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BOSTON-A review of more than 1,600 patients in the Oncology Practice Pattern Study found a 50% higher risk of febrile neutropenia for elderly patients than younger patients. Most incidents occurred during the first 21 days of chemotherapy, according to a presented at the third meeting of the International Society of Geriatric Oncology (SIOG abstract P-22). Based on the analysis, Vincent Caggiano, MD, medical director, Sutter Cancer Center, Sacramento, and his colleagues urged oncologists to consider giving prophylactic colony-stimulating factors (CSFs) during the first two chemotherapy cycles-especially among older patients who are more vulnerable to the complication.

SEATTLE-Cigarette smoking appears to be a significant risk factor for colon polyps, equal to a family history of colon cancer, according to Rajeev Attam, MD, a senior fellow in the Division of Gastroenterology, Stony Brook University School of Medicine, New York. In a large colon cancer screening study, approximately 19% of ex-smokers and 17% of nonsmokers had polyps, compared with 25% of current smokers.

BETHESDA, Maryland-With its budget frozen at last year’s level, National Cancer Institute (NCI) officials have cut back on the number of competing research grants awarded during the first 3 months of fiscal year 2003, which began last October 1.

NEW YORK-Dose escalation of irinotecan (Camptosar) is continuing in a phase I trial of a four-drug regimen that has shown encouraging activity in patients with pancreatic and gallbladder cancer, according to a report at the Mount Sinai School of Medicine Chemotherapy Foundation Symposium XX.

NEW YORK-New data suggests that granisetron (Kytril) can effectively prevents postoperative nausea and vomiting at doses as low as 0.1 mg. Robert D’Angelo, MD, Department of Anesthesiology, Wake Forest University, Baptist Medical Center, presented the study results at the 56th Annual Post Graduate Assembly in Anesthesiology.

BETHESDA, Maryland-The National Cancer Institute (NCI) has launched a 5-year, $7.6 million project at seven leading cancer centers to address the disease among Asian Americans. Although Asian Americans have a relatively low overall risk, their cancer incidence is rising faster than that of any other racial or ethnic group in the United States.

NEW ORLEANS-The addition of concurrent cisplatin (Platinol) chemotherapy to radiation therapy after surgery failed to significantly improve locoregional control of high-risk head and neck cancers in the RTOG 9501/Intergroup phase III trial reported at the plenary session of the American Society for Therapeutic Radiology and Oncology (abstract plenary 3).

TARRYTOWN, New York-Aton Pharma, Inc and its collaborators presented phase I data on its oral histone deacetylase inhibitor SAHA (suberoylanilide hydroxamic acid) at the 14th Annual EORTC/NCI/AACR symposium, held in Frankfurt, Germany. The trial of patients with refractory solid tumors, lymphomas, and leukemias, being conducted with researchers at Memorial Sloan-Ket-tering Cancer Center, defined a safe daily oral dosing regimen.

BETHESDA, Maryland-A 6-year prostate cancer research plan released by the National Institutes of Health (NIH) contains a detailed outline of the National Cancer Institute’s (NCI) future strategy for dealing with the disease, which includes a shift in the standard treatment model from seek-and-destroy to target-and-control.

NEW YORK-The disadvantaged, once they have cancer, are then more likely to die from it, according to Prof. Harry Burns. "Poverty influences cancer in some quite unexpected ways," said Prof. Burns, director of public health, Greater Glasgow Health Board, Glasgow, Scotland. "The politicians, and all of us as voters, have a responsibility to think about this."

MELVILLE, New York-ONI is pleased to announce the creation of an Editorial Advisory Board for Oncology Nursing, to work with Sharon Krumm, PhD, RN, the Editor of Oncology Nursing, and staff to report research by oncology nurses and issues of special interest to oncology nurses. The first two appointees to the board are Catherine (Cathy) Coleman, RN, OCN, and Mary McCabe, BSN, MA.

PHILADELPHIA-Salvage therapy with the radiolabeled monoclonal antibody tositumomab (Bexxar) produced durable complete remissions in patients with multiply relapsed or refractory non-Hodgkin’s lymphoma (NHL) or transformed indolent lymphoma when used as second-line therapy, and first-line tositumomab produced 5-year progression-free survival of 58.9% in patients with advanced follicular lymphoma.

NEW ORLEANS-Template-based interstitial brachytherapy is an effective method for treating breast cancer, according to a study presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 147). The study is one of the first to use a template to position interstitial implants in its entire study population as part of its protocol.

NIAGARA-ON-THE-LAKE, Ontario, Canada-Survivors of childhood cancer generally enjoy good quality of life (QOL) as adults, according to two reports presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute.

NEW ORLEANS-Toxicity for low-dose-rate and high-dose-rate accelerated partial breast irradiation (APBI) (brachytherapy) is comparable to that observed in women treated with conventional whole breast external beam radiation therapy after lumpectomy, according to a 10-year study (RTOG 95-17) presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 146).

WASHINGTON-A seven-state pilot project will study the best way to help older smokers kick their nicotine habit. The program, financed by the Centers for Medicare & Medicaid Services (CMS), will test counseling in person and by phone, a prescription smoking cessation drug, nicotine patches, and education materials.

BETHESDA, Maryland-The first clinical trial of an HIV-1 vaccine based on multiple genes from three subtypes, or clades, of the virus began November 13, 2002, when researchers at the National Institute of Allergy and Infectious Diseases (NIAID) vaccinated three healthy volunteers. Researchers expect to enroll 50 participants in the 12-month phase I study. The DNA vaccine contains modified material from four genes from clades A, B, and C, which cause about 90% of HIV infections worldwide.

Venous thromboembolic disease is a common but likely underdiagnosedcondition in the cancer patient population. Timely and accuratediagnosis of venous thromboembolism is imperative due to the unacceptablemorbidity and mortality associated with a misdiagnosis.Because diagnosis of the condition based on clinical grounds alone isunreliable, physicians should select an appropriate objective diagnostictest to confirm or refute their clinical impressions. Compressionduplex ultrasound is the best initial imaging test for both suspectedupper- and lower-extremity deep venous thrombosis. Magnetic resonancevenography (MRV) is a valid alternative when ultrasound isinconclusive, but contrast venography remains the “gold standard.”Suspected pulmonary embolism should be initially evaluated by helical(spiral) computed tomography (CT) or ventilation/perfusion lungscintigraphy, the former being preferred in cases of obvious pulmonaryor pleural disease. Indeterminate studies should prompt performanceof contrast pulmonary angiography. Inferior vena cava thrombosis isalso best assessed by contrast venography, with MRV and CT reservedas alternative imaging modalities. Evidence to date suggests thatD-dimer assays remain unreliable in excluding venous thromboembolismin cancer patients. A newer latex agglutination D-dimer assay mayprove to be clinically useful in this setting.

Erectile dysfunction is a common sequela following potentiallycurative local treatment for early-stage carcinoma of the prostategland. With larger studies and longer follow-up, it is clear that erectiledysfunction following prostate brachytherapy is more common thanpreviously reported, with a myriad of previously unrecognized sexualsymptoms. Approximately 50% of patients develop erectile dysfunctionwithin 5 years of implantation. Several factors including preimplantpotency, patient age, the use of supplemental external-beam irradiation,radiation dose to the prostate gland, radiation dose to the bulb ofthe penis, and diabetes mellitus appear to exacerbate brachytherapyrelatederectile dysfunction. The majority of patients with brachytherapy-induced erectile dysfunction respond favorably to sildenafil citrate(Viagra). Despite reports questioning the potency-sparing advantageassociated with brachytherapy, recent elucidations of brachytherapyrelatederectile dysfunction may result in refinement of treatmenttechniques, an increased likelihood of potency preservation, andultimately, improved quality of life.

Drs. Basche and Kelly presentan excellent comprehensivereview of the treatment ofnon–small-cell lung cancer in olderpersons. Articles such as this, whichfocus on the older patient, are of paramountimportance for several reasons.First, cancer is a disease ofaging, with an 11-fold increased incidenceand a 16-fold increase in cancer-related mortality among patientsover age 65 compared to those under65.[1] Second, the population is aging,and in the year 2030, approximately22% will be over 65.[1] Third,data on older cancer patients are limitedsecondary to an underrepresentationof this population in clinicaltrials.[2,3] Based on these facts, acomprehensive review of the availabledata is important, especially toguide future research.

This article by Marcelo Gomes,MD, and Steven Deitcher, MD,is a well conducted, thorough,and scholarly review of the diagnosticmethods for venous thromboembolismin cancer patients. The authorshave specifically looked at upperandlower-extremity deep venousthrombosis (DVT), pulmonary embolism,and rarer conditions includingthrombosis of the inferior venacava (IVC), pelvic veins, and eventhe portal vein. They offer descriptionsof the various tests available,address the pros and cons of thosetests, and provide the reader with algorithmsfor the diagnosis of DVT andpulmonary embolism, including twofor pulmonary embolism-one basedon ventilation/perfusion (V/Q) scanningand one based on helical computedtomography (CT) scanning.

The article by Drs. Merrick,Wallner, and Butler providesan excellent overview of issuespertaining to sexual dysfunctionfollowing prostate brachytherapy.The authors were the first to addressthe historical and current problemswith diagnosing sexual dysfunction.They make a strong case for developinga quality-of-life (QOL) instrumentthat is specific for prostatebrachytherapy.

The importance of cancer as aproblem in the elderly is gainingincreasing appreciationdue, in part, to the demographicchanges taking place in this countryand around the world and their associationto the incidence of cancer.Ongoing epidemiologic research overthe past several decades has consistentlyconfirmed the continuing trendtoward an aging population. In theUnited States, an anticipated 20.1%of the population will be 65 years ofage or older by 2030, the number ofpeople 75 years of age or older willhave tripled, and the 85-or-older agegroup will have doubled.[1]

The majority of individuals diagnosed with lung cancer in theUnited States are 70 years of age and older. Defining appropriatetherapy for older patients with non–small-cell lung cancer (NSCLC) isbecoming a major focus of clinical research. In this article, we reviewthe available data on clinical predictors of risk and benefit for elderlyNSCLC patients receiving treatment via a variety of modalities, includingsurgery, radiotherapy, combined radiotherapy and chemotherapy,and chemotherapy alone. The data demonstrate that subgroups ofelderly patients benefit from appropriately selected treatment. Participationof older patients in clinical trials designed to assess efficacy,toxicity, and quality-of-life outcomes for recently developed treatmentmodalities in this population is critical.

The diagnosis of venous thromboembolismon the basis ofclinical signs and symptoms isnotoriously inaccurate and, therefore,mandates confirmatory diagnostictesting. Unfortunately, all diagnostictests for deep venous thrombosis(DVT) and pulmonary embolismhave clinical or practical limitations.Contrast venography and pulmonaryarteriography are usually regarded asthe reference standards for the diagnosisof DVT and pulmonary embolism,respectively. However, evencontrast venography may be impossibleto perform in 9% to 14% ofpatients, may fail to visualize 10% to30% of venous segments, and maybe associated with postvenographythrombosis in up to 8% of patients.[1]

Over the past decade, prostatebrachytherapy has been usedincreasingly as definitivetreatment for early-stage carcinomaof the prostate gland, with the majorityof the literature on brachytherapyreporting biochemical results as favorableas those in the most positiveradical prostatectomy and externalbeamradiation therapy series.[1-4]Because of a lack of definitive evidencesupporting the efficacy of onelocal treatment approach over another,quality-of-life (QOL) parametershave assumed greater importance. Ithas been widely asserted that preservationof potency is more likely followingbrachytherapy, but longerfollow-up has raised substantialdoubts about brachytherapy’s potency-sparing advantage.[5,6] In addition,brachytherapy results in amyriad of previously unrecognizedeffects on sexual function.[7,8]

The current ONCOLOGY articleby Drs. Merrick, Wallner,and Butler is a valuable additionto the literature. An estimated189,000 American men were diagnosedwith prostate cancer in 2002,and 30,200 died of the disease, makingit the most common cancer amongmen, and the second most commoncause of cancer death.[1] The treatmentshave led to a high rate of cure,but the results of treatment oftencause a reduction in quality of life.

This article nicely describes concernsabout the underdiagnosisof deep vein thrombosis(DVT) and superficial vein thrombosisin patients with malignancy. Theincidence of these conditions in thissetting has been demonstrated to beas high as 51% in postmortem studies,as opposed to the clinically recognized15% rate. The articlereinforces the need for better diagnostictools than are currently availablein clinical practice. It alsostresses the need for a high clinicalsuspicion. Duplex ultrasound shouldbe used as a first step, and othermodalities listed in the article needto be used when appropriate.

High-dose myeloablative therapy with allogeneic hematopoietictransplantation is an effective treatment for hematologic malignancies,but this approach is associated with a high risk of complications.The use of relatively nontoxic, nonmyeloablative, or reduced-intensitypreparative regimens still allows engraftment and the generation ofgraft-vs-malignancy effects, is potentially curative for susceptiblemalignancies, and reduces the risk of treatment-related morbidity.Two general strategies along these lines have emerged, based on theuse of (1) immunosuppressive chemotherapeutic drugs, usually apurine analog in combination with an alkylating agent, and (2) lowdosetotal body irradiation, alone or in combination with fludarabine(Fludara).

Over the next 2 decades, we will see an increasing shortage of nurses if current trends continue, according to a report by the Health Resources and Services Administration. The report points to a worsening shortfall as nurses retire and too few new