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BALTIMORE-Between 65% and 85% of advanced cancer patients suffer pain, but between 85% and 95% of those patients, if properly treated, can experience relief. Providing effective pain management is a multidisciplinary effort requiring detailed planning and persistent implementation by a team committed to using a variety of resources and techniques. These concepts and how they are integrated into the Johns Hopkins approach to pain management were described by Suzanne A. Nesbit, PharmD, BCPS, clinical specialist in pain management in the Department of Pharmacy at Johns Hopkins Hospital in Baltimore and Kathy Smolinski, LCSW-C, senior clinical social worker in the Cancer Pain Service of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

BETHESDA, Maryland-The understanding of carcinogenesis that has emerged from molecular and genetic studies has provided a new vision of treatment, commonly called molecular targeting. In it, debilitating cytotoxic drugs will give way to agents that target specific proteins that mark specific cancer cells.

InTouch magazine, a sister publication of ONCOLOGY and Oncology News International, has been selected by the National Library of Medicine to be indexed and included in Index Medicus and Medline. InTouch is published by PRR for cancer patients and their families.

NEW YORK-The next decade will bring advances in pain management as a direct result of research currently making its way from bench to bedside, said pain management expert Russell K. Portenoy, MD.

BALTIMORE-Medical personnel are often "dreadful" at singling out individuals facing mood disturbances, emotional issues, and practical problems that can cause severe distress during cancer treatment, according to Matthew Loscalzo, MSW, director of patient and family services and co-director of oncology pain services at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore. A new screening and assessment tool used at the onset of treatment, however, identifies the issues most important to each individual patient and allows staff to promptly arrange for needed services, he told an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting.

BALTIMORE-Fatigue is a universally recognized complication of cancer, caused by both the disease itself and its treatment, but the role of anemia in causing fatigue has received insufficient attention, according to MiKaela Olsen, RN, MS. This oversight has led to undertreatment of anemia, but proper evaluation and treatment can reduce anemia and the fatigue and other troubling symptoms it causes, she said at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting. Ms. Olsen is an oncology/bone marrow transplant/hematology clinical nurse specialist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore.

NEW YORK-Aromatherapy massage reduces short-term anxiety in cancer patients, improves quality of life (QOL), and is perceived by cancer patients as being beneficial, according to results to date from evaluations conducted by researchers in the United Kingdom.

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.