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SAN DIEGO--Because of the new realities of health care, it is time to rethink the concept of traditional oncology units, Jeanne T. Reardon, RN, said at the 8th Annual Cancer Care Symposium sponsored by the Society for Ambulatory Care Professionals and Health Technology Assessment of the American Hospital Association.

The Moran article presents an excellent summary of the malignancies associated with HIV. The diagnosis of an HIV-related malignancy places additional stress on an already compromised immune system. Neoplasms arising in AIDS patients tend to be aggressive, and because of the immunocompromised state of these patients, they are unable to tolerate the side effects of the various modalities used in treatment.

VANCOUVER, BC--Human herpesvirus-8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus or KSHV, appears to be linked to the development not only of Kaposi's sarcoma (KS) but also to a newly identified type of AIDS lymphoma, Alexandra Levine, MD, said at an educational symposium at the 11th International Conference on AIDS.

OWINGS MILLS, Md--"I once worked with an oncologist who would not treat a child the same age as his son. One year it was 10; the next year, 11," said Daniel Timmel, LCSW, of the Medical and Chirurgical Faculty of Maryland (the state medical society). "Defenses are very interesting."

A recent survey of 224 hospitals nationwide, conducted by health-care management consulting firm TriBrook/AM&G, revealed that the number of hospitals pursuing managed-care affiliations is growing quickly, outpacing the growth in mergers and acquisitions.

Researchers at the Howard Hughes Medical Institute at Duke University Medical Center have shown how drugs that stop organ transplant rejection also partially reverse drug resistance in certain cancer cells.

Times change; the pendulum swings. Once, not so many years ago, mainstream health providers and insurers viewed all alternative and complementary practitioners as quacks.

BETHESDA, Md--A clinical education television series--Bench to Bedside--NIH Grand Rounds--is set to debut on January 15, 1997. Once a month, the world's leading clinicians from the various NIH institutes will discuss critical medical topics of the day.

PRINCETON, NJ--Bristol-Myers Squibb Company has received FDA clearance to market Etopophos (etoposide phosphate) for injection, a new water-soluble version of its anticancer drug VePesid (etoposide).

The American Association for Cancer Research (AACR) has announced the availability of its four annual research awards. The Gertrude Elion award, provided through an educational grant from Glaxo Wellcome Oncology, is open to nontenured cancer researchers in clinical, basic, or translational research in the United States and Canada.

VANCOUVER, BC--Expansion of CD4+ cells could help reconstitute the immune system in patients with AIDS. However, this approach has been unfeasible because stimulation of a patient's CD4+ cells to replicate also leads to HIV replication and greater cell death.

Medical College of Wisconsin researchers recently reported on a study linking Helicobacter pylori to precancerous lesions of the stomach. By infecting specially bred mice with H pylori and showing the resulting precancerous changes in their stomachs, the researchers have uncovered an important clue to the origins of stomach cancer. Their results are the closest evidence to date showing that H pylori causes stomach cancer in any animal model.

BOSTON--Previous study results showing that screening mammography is beneficial only in women over age 50 may stem from inappropriate grouping of age-based data rather than an actual change in benefit at age 50, Daniel B. Kopans, MD, and his colleagues assert in a new study.

Cancer is a genetic disease wherein mutations of growth regulatory genes result in abnormal proliferative capacity, recognized clinically as the occurrence of a malignant tumor. Transcription factors govern the expression of genes, be they "housekeeping" or regulatory. These factors organize the first crucial step in establishing the function of the gene, namely, the transcription of information in DNA into messenger RNA (mRNA). Translation of mRNA results in the synthesis of the oncogenic protein. Hence, the design of therapeutic agents targeted at transcription factors regulating the initial flow of "bad" information from "damaged" genes should be the ultimate goal of efforts to develop new weapons in the therapeutic armamentarium of the oncologist and, indeed, the general internist.

elloff and colleagues have been key players in the recent development of chemoprevention strategies--as initiators of their own studies and minders of others. The succinct summary of their approach is of particular value to oncologists, both because it provides a great deal of data on the current state of chemoprevention research itself and because it draws some useful distinctions between chemoprevention and chemotherapy.

The article by Kelloff et al is a useful, comprehensive review of the current strategy underlying the development of clinically useful chemoprevention agents. One important topic that is not addressed in the article is the failure of micronutrients (selected on the basis of favorable epidemiologic finding) when tested as chemopreventive agents in clinical trials. Two examples of this are particularly noteworthy: In two large randomized trials involving heavy current or former smokers, b-carotene supplementation resulted in an increase in lung cancers compared to placebo.[1,2] Also, in two large randomized trials, folic acid supplementation had no effect on the natural history of cervical intraepithelial neoplasia.[3,4]

Moran provides a comprehensive overview of the myriad nursing challenges posed by patients who have a dual diagnosis of HIV disease and cancer. At least two factors make it imperative for nurses to become increasingly proficient in the care of patients with HIV-related malignancies. First, it is now estimated that 1 in every 250 people in this country is infected with HIV, with the largest increases occurring in heterosexual men and women.[1] Second, patients with HIV disease are being seen in virtually all health-care settings, and many dedicated oncology and HIV/AIDS services are now being mainstreamed into general medical services. Thus, nurses who may have had little experience with this patient population in the past are now much more likely to encounter these patients.

A 43-year-old married man was referred to Memorial Sloan-Kettering Cancer Center in June, 1995, for further management of a malignant brain tumor. He was asymptomatic until April, 1994, when he suffered a generalized seizure and was admitted to a local hospital. An MRI revealed a right parietal lobe lesion. The tumor was resected and found to be a glioblastoma multiforme.

HOUSTON--Opioid solutions appear to be physically compatible with a number of adjuvant agents used in supportive care, researchers from M.D. Anderson Cancer Center report. They evaluated the physical compatibility of four injectable opioids--fentanyl, hydro-morphone, methadone, and morphine--with 14 drugs used for pain and symptom management (see table) for 48 hours.

This text, originally published as Dameshek and Gunz's textbook Leukemia (1958), is now edited by an international team consisting of Dr. Henderson, Dr. Lister, and Dr. Greaves. This continues to be an outstanding text in its field, covering virtually all aspects of the acute and chronic leukemias.

The period immediately after a cancer diagnosis is generally a time of stress and uncertainty, and the need to make treatment decisions may further add to the distress. If you have been diagnosed with cancer, you need to be able to talk openly with your doctor about your treatment options, and continue to ask questions and stay informed throughout your treatment and follow-up.

BUFFALO, NY--Despite a history of aggressive chemotherapy, survivors of childhood cancer are capable of conceiving and giving birth to healthy children, Daniel M. Green, MD, of the Department of Pediatrics, Roswell Park Cancer Institute, said at the 4th International Conference on Long-Term Complications of Children and Adolescents for Cancer.

For persons with AIDS, current health status does not necessarily affect their desire to be revived if their heart stops, according to a study supported by the Agency for Health Care Policy and Research (HS06239).

BALTIMORE--Following the battlefield tactic of divide and conquer (in this case, dividing a molecule into two fragments), University of Maryland Baltimore County (UMBC) researchers have determined the three-dimensional structure of a key part of the HIV-1 p24 capsid protein (see illustration on page 1).

BETHESDA, Md--As part of its resolution commemorating the 25th anniversary of the National Cancer Act, the National Cancer Advisory Board (NCAB) has voted to initiate a 1-year public education program to reaffirm the national commitment to cancer research.

Both physicians and public health specialists can learn valuable lessons about communicating cancer risks from the experiences of those engaged in environmental risk communications, said Frank Baker, phd, a senior official of the American Cancer Society (ACS).

VANCOUVER, BC--The goals of cost-effective therapy for HIV infection are to suppress viral replication to a level that halts disease progression, maximizes immune recovery, and limits the emergence of drug resistance, Margaret Fischl, MD, said at the 11th International Conference on AIDS.

NEW YORK--Choice In Dying is offering a new service that electronically stores advance directives (living wills and health care proxies). The service provides instant access to these documents with one phone call, thus avoiding the search for documents at a critical time, as, for example, when a patient becomes unconscious or unable to speak for himself.

NEW YORK--Scientists at the Aaron Diamond AIDS Research Center appear to have solved one of the long-standing enigmas of HIV infection--why some people remain uninfected even after repeated exposures to the virus. The answer lies in the genes, and in basic research published only a few months earlier.

JACKSONVILLE, Fla--In a scenario out of a recent John Grisham novel (The Runaway Jury), a Florida jury has returned a verdict in favor of a plaintiff suing a large tobacco company, causing a precipitous fall in the price of stocks of all the major tobacco companies. Philip Morris shares, for example, lost more than 10% of their value.