studies regarding this difficult-to-quantify area of medical and social services. Moreover, they appropriately highlight the difficulties in attempting to capture direct costs of medical care and the far more elusive indirect costs.

The non-Hodgkin’s lymphomas (NHL) are the fifth most common cause of cancer in men and women in the United States, and the fifth and sixth leading causes of cancer deaths, respectively. Approximately 54,000 new cases are projected to be diagnosed in the United States this year,[1] 25% to 30% of which are indolent histologies, with the remainder being aggressive tumors.

A 54-year-old female seeks medical attention with a complaint of worsening exertional dyspnea of 3 to 4 weeks’ duration. She has a history of small-cell lung carcinoma, first diagnosed 3 months previously, and has had an excellent response to treatment, which included both chemotherapy and external-beam radiation. Consistent with her cancer diagnosis, she has a 30 pack-year history of cigarette smoking, and her pulmonary function tests indicate mild airflow obstruction, slight hyperinflation on lung volumes, and a mildly decreased diffusion capacity. In addition to her dyspnea with exertion, the patient describes symptoms of an intermittently productive cough, fatigue, and, recently, a poor appetite.

I read with interest the commentary by Drs. Michael S. Givel and Stanton A. Glantz, regarding state-level disbursement of monies generated by the Master Settlement Agreement with Big Tobacco, which appeared in the February 2002 issue of ONCOLOGY.[1] Unfortunately, the authors omitted the key challenge facing antitobacco activists. Although they accurately depicted underfunding of tobacco control programs (~5% of total annual allocated payments)-far lower than levels recommended by the Centers for Disease Control and Prevention (~25%)[2]-they failed to analyze the deceptive nature of how the remaining funds are being categorized.

Dyspnea is an extremely common symptom among cancer patients.[1] Like pain, it is inherently subjective and is best defined as the perception of difficulty in breathing, or an uncomfortable awareness of breathing. Although it may be associated with one or more physiologic disturbances (such as hypercapnia, hypoxia, obstructive or restrictive patterns on pulmonary function tests, or various abnormalities on chest imaging studies), it is not strongly associated with any specific abnormality and may occur in the absence of any. Patient self-report is the gold standard for assessment and may range from mild breathlessness on exertion to a terrifying sense of suffocation.

Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose.

As active participants in the care of patients with acquired immunodeficiency syndrome (AIDS), oncologists need to be aware of the many facets of pain management in this population. This two-part article, which will conclude in the July 2002 issue, describes the prevalence and types of pain syndromes encountered in patients with AIDS, and reviews the psychological and functional impact of pain as well as the barriers to adequate pain treatment in this group and others with human immunodeficiency virus (HIV)-related disease.

EVANSTON, Illinois-Although biopsy of sentinel lymph nodes is often considered an almost risk-free procedure in the staging of breast cancer, a retrospective chart review showed a surprising incidence of lymphedema associated with this procedure. Carole H. Martz, RN, MS, and colleagues at Evanston Northwestern Healthcare in Illinois reported a 3% risk of lymphedema after sentinel lymph node biopsy (SNLB, n = 303), compared to a 17% risk after axillary dissection (n = 117).

ST. PETERSBURG, Florida-New cancer regimens are sometimes a double-edged sword, offering better survival but also delayed toxicity affecting quality of life. At the Late Effects of Normal Tissues (LENT) IV workshop, an international, multidisciplinary panel tackled the Herculean task of defining, grading, and reporting chronic toxicity. The workshop included representatives from more than 10 countries, including two European organizations.

SAN ANTONIO-Patients who develop a local recurrence after conservative surgery and radiation therapy for early-stage breast cancer generally have a good long-term prognosis, particularly if treated with mastectomy, lead researcher Sharon Galper, MD, told ONI. In this study, 59% of patients with a local recurrence were alive at 10 years, said Dr. Galper, assistant professor of radiation oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School.

BALTIMORE-For cancer patients with breakthrough pain, oral transmucosal fentanyl (Actiq) continues to provide good relief with long-term use, Richard Payne, MD, said at the 21st Annual Scientific Meeting of the American Pain Society (abstract 770).

WASHINGTON-Young people are frequently exposed to high levels of tobacco promotion despite current advertising restrictions, and a new report from the Centers for Disease Control and Prevention says such advertising exists in more than 90% of retail stores selling tobacco products.

SAN FRANCISCO-Retrospective and laboratory studies have suggested that green tea might be useful for both the prevention and treatment of cancer. Two presentations at the 93rd Annual Meeting of the American Association for Cancer Research, however, showed conflicting results on the effectiveness of this beverage as an anticarcinogenic agent.

A substantial minority of the women who see themselves as being at high risk for breast cancer because of family history suffer noticeable depressive symptoms and anxiety, and the anxiety can interfere with compliance with recommendations on breast self-examination (BSE), according to studies at the UCLA Revlon Breast Center.

NEW YORK-Actor Danny Glover is serving as spokesman for Anemia LifeLine, a new educational initiative. Mr. Glover’s father had anemia associated with chronic kidney disease. At a press conference to launch the initiative, Mr. Glover told how anemia had robbed his father James Glover of his desire to do the things he loved. He said his father was ready to give up, but treatment gave him back his energy and independence.

WASHINGTON-Heath care spending is projected to more than double in the coming decade. The projected figure for 2011 is $2.8 trillion, up from $1.3 trillion in 2000, and the expected average annual growth rate is 7.3%, according to the Centers for Medicare and Medicaid Services.

SAN DIEGO--More than a year after the opening of the Barbara Ann Karmanos Cancer Institute, patients and staff alike are giving its design high marks. Dore Shepard, RN, MS, OCN, administrative manager for Cancer Patient Services at the Institute, said that the goal was to have a facility that creates a healing environment for patients.

NEW YORK-State regulators and medical boards are adopting new pain management policies favorable to physicians and patients even at a time when drug abuse issues are at the forefront of national attention, according to policy researcher Aaron M. Gilson, PhD.

ORLANDO-Patients with chronic lymphocytic leukemia (CLL) complicated by autoimmune hemolytic anemia (AIHA) usually improve following treatment with high-dose steroids but have few options if such treatment fails.

WASHINGTON-Well-documented racial and ethnic disparities exist in health care even among individuals with the same income and health insurance, and a significant part of the problem lies with the health care system and its professionals, according to a report by the Institute of Medicine (IOM).

WASHINGTON-AIDS deaths in the United States total more than 440,000 since 1981, according to a new Department of Health and Human Services (HHS) fact sheet. The number of HIV-infected Americans now stands at an estimated 850,000 to 950,000, one quarter of whom do not know they carry the virus.

THOUSAND OAKS, California-How do endogenous and exogenous erythropoietin (EPO) directly and indirectly affect the central nervous system (CNS)? How can erythropoietic agents penetrate the blood-brain/blood-cerebrospinal fluid (CSF) barrier so that their potential neuroprotective benefits can be realized?

BETHESDA, Maryland-The search for the ideal blood substitute continues, although with less urgency now that the nation’s blood supply is safer than it has ever been. None of the products currently being developed and nearing licensure can truly be considered substitutes for blood, according to Harvey Klein, MD.

ROCKVILLE, Maryland-The FDA-going against a recommendation of its Oncologic Drugs Advisory Committee (ODAC)-has denied the supplemental new drug application for the use of Gliadel Wafer (polifeprosan 20 with carmustine implant, Guilford Pharmaceuticals) to treat newly diagnosed malignant glioma.

KITCHAWAN, New York-Beyond its "classical" hormonal role signaling bone marrow to increase circulating red blood cells, erythropoietin (EPO) and its receptor (EPO-R) may have critical roles in the development, maintenance, protection, and repair of the brain. These roles rely on the status of the EPO and EPO-R molecules as cytokines and have been demonstrated by animal studies. Michael L. Brines, MD, PhD, senior member at the Kenneth S. Warren Institute in Kitchawan, New York, reported on these studies as well as "highly positive" results of the first human trial using recombinant human EPO to treat stroke.

TAMPA, Florida-"Increasingly we have acknowledged that there is more to cancer treatment than the eradication of disease," stated Paul Jacobsen, PhD. "The treatment of anemia and its effects on quality of life have demonstrated that a treatment can be considered effective and clinically useful if it results in significant quality-of-life benefits, even in the absence of significant survival benefits."

HOLLYWOOD, Florida-An important part of the cancer guidelines effort by the National Comprehensive Cancer Network (NCCN), a coalition of 19 major US cancer centers, is to monitor concordance with the guidelines through the use of outcomes databases. Results from the breast cancer and non-Hodgkin’s lymphoma databases were presented during the NCCN’s Seventh Annual Conference.

President Bush announced changes in the medical records privacy rule proposed by President Bill Clinton before he left office. Physicians do not have to comply with these rules until 2003.

LOS ANGELES-Progress in treating cancer-related anemia has accelerated in the almost 20 years since the human erythropoietin gene was cloned. That was in 1983. Ten years later, the Food and Drug Administration approved epoetin alfa (Epogen, Procrit) for transfusion-preventing treatment of patients with anemia-complicating therapy.

LOS ANGELES-To better manage fatigue, cancer patients need clear, concise information about what to expect and how to deal with reduced energy, memory, and other cognitive functions. The challenge for oncology nurses and physicians, noted Patricia Jakel, RN, MN, AOCN, is to provide this information in a manner that is sensitive to the individual patient’s changing attitudes toward treatment and need for information at each visit. "We need to know what the patients feel and what the patients want us to communicate to them," Ms. Jakel said. She is a clinical nurse specialist at University of California Medical Center, and associate professor, University of California School of Nursing, Los Angeles.