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Research and Reviews for the Practicing Oncologist
Hypertension in cancer patients
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Hypertension is the force of blood pushing against the walls of the arteries. It is measured as systolic pressure when the heart beats and pumps blood and as diastolic pressure in the arteries when the heart rests between beats. There are 4 stages in blood pressure classification—normal, prehypertension, stage 1, and stage 2. Hypertension affects approximately 50 million people in the United States and 1 billion people worldwide. People who are normotensive at age 55 years have a 90% chance of developing hypertension in their lifetime. Starting with a blood pressure of 115/75 mmHg, the risk of cardiovascular death doubles with each 20/10 mmHg increment...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Recent developments in the treatment of high-grade gliomas
Patients with glioblastoma and other high-grade gliomas have poor outcomes and are challenging to treat. The relative rarity of these tumors has made large-scale, practice-changing trials difficult to accomplish and has led to the formation of large multinational organizations that focus on neuro-oncology. This has resulted in the rapid completion of several large trials that in some cases have set new standards of care that can offer increased progression-free and overall survivals for some patients. The incorporation of correlative tissue studies in these trials has led to the identification of prognostic and predictive genetic markers that demonstrate the heterogeneity of these tumors and will assist in developing individualized treatment strategies as research continues to uncover new therapeutic targets. This review of recently completed and in-progress phase 3 trials in high-grade gliomas highlights the developments and future directions in the treatment of these tumors...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Patients with glioblastoma and other high-grade gliomas have poor outcomes and are challenging to treat. The relative rarity of these tumors has made large-scale, practice-changing trials difficult to accomplish and has led to the formation of large multinational organizations that focus on neuro-oncology. This has resulted in the rapid completion of several large trials that in some cases have set new standards of care that can offer increased progression-free and overall survivals for some patients. The incorporation of correlative tissue studies in these trials has led to the identification of prognostic and predictive genetic markers that demonstrate the heterogeneity of these tumors and will assist in developing individualized treatment strategies as research continues to uncover new therapeutic targets. This review of recently completed and in-progress phase 3 trials in high-grade gliomas highlights the developments and future directions in the treatment of these tumors...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Patients with glioblastoma and other high-grade gliomas have poor outcomes and are challenging to treat. The relative rarity of these tumors has made large-scale, practice-changing trials difficult to accomplish and has led to the formation of large multinational organizations that focus on neuro-oncology. This has resulted in the rapid completion of several large trials that in some cases have set new standards of care that can offer increased progression-free and overall survivals for some patients. The incorporation of correlative tissue studies in these trials has led to the identification of prognostic and predictive genetic markers that demonstrate the heterogeneity of these tumors and will assist in developing individualized treatment strategies as research continues to uncover new therapeutic targets. This review of recently completed and in-progress phase 3 trials in high-grade gliomas highlights the developments and future directions in the treatment of these tumors...
*For PDFs of the full article and related Commentary, click on the links to the left of this introduction.
Community Oncology Podcast - Carfilzomib and multiple myeloma
What’s the role of parenteral iron use in the oncology clinic? How does carfilzomib fit into the treatment of multiple myeloma? Listen to the the September podcast of Community Oncology from Editor-in-Chief Dr. David H. Henry.
What’s the role of parenteral iron use in the oncology clinic? How does carfilzomib fit into the treatment of multiple myeloma? Listen to the the September podcast of Community Oncology from Editor-in-Chief Dr. David H. Henry.
What’s the role of parenteral iron use in the oncology clinic? How does carfilzomib fit into the treatment of multiple myeloma? Listen to the the September podcast of Community Oncology from Editor-in-Chief Dr. David H. Henry.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.
Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status
Ulla Näppä, RN, MSc
Abstract
Background
Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
Objectives
To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
Methods
The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
Results
After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
Limitations
At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
Conclusion
Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
*For a PDF of the full article and accompanying commentary by Dr Jamie von Roenn, click on the links to the left of this introduction.
The Development of an eHealth Tool Suite for Prostate Cancer Patients and Their Partners
Donna Van Bogaert, PhD
Abstract
Background
eHealth resources for people facing health crises must balance the expert knowledge and perspective of developers and clinicians against the very different needs and perspectives of prospective users. This formative study explores the information and support needs of posttreatment prostate cancer patients and their partners as a way to improve an existing eHealth information and support system called CHESS (Comprehensive Health Enhancement Support System).
Methods
Focus groups with patient survivors and their partners were used to identify information gaps and information-seeking milestones.
Results
Both patients and partners expressed a need for assistance in decision making, connecting with experienced patients, and making sexual adjustments. Female partners of patients are more active in searching for cancer information. All partners have information and support needs distinct from those of the patient.
Conclusions
Findings were used to develop a series of interactive tools and navigational features for the CHESS prostate cancer computer-mediated system.
*For a PDF of the full article, click on the link to the left of this introduction.
Donna Van Bogaert, PhD
Abstract
Background
eHealth resources for people facing health crises must balance the expert knowledge and perspective of developers and clinicians against the very different needs and perspectives of prospective users. This formative study explores the information and support needs of posttreatment prostate cancer patients and their partners as a way to improve an existing eHealth information and support system called CHESS (Comprehensive Health Enhancement Support System).
Methods
Focus groups with patient survivors and their partners were used to identify information gaps and information-seeking milestones.
Results
Both patients and partners expressed a need for assistance in decision making, connecting with experienced patients, and making sexual adjustments. Female partners of patients are more active in searching for cancer information. All partners have information and support needs distinct from those of the patient.
Conclusions
Findings were used to develop a series of interactive tools and navigational features for the CHESS prostate cancer computer-mediated system.
*For a PDF of the full article, click on the link to the left of this introduction.
Donna Van Bogaert, PhD
Abstract
Background
eHealth resources for people facing health crises must balance the expert knowledge and perspective of developers and clinicians against the very different needs and perspectives of prospective users. This formative study explores the information and support needs of posttreatment prostate cancer patients and their partners as a way to improve an existing eHealth information and support system called CHESS (Comprehensive Health Enhancement Support System).
Methods
Focus groups with patient survivors and their partners were used to identify information gaps and information-seeking milestones.
Results
Both patients and partners expressed a need for assistance in decision making, connecting with experienced patients, and making sexual adjustments. Female partners of patients are more active in searching for cancer information. All partners have information and support needs distinct from those of the patient.
Conclusions
Findings were used to develop a series of interactive tools and navigational features for the CHESS prostate cancer computer-mediated system.
*For a PDF of the full article, click on the link to the left of this introduction.
Can Counseling Add Value to an Exercise Intervention for Improving Quality of Life in Breast Cancer Survivors? A Feasibility Study
Fiona Naumann, PhD
Abstract
Background
Improved survivorship has led to increased recognition of the need to manage the side effects of cancer and its treatment. Exercise and psychological interventions benefit survivors; however, it is unknown if additional benefits can be gained by combining these two modalities.
Objective
Our purpose was to examine the feasibility of delivering an exercise and counseling intervention to 43 breast cancer survivors, to determine if counseling can add value to an exercise intervention for improving quality of life (QOL) in terms of physical and psychological function.
Methods
We compared exercise only (Ex), counseling only (C), exercise and counseling (ExC), and usual care (UsC) over an 8 week intervention.
Results
In all, 93% of participants completed the interventions, with no adverse effects documented. There were significant improvements in VO2max as well as upper body and lower body strength in the ExC and Ex groups compared to the C and UsC groups (P < .05). Significant improvements on the Beck Depression Inventory were observed in the ExC and Ex groups, compared with UsC (P < .04), with significant reduction in fatigue for the ExC group, compared with UsC, and no significant differences in QOL change between groups, although the ExC group had significant clinical improvement.
Limitations
Limitations included small subject number and study of only breast cancer survivors.
Conclusions
These preliminary results suggest that a combined exercise and psychological counseling program is both feasible and acceptable for breast cancer survivors and may improve QOL more than would a single-entity intervention.
*For a PDF of the full article, click on the link to the left of this introduction.
Fiona Naumann, PhD
Abstract
Background
Improved survivorship has led to increased recognition of the need to manage the side effects of cancer and its treatment. Exercise and psychological interventions benefit survivors; however, it is unknown if additional benefits can be gained by combining these two modalities.
Objective
Our purpose was to examine the feasibility of delivering an exercise and counseling intervention to 43 breast cancer survivors, to determine if counseling can add value to an exercise intervention for improving quality of life (QOL) in terms of physical and psychological function.
Methods
We compared exercise only (Ex), counseling only (C), exercise and counseling (ExC), and usual care (UsC) over an 8 week intervention.
Results
In all, 93% of participants completed the interventions, with no adverse effects documented. There were significant improvements in VO2max as well as upper body and lower body strength in the ExC and Ex groups compared to the C and UsC groups (P < .05). Significant improvements on the Beck Depression Inventory were observed in the ExC and Ex groups, compared with UsC (P < .04), with significant reduction in fatigue for the ExC group, compared with UsC, and no significant differences in QOL change between groups, although the ExC group had significant clinical improvement.
Limitations
Limitations included small subject number and study of only breast cancer survivors.
Conclusions
These preliminary results suggest that a combined exercise and psychological counseling program is both feasible and acceptable for breast cancer survivors and may improve QOL more than would a single-entity intervention.
*For a PDF of the full article, click on the link to the left of this introduction.
Fiona Naumann, PhD
Abstract
Background
Improved survivorship has led to increased recognition of the need to manage the side effects of cancer and its treatment. Exercise and psychological interventions benefit survivors; however, it is unknown if additional benefits can be gained by combining these two modalities.
Objective
Our purpose was to examine the feasibility of delivering an exercise and counseling intervention to 43 breast cancer survivors, to determine if counseling can add value to an exercise intervention for improving quality of life (QOL) in terms of physical and psychological function.
Methods
We compared exercise only (Ex), counseling only (C), exercise and counseling (ExC), and usual care (UsC) over an 8 week intervention.
Results
In all, 93% of participants completed the interventions, with no adverse effects documented. There were significant improvements in VO2max as well as upper body and lower body strength in the ExC and Ex groups compared to the C and UsC groups (P < .05). Significant improvements on the Beck Depression Inventory were observed in the ExC and Ex groups, compared with UsC (P < .04), with significant reduction in fatigue for the ExC group, compared with UsC, and no significant differences in QOL change between groups, although the ExC group had significant clinical improvement.
Limitations
Limitations included small subject number and study of only breast cancer survivors.
Conclusions
These preliminary results suggest that a combined exercise and psychological counseling program is both feasible and acceptable for breast cancer survivors and may improve QOL more than would a single-entity intervention.
*For a PDF of the full article, click on the link to the left of this introduction.
Integrating Palliative Care in the Intensive Care Unit
Jacob J. Strand, MD
Abstract
The admission of cancer patients into intensive care units (ICUs) is on the rise. These patients are at high risk for physical and psychosocial suffering. Patients and their families often face difficult end-of-life decisions that highlight the importance of effective and empathetic communication. Palliative care teams are uniquely equipped to help care for cancer patients who are admitted to ICUs.
When utilized in the ICU, palliative care has the potential to improve a patient's symptoms, enhance the communication between care teams and families, and improve family-centered decision making. Within the context of this article, we will discuss how palliative care can be integrated into the care of ICU patients and how to enhance family-centered communication; we will also highlight the care of ICU patients at the end of life.
*For a PDF of the full article, click on the link to the left of this introduction.
Jacob J. Strand, MD
Abstract
The admission of cancer patients into intensive care units (ICUs) is on the rise. These patients are at high risk for physical and psychosocial suffering. Patients and their families often face difficult end-of-life decisions that highlight the importance of effective and empathetic communication. Palliative care teams are uniquely equipped to help care for cancer patients who are admitted to ICUs.
When utilized in the ICU, palliative care has the potential to improve a patient's symptoms, enhance the communication between care teams and families, and improve family-centered decision making. Within the context of this article, we will discuss how palliative care can be integrated into the care of ICU patients and how to enhance family-centered communication; we will also highlight the care of ICU patients at the end of life.
*For a PDF of the full article, click on the link to the left of this introduction.
Jacob J. Strand, MD
Abstract
The admission of cancer patients into intensive care units (ICUs) is on the rise. These patients are at high risk for physical and psychosocial suffering. Patients and their families often face difficult end-of-life decisions that highlight the importance of effective and empathetic communication. Palliative care teams are uniquely equipped to help care for cancer patients who are admitted to ICUs.
When utilized in the ICU, palliative care has the potential to improve a patient's symptoms, enhance the communication between care teams and families, and improve family-centered decision making. Within the context of this article, we will discuss how palliative care can be integrated into the care of ICU patients and how to enhance family-centered communication; we will also highlight the care of ICU patients at the end of life.
*For a PDF of the full article, click on the link to the left of this introduction.
Implementing the Exercise Guidelines for Cancer Survivors
Kathleen Y. Wolin, ScD, Anna L. Schwartz, PhD, Charles E. Matthews, PhD, FACSM, Kerry S. Courneya, PhD, Kathryn H. Schmitz, PhD
Abstract
In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life, and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community.
*For a PDF of the full article and accompanying commentary by Nicole Stout, click on the links to the left of this introduction.
Kathleen Y. Wolin, ScD, Anna L. Schwartz, PhD, Charles E. Matthews, PhD, FACSM, Kerry S. Courneya, PhD, Kathryn H. Schmitz, PhD
Abstract
In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life, and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community.
*For a PDF of the full article and accompanying commentary by Nicole Stout, click on the links to the left of this introduction.
Kathleen Y. Wolin, ScD, Anna L. Schwartz, PhD, Charles E. Matthews, PhD, FACSM, Kerry S. Courneya, PhD, Kathryn H. Schmitz, PhD
Abstract
In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life, and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community.
*For a PDF of the full article and accompanying commentary by Nicole Stout, click on the links to the left of this introduction.
Access to specialized treatment by adult Hispanic brain tumor patients: findings from a single-institution retrospective study
Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.
Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.
Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.
Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P .023). There were no differences on overall survival between the 2 groups of patients.
Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings
Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.
*To read the the full article, click on the link at the top of this introduction.
Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.
Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.
Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.
Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P .023). There were no differences on overall survival between the 2 groups of patients.
Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings
Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.
*To read the the full article, click on the link at the top of this introduction.
Background: The Hispanic population accounts for 15% of the population of the United States, and for as much as 75% in cities throughout California. Racial disparities that are reflected by limited access to health care and worse disease outcomes are well documented for adult Hispanic cancer patients.
Objective: To determine whether there are similar disparities—including delays in accessing surgery, radiation, and oncologic care—for adult Hispanic non English-speaking (HNES) neuro-oncology patients and white English-only–speaking (WES) patients in an academic, tertiary care center with a multidisciplinary neuro-oncology team.
Methods: This retrospective study was conducted at the Chao Family Comprehensive Cancer Center of the University of California, Irvine. All patients who were diagnosed with a primary brain tumor during January 1, 2003, to December 31, 2008, were identified and data were collected on their age, sex, ethnicity, languages spoken, diagnosis, and insurance status. The times from the date of diagnosis to the date of surgery, from the date of surgery to the date of starting radiation (if indicated), and from the date of finishing radiation to the date of starting chemotherapy (if indicated) were also recorded.
Results: Most of the HNES patients (56.4%) had state insurance for the indigent, whereas most of the WES patients (41.8%) had private insurance from a health maintenance organization. Moreover, 12.8% of HNES patients were uninsured, compared with 4.5% of WES patients. There were no significant delays in the time from diagnosis to surgery, but there was a significant delay in access to radiation treatment (P .023). There were no differences on overall survival between the 2 groups of patients.
Limitations: This is a retrospective study of a relatively small number of patients. Larger studies are needed to corroborate these findings
Conclusions: The findings demonstrate that there are disparities in insurance status and access to radiation therapy between HNES and WES neuro-oncology patients.
*To read the the full article, click on the link at the top of this introduction.
Carfilzomib and bortezomib therapy in patients with multiple myeloma
In July 2012, carfilzomib was given accelerated approval by the Food and Drug Administration for the treatment of patients with multiple myeloma (MM) who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have exhibited disease progression during or within 60 days of completing their last therapy. The approval was based on results of a single-arm, multicenter phase 2 trial of carfilzomib in patients with relapsed and refractory MM. As a condition of the accelerated approval, the manufacturer of the drug has to submit a final analysis of an ongoing phase 3 trial that compares carfilzomib plus lenalidomide plus low-dose dexamethasone with lenalidomide plus low-dose dexamethasone in patients with relapsed and refractory MM after 1 to 3 previous therapies. The primary end point of this trial is progression-free survival (PFS)...
*For a PDF of the full article and accompanying Commentaries, click on the links to the left of this introduction.
In July 2012, carfilzomib was given accelerated approval by the Food and Drug Administration for the treatment of patients with multiple myeloma (MM) who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have exhibited disease progression during or within 60 days of completing their last therapy. The approval was based on results of a single-arm, multicenter phase 2 trial of carfilzomib in patients with relapsed and refractory MM. As a condition of the accelerated approval, the manufacturer of the drug has to submit a final analysis of an ongoing phase 3 trial that compares carfilzomib plus lenalidomide plus low-dose dexamethasone with lenalidomide plus low-dose dexamethasone in patients with relapsed and refractory MM after 1 to 3 previous therapies. The primary end point of this trial is progression-free survival (PFS)...
*For a PDF of the full article and accompanying Commentaries, click on the links to the left of this introduction.
In July 2012, carfilzomib was given accelerated approval by the Food and Drug Administration for the treatment of patients with multiple myeloma (MM) who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have exhibited disease progression during or within 60 days of completing their last therapy. The approval was based on results of a single-arm, multicenter phase 2 trial of carfilzomib in patients with relapsed and refractory MM. As a condition of the accelerated approval, the manufacturer of the drug has to submit a final analysis of an ongoing phase 3 trial that compares carfilzomib plus lenalidomide plus low-dose dexamethasone with lenalidomide plus low-dose dexamethasone in patients with relapsed and refractory MM after 1 to 3 previous therapies. The primary end point of this trial is progression-free survival (PFS)...
*For a PDF of the full article and accompanying Commentaries, click on the links to the left of this introduction.