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Research and Reviews for the Practicing Oncologist
PEER VIEWPOINT: Respiratory Symptoms in Advanced Lung Cancer: A Persistent Challenge
Respiratory Symptoms in Advanced Lung Cancer: A Persistent Challenge
- Available online 23 November 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.10.004
Drs. McCannon and Temel have written an interesting review on the management of respiratory symptoms in advanced lung cancer patients. Their article is structured in a systematic, easy-to-follow format and will be a useful tool for physicians caring for patients with advanced lung cancer.
The authors reviewed up-to-date literature on frequent complications of advanced lung cancer such as pulmonary embolism, pleural effusion, pericardial tamponade, postobstructive pneumonia, and treatment-related pneumonitis (resulting from radiation therapy and certain types of chemotherapy). They also provide useful recommendations and suggest practical interventions which are supported by evidence from the literature. Clinicians caring for such patients must have a comprehensive knowledge of such complications to make a diagnosis and provide specific treatment.
Drs. McCannon and Temel address common symptoms associated with advanced lung cancer. In addition to their comprehensive review of the management of dyspnea, they address other symptoms such as cough and hemoptysis and provide specific recommendations on the management of each symptom with supportive evidence from the literature for each intervention.
Respiratory Symptoms in Advanced Lung Cancer: A Persistent Challenge
- Available online 23 November 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.10.004
Drs. McCannon and Temel have written an interesting review on the management of respiratory symptoms in advanced lung cancer patients. Their article is structured in a systematic, easy-to-follow format and will be a useful tool for physicians caring for patients with advanced lung cancer.
The authors reviewed up-to-date literature on frequent complications of advanced lung cancer such as pulmonary embolism, pleural effusion, pericardial tamponade, postobstructive pneumonia, and treatment-related pneumonitis (resulting from radiation therapy and certain types of chemotherapy). They also provide useful recommendations and suggest practical interventions which are supported by evidence from the literature. Clinicians caring for such patients must have a comprehensive knowledge of such complications to make a diagnosis and provide specific treatment.
Drs. McCannon and Temel address common symptoms associated with advanced lung cancer. In addition to their comprehensive review of the management of dyspnea, they address other symptoms such as cough and hemoptysis and provide specific recommendations on the management of each symptom with supportive evidence from the literature for each intervention.
Respiratory Symptoms in Advanced Lung Cancer: A Persistent Challenge
- Available online 23 November 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.10.004
Drs. McCannon and Temel have written an interesting review on the management of respiratory symptoms in advanced lung cancer patients. Their article is structured in a systematic, easy-to-follow format and will be a useful tool for physicians caring for patients with advanced lung cancer.
The authors reviewed up-to-date literature on frequent complications of advanced lung cancer such as pulmonary embolism, pleural effusion, pericardial tamponade, postobstructive pneumonia, and treatment-related pneumonitis (resulting from radiation therapy and certain types of chemotherapy). They also provide useful recommendations and suggest practical interventions which are supported by evidence from the literature. Clinicians caring for such patients must have a comprehensive knowledge of such complications to make a diagnosis and provide specific treatment.
Drs. McCannon and Temel address common symptoms associated with advanced lung cancer. In addition to their comprehensive review of the management of dyspnea, they address other symptoms such as cough and hemoptysis and provide specific recommendations on the management of each symptom with supportive evidence from the literature for each intervention.
What is mental health and why do I care?
Happy New Year for 2012, and all that January brings: fair-weather dieters, exercise equipment sales, and inevitable changes in insurance plans that take effect as the ball drops in Times Square.
This year may bring to many of your patients substantial changes in coverage for mental health services reflecting, at long last, the changes implemented by the federal Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Although its provisions technically went into effect on Jan. 1, 2011, insurance plans were not required to implement MHPAEA until the onset of a new health plan year, following open enrollment periods that occurred, for most companies, in the fall of 2011. New cards, along with an inevitably complex description of changes to mental health benefits, have just arrived.
In a nutshell, what mental health parity means for most patients:
Benefits for mental health services that are at least equal to those offered for medical diagnoses
An end to pre-approval for a set number of visits to a psychologist or other mental health professional, unless such pre-approval is also required for visits to physicians
Equal deductibles, co-pays, and maximum out-of-pocket thresholds for medical and mental health services
Coverage of out-of-network mental health provider services on par with those offered for out-of-network medical providers
Previously, many people with employer-sponsored benefits could access mental health care and/or substance use treatment, but only after receiving pre-approval to see a provider on the panel of a "carved out" plan. The approval would permit only a certain number of visits, say, once weekly sessions for 15 weeks, and only for certain diagnoses. Quite often, co-pays were high and visits were capped for an individual over the course of a calendar year.
Such limitations, in my opinion, were unfair and unwise. To illustrate the point, an analogous plan for medical benefits would have started the clock ticking on a patient if he visited a pre-approved doctor in January for diabetes care, and then only pay for 15 visits (one per week), no matter whether his blood sugars were under control, he had an exacerbation of the condition, or he was unlucky enough to also get influenza late in the year.
By failing to cover certain diagnoses altogether, and sharply limiting coverage of others, token mental health insurance plans erected financial barriers to patients savvy enough to recognize that they needed help to get through a clinical depression, a series of panic attacks, or a profoundly difficult life event, such as a new or recurrent diagnosis of cancer.
Of course, many community and regional health centers, as well as local chapters of the American Cancer Society, offer no- or low-cost psychological support to cancer patients and their families in the form of support groups, and in some cases, individual, couples, and family counseling services.
However, constricting budgets have reduced such offerings in many places, and some patients and families simply need more intensive psychological assistance than these donation-supported programs can provide. Some cancer centers are shifting to billing insurance companies for mental health services for patients who have coverage.
The political fight for mental health parity spanned years and sought to banish longstanding inequities in employer benefit packages that often treated mental health coverage as a bedraggled stepchild relegated to the back of the insurance card.
The philosophy behind parity reflected a heightening awareness of the connections between mind and body, the tangible benefits to overall health of improved treatment of psychological and substance use disorders, and the harm done by continued stigma associated with mental health treatment.
As with most political footballs, this one was kicked around quite a bit before the change was finally enacted as the result of bipartisan cooperation that today would be impossible. Nonetheless, it contained – surprise! – massive loopholes.
For example, the federal law does not cover people with individually purchased insurance policies or group health plans for companies with fewer than 50 employees. It does not require employers to offer mental health coverage, only requiring parity if both medical and mental health benefits are included in a plan.
As summarized by the American Psychological Association, the federal changes will supersede state parity laws when the federal provisions are stronger.
The provisions of the MHPAEA aren’t perfect, to be sure. However, in that they balance medical and mental health coverage for employees of the nation’s largest, bellweather companies and begin to chip away at stigma-based barriers to the overall health of Americans, they’re certainly a start.
And I’ll make a New Year’s toast to that.
Happy New Year for 2012, and all that January brings: fair-weather dieters, exercise equipment sales, and inevitable changes in insurance plans that take effect as the ball drops in Times Square.
This year may bring to many of your patients substantial changes in coverage for mental health services reflecting, at long last, the changes implemented by the federal Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Although its provisions technically went into effect on Jan. 1, 2011, insurance plans were not required to implement MHPAEA until the onset of a new health plan year, following open enrollment periods that occurred, for most companies, in the fall of 2011. New cards, along with an inevitably complex description of changes to mental health benefits, have just arrived.
In a nutshell, what mental health parity means for most patients:
Benefits for mental health services that are at least equal to those offered for medical diagnoses
An end to pre-approval for a set number of visits to a psychologist or other mental health professional, unless such pre-approval is also required for visits to physicians
Equal deductibles, co-pays, and maximum out-of-pocket thresholds for medical and mental health services
Coverage of out-of-network mental health provider services on par with those offered for out-of-network medical providers
Previously, many people with employer-sponsored benefits could access mental health care and/or substance use treatment, but only after receiving pre-approval to see a provider on the panel of a "carved out" plan. The approval would permit only a certain number of visits, say, once weekly sessions for 15 weeks, and only for certain diagnoses. Quite often, co-pays were high and visits were capped for an individual over the course of a calendar year.
Such limitations, in my opinion, were unfair and unwise. To illustrate the point, an analogous plan for medical benefits would have started the clock ticking on a patient if he visited a pre-approved doctor in January for diabetes care, and then only pay for 15 visits (one per week), no matter whether his blood sugars were under control, he had an exacerbation of the condition, or he was unlucky enough to also get influenza late in the year.
By failing to cover certain diagnoses altogether, and sharply limiting coverage of others, token mental health insurance plans erected financial barriers to patients savvy enough to recognize that they needed help to get through a clinical depression, a series of panic attacks, or a profoundly difficult life event, such as a new or recurrent diagnosis of cancer.
Of course, many community and regional health centers, as well as local chapters of the American Cancer Society, offer no- or low-cost psychological support to cancer patients and their families in the form of support groups, and in some cases, individual, couples, and family counseling services.
However, constricting budgets have reduced such offerings in many places, and some patients and families simply need more intensive psychological assistance than these donation-supported programs can provide. Some cancer centers are shifting to billing insurance companies for mental health services for patients who have coverage.
The political fight for mental health parity spanned years and sought to banish longstanding inequities in employer benefit packages that often treated mental health coverage as a bedraggled stepchild relegated to the back of the insurance card.
The philosophy behind parity reflected a heightening awareness of the connections between mind and body, the tangible benefits to overall health of improved treatment of psychological and substance use disorders, and the harm done by continued stigma associated with mental health treatment.
As with most political footballs, this one was kicked around quite a bit before the change was finally enacted as the result of bipartisan cooperation that today would be impossible. Nonetheless, it contained – surprise! – massive loopholes.
For example, the federal law does not cover people with individually purchased insurance policies or group health plans for companies with fewer than 50 employees. It does not require employers to offer mental health coverage, only requiring parity if both medical and mental health benefits are included in a plan.
As summarized by the American Psychological Association, the federal changes will supersede state parity laws when the federal provisions are stronger.
The provisions of the MHPAEA aren’t perfect, to be sure. However, in that they balance medical and mental health coverage for employees of the nation’s largest, bellweather companies and begin to chip away at stigma-based barriers to the overall health of Americans, they’re certainly a start.
And I’ll make a New Year’s toast to that.
Happy New Year for 2012, and all that January brings: fair-weather dieters, exercise equipment sales, and inevitable changes in insurance plans that take effect as the ball drops in Times Square.
This year may bring to many of your patients substantial changes in coverage for mental health services reflecting, at long last, the changes implemented by the federal Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Although its provisions technically went into effect on Jan. 1, 2011, insurance plans were not required to implement MHPAEA until the onset of a new health plan year, following open enrollment periods that occurred, for most companies, in the fall of 2011. New cards, along with an inevitably complex description of changes to mental health benefits, have just arrived.
In a nutshell, what mental health parity means for most patients:
Benefits for mental health services that are at least equal to those offered for medical diagnoses
An end to pre-approval for a set number of visits to a psychologist or other mental health professional, unless such pre-approval is also required for visits to physicians
Equal deductibles, co-pays, and maximum out-of-pocket thresholds for medical and mental health services
Coverage of out-of-network mental health provider services on par with those offered for out-of-network medical providers
Previously, many people with employer-sponsored benefits could access mental health care and/or substance use treatment, but only after receiving pre-approval to see a provider on the panel of a "carved out" plan. The approval would permit only a certain number of visits, say, once weekly sessions for 15 weeks, and only for certain diagnoses. Quite often, co-pays were high and visits were capped for an individual over the course of a calendar year.
Such limitations, in my opinion, were unfair and unwise. To illustrate the point, an analogous plan for medical benefits would have started the clock ticking on a patient if he visited a pre-approved doctor in January for diabetes care, and then only pay for 15 visits (one per week), no matter whether his blood sugars were under control, he had an exacerbation of the condition, or he was unlucky enough to also get influenza late in the year.
By failing to cover certain diagnoses altogether, and sharply limiting coverage of others, token mental health insurance plans erected financial barriers to patients savvy enough to recognize that they needed help to get through a clinical depression, a series of panic attacks, or a profoundly difficult life event, such as a new or recurrent diagnosis of cancer.
Of course, many community and regional health centers, as well as local chapters of the American Cancer Society, offer no- or low-cost psychological support to cancer patients and their families in the form of support groups, and in some cases, individual, couples, and family counseling services.
However, constricting budgets have reduced such offerings in many places, and some patients and families simply need more intensive psychological assistance than these donation-supported programs can provide. Some cancer centers are shifting to billing insurance companies for mental health services for patients who have coverage.
The political fight for mental health parity spanned years and sought to banish longstanding inequities in employer benefit packages that often treated mental health coverage as a bedraggled stepchild relegated to the back of the insurance card.
The philosophy behind parity reflected a heightening awareness of the connections between mind and body, the tangible benefits to overall health of improved treatment of psychological and substance use disorders, and the harm done by continued stigma associated with mental health treatment.
As with most political footballs, this one was kicked around quite a bit before the change was finally enacted as the result of bipartisan cooperation that today would be impossible. Nonetheless, it contained – surprise! – massive loopholes.
For example, the federal law does not cover people with individually purchased insurance policies or group health plans for companies with fewer than 50 employees. It does not require employers to offer mental health coverage, only requiring parity if both medical and mental health benefits are included in a plan.
As summarized by the American Psychological Association, the federal changes will supersede state parity laws when the federal provisions are stronger.
The provisions of the MHPAEA aren’t perfect, to be sure. However, in that they balance medical and mental health coverage for employees of the nation’s largest, bellweather companies and begin to chip away at stigma-based barriers to the overall health of Americans, they’re certainly a start.
And I’ll make a New Year’s toast to that.
Family and Caregiver Needs Over the Course of the Cancer Trajectory
When a patient is diagnosed with cancer, family members often assume responsibility for providing care. They are typically involved not only with the diagnostic and treatment phases of care but also across the care trajectory and into survivorship. These caregivers are a primary source of support to individuals with cancer. The purpose of this article is to present an overview of the challenges, needs, and roles of family caregivers over the course of the cancer treatment trajectory and to discuss what support the professionals can provide.
Click of the PDF icon at the top of this introduction to read the full article.
When a patient is diagnosed with cancer, family members often assume responsibility for providing care. They are typically involved not only with the diagnostic and treatment phases of care but also across the care trajectory and into survivorship. These caregivers are a primary source of support to individuals with cancer. The purpose of this article is to present an overview of the challenges, needs, and roles of family caregivers over the course of the cancer treatment trajectory and to discuss what support the professionals can provide.
Click of the PDF icon at the top of this introduction to read the full article.
When a patient is diagnosed with cancer, family members often assume responsibility for providing care. They are typically involved not only with the diagnostic and treatment phases of care but also across the care trajectory and into survivorship. These caregivers are a primary source of support to individuals with cancer. The purpose of this article is to present an overview of the challenges, needs, and roles of family caregivers over the course of the cancer treatment trajectory and to discuss what support the professionals can provide.
Click of the PDF icon at the top of this introduction to read the full article.
Community-Based Surveillance in Clinical Stage I Germ Cell Tumors
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores 40 participated clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores 40 participated clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores 40 participated clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
Treatment of chemotherapy-induced nausea
Harper Cancer Research Institute, Indiana University School of Medicine, South Bend, IN; University of Notre Dame, Notre Dame, IN
The purpose of this review is to evaluate the effectiveness of the various antiemetic agents currently in use for the prevention of chemotherapy-induced nausea and to provide suggestions for the prevention of chemotherapy-induced nausea. The current data in the literature from numerous large studies suggest that the first- or second-generation 5-hydroxytryptamine-3 (5-HT3) receptor (serotonin) antagonists and the neurokinin-1 (NK-1) receptor (substance P) antagonist aprepitant have not been effective in the control of nausea in patients who receive either moderately or highly emetogenic chemotherapy, despite the marked improvement in the control of emesis with these agents. Recent phase II and III studies with olanzapine have demonstrated good control of emesis and nausea in patients receiving either moderately or highly emetogenic chemotherapy. Preliminary small studies with gabapentin, cannabinoids, and ginger are inconclusive in defining the role of those three agents, if any, in the prevention of chemotherapy-induced nausea and vomiting...
*For a PDF of the full article, click in the link to the left of this introduction.
Harper Cancer Research Institute, Indiana University School of Medicine, South Bend, IN; University of Notre Dame, Notre Dame, IN
The purpose of this review is to evaluate the effectiveness of the various antiemetic agents currently in use for the prevention of chemotherapy-induced nausea and to provide suggestions for the prevention of chemotherapy-induced nausea. The current data in the literature from numerous large studies suggest that the first- or second-generation 5-hydroxytryptamine-3 (5-HT3) receptor (serotonin) antagonists and the neurokinin-1 (NK-1) receptor (substance P) antagonist aprepitant have not been effective in the control of nausea in patients who receive either moderately or highly emetogenic chemotherapy, despite the marked improvement in the control of emesis with these agents. Recent phase II and III studies with olanzapine have demonstrated good control of emesis and nausea in patients receiving either moderately or highly emetogenic chemotherapy. Preliminary small studies with gabapentin, cannabinoids, and ginger are inconclusive in defining the role of those three agents, if any, in the prevention of chemotherapy-induced nausea and vomiting...
*For a PDF of the full article, click in the link to the left of this introduction.
Harper Cancer Research Institute, Indiana University School of Medicine, South Bend, IN; University of Notre Dame, Notre Dame, IN
The purpose of this review is to evaluate the effectiveness of the various antiemetic agents currently in use for the prevention of chemotherapy-induced nausea and to provide suggestions for the prevention of chemotherapy-induced nausea. The current data in the literature from numerous large studies suggest that the first- or second-generation 5-hydroxytryptamine-3 (5-HT3) receptor (serotonin) antagonists and the neurokinin-1 (NK-1) receptor (substance P) antagonist aprepitant have not been effective in the control of nausea in patients who receive either moderately or highly emetogenic chemotherapy, despite the marked improvement in the control of emesis with these agents. Recent phase II and III studies with olanzapine have demonstrated good control of emesis and nausea in patients receiving either moderately or highly emetogenic chemotherapy. Preliminary small studies with gabapentin, cannabinoids, and ginger are inconclusive in defining the role of those three agents, if any, in the prevention of chemotherapy-induced nausea and vomiting...
*For a PDF of the full article, click in the link to the left of this introduction.
Posterior reversible encephalopathy syndrome: a potential side effect of gemcitabine
A 50-year-old woman presented to her primary care physician with abdominal pain and jaundice. Computed tomographic (CT) scan of the abdomen revealed a pancreatic head mass. Exploratory laparotomy showed a tumor obstructing the duodenum and encasing the portal vein and superior mesenteric artery, deeming it unresectable. Biopsies confirmed it to be an adenocarcinoma with mucinous differentiation...
Click on the PDF icon at the top of this introduction to read the full article.
A 50-year-old woman presented to her primary care physician with abdominal pain and jaundice. Computed tomographic (CT) scan of the abdomen revealed a pancreatic head mass. Exploratory laparotomy showed a tumor obstructing the duodenum and encasing the portal vein and superior mesenteric artery, deeming it unresectable. Biopsies confirmed it to be an adenocarcinoma with mucinous differentiation...
Click on the PDF icon at the top of this introduction to read the full article.
A 50-year-old woman presented to her primary care physician with abdominal pain and jaundice. Computed tomographic (CT) scan of the abdomen revealed a pancreatic head mass. Exploratory laparotomy showed a tumor obstructing the duodenum and encasing the portal vein and superior mesenteric artery, deeming it unresectable. Biopsies confirmed it to be an adenocarcinoma with mucinous differentiation...
Click on the PDF icon at the top of this introduction to read the full article.
Severe and rapid cardiac toxicity from sunitinib therapy in a patient with metastatic renal cell carcinoma
A 67-year-old man with a history of leftsided renal cell carcinoma status after undergoing a radical nephrectomy presented to the oncology clinic after sustaining a pathologic fracture of the left humerus. Computed tomography revealed a right suprarenal mass with invasion into the inferior vena cava and right atrium, confirmed to be poorly differentiated RCC on biopsy. Transthoracic echocardiogram showed tumor thrombus occluding the IVC lumen; the tumor also extended into the right atrium, measuring 8 cm in circumference. Despite this direct invasion, cardiac function remained normal; there was no evidence of valvular or wall motion abnormalities, and left ventricular ejection fraction was preserved at 67%. Therapy for metastatic RCC was initiated with the tyrosine kinase inhibitor sunitinib at 50 mg daily. Body mass index at this time was 24.8. Within 12 days of starting therapy, however, the patient exhibited symptoms of New York Heart Association class IV heart failure and was referred to the emergency department.
Click on the PDF icon at the top of this introduction to read the full article.
A 67-year-old man with a history of leftsided renal cell carcinoma status after undergoing a radical nephrectomy presented to the oncology clinic after sustaining a pathologic fracture of the left humerus. Computed tomography revealed a right suprarenal mass with invasion into the inferior vena cava and right atrium, confirmed to be poorly differentiated RCC on biopsy. Transthoracic echocardiogram showed tumor thrombus occluding the IVC lumen; the tumor also extended into the right atrium, measuring 8 cm in circumference. Despite this direct invasion, cardiac function remained normal; there was no evidence of valvular or wall motion abnormalities, and left ventricular ejection fraction was preserved at 67%. Therapy for metastatic RCC was initiated with the tyrosine kinase inhibitor sunitinib at 50 mg daily. Body mass index at this time was 24.8. Within 12 days of starting therapy, however, the patient exhibited symptoms of New York Heart Association class IV heart failure and was referred to the emergency department.
Click on the PDF icon at the top of this introduction to read the full article.
A 67-year-old man with a history of leftsided renal cell carcinoma status after undergoing a radical nephrectomy presented to the oncology clinic after sustaining a pathologic fracture of the left humerus. Computed tomography revealed a right suprarenal mass with invasion into the inferior vena cava and right atrium, confirmed to be poorly differentiated RCC on biopsy. Transthoracic echocardiogram showed tumor thrombus occluding the IVC lumen; the tumor also extended into the right atrium, measuring 8 cm in circumference. Despite this direct invasion, cardiac function remained normal; there was no evidence of valvular or wall motion abnormalities, and left ventricular ejection fraction was preserved at 67%. Therapy for metastatic RCC was initiated with the tyrosine kinase inhibitor sunitinib at 50 mg daily. Body mass index at this time was 24.8. Within 12 days of starting therapy, however, the patient exhibited symptoms of New York Heart Association class IV heart failure and was referred to the emergency department.
Click on the PDF icon at the top of this introduction to read the full article.
Oncology’s transitional generation: charting the way to integrated, efficient, and cost-effective delivery systems
As we move into a new year, it is worth reflecting on the substantial advances in oncology during 2011. It was a remarkable year, with progress in basic as well as translational research that yielded major new therapies in breast cancer, melanoma, prostate cancer, leukemias, and several other cancers and blood diseases. We saw progress in prevention for breast cancer, in improving cure rates in early-stage diseases, and in prolonging life in several advanced-stage cancers. The publication of data suggesting targeted immunotherapy as a possible cure for patients with advanced refractory chronic lymphocytic leukemia (CLL) should encourage us to prioritize referrals to and participation in clinical trials...
*For a PDF of the full article, click in the link to the left of this introduction.
As we move into a new year, it is worth reflecting on the substantial advances in oncology during 2011. It was a remarkable year, with progress in basic as well as translational research that yielded major new therapies in breast cancer, melanoma, prostate cancer, leukemias, and several other cancers and blood diseases. We saw progress in prevention for breast cancer, in improving cure rates in early-stage diseases, and in prolonging life in several advanced-stage cancers. The publication of data suggesting targeted immunotherapy as a possible cure for patients with advanced refractory chronic lymphocytic leukemia (CLL) should encourage us to prioritize referrals to and participation in clinical trials...
*For a PDF of the full article, click in the link to the left of this introduction.
As we move into a new year, it is worth reflecting on the substantial advances in oncology during 2011. It was a remarkable year, with progress in basic as well as translational research that yielded major new therapies in breast cancer, melanoma, prostate cancer, leukemias, and several other cancers and blood diseases. We saw progress in prevention for breast cancer, in improving cure rates in early-stage diseases, and in prolonging life in several advanced-stage cancers. The publication of data suggesting targeted immunotherapy as a possible cure for patients with advanced refractory chronic lymphocytic leukemia (CLL) should encourage us to prioritize referrals to and participation in clinical trials...
*For a PDF of the full article, click in the link to the left of this introduction.
Brentuximab vedotin ushers in a new era in treating lymphomas
Hodgkin lymphoma represents one of the major successes of modern oncology. Several decades ago, it was fatal in most patients. With the development of the combination therapy mechlorethamine, vincristine, prednisone, and procarbazine (MOPP), many patients were cured of this disease. However, the regimen was associated with an unacceptable risk of acute toxicities, infertility, and secondary malignancies.1 Several subsequent studies established adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) as the standard treatment because of its greater efficacy and less toxicity compared with MOPP.2 As a result, about 90% of patients with limited-stage disease are now cured, as are 60% of those with advanced disease. Newer regimens such as bleomycin, etoposide, adriamycin, cyclophosphamide, prednisone, and procarbazine (BEACOPP) seem to prolong time to treatment failure, but with considerably greater toxicity,3 and with no clear improvement in overall survival. A minority of patients who are either refractory to initial treatment or who subsequently relapse can be cured with such modalities as stem-cell transplantation. However, few effective options are available for the remainder of patients...
*For a PDF of the full article, click in the link to the left of this article.
(See Community Translations, “Bretuximab vedotin in Hodgkin lymphoma and systemic anaplastic large-cell lymphoma”)
Hodgkin lymphoma represents one of the major successes of modern oncology. Several decades ago, it was fatal in most patients. With the development of the combination therapy mechlorethamine, vincristine, prednisone, and procarbazine (MOPP), many patients were cured of this disease. However, the regimen was associated with an unacceptable risk of acute toxicities, infertility, and secondary malignancies.1 Several subsequent studies established adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) as the standard treatment because of its greater efficacy and less toxicity compared with MOPP.2 As a result, about 90% of patients with limited-stage disease are now cured, as are 60% of those with advanced disease. Newer regimens such as bleomycin, etoposide, adriamycin, cyclophosphamide, prednisone, and procarbazine (BEACOPP) seem to prolong time to treatment failure, but with considerably greater toxicity,3 and with no clear improvement in overall survival. A minority of patients who are either refractory to initial treatment or who subsequently relapse can be cured with such modalities as stem-cell transplantation. However, few effective options are available for the remainder of patients...
*For a PDF of the full article, click in the link to the left of this article.
(See Community Translations, “Bretuximab vedotin in Hodgkin lymphoma and systemic anaplastic large-cell lymphoma”)
Hodgkin lymphoma represents one of the major successes of modern oncology. Several decades ago, it was fatal in most patients. With the development of the combination therapy mechlorethamine, vincristine, prednisone, and procarbazine (MOPP), many patients were cured of this disease. However, the regimen was associated with an unacceptable risk of acute toxicities, infertility, and secondary malignancies.1 Several subsequent studies established adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) as the standard treatment because of its greater efficacy and less toxicity compared with MOPP.2 As a result, about 90% of patients with limited-stage disease are now cured, as are 60% of those with advanced disease. Newer regimens such as bleomycin, etoposide, adriamycin, cyclophosphamide, prednisone, and procarbazine (BEACOPP) seem to prolong time to treatment failure, but with considerably greater toxicity,3 and with no clear improvement in overall survival. A minority of patients who are either refractory to initial treatment or who subsequently relapse can be cured with such modalities as stem-cell transplantation. However, few effective options are available for the remainder of patients...
*For a PDF of the full article, click in the link to the left of this article.
(See Community Translations, “Bretuximab vedotin in Hodgkin lymphoma and systemic anaplastic large-cell lymphoma”)
SURVIVORSHIP Embracing the ‘new normal’
Since 1971, when President Richard M. Nixon announced the “war on cancer” with the signing of the National Cancer Act, we have seen an increase of 300% in the number of survivors, which is now reaching more than 12 million in the United States, according to the Centers for Disease Control. By 2020, that number will likely approach 20 million. Investment in research, early detection, and prevention has contributed to making these numbers a reality, and community-based oncology centers have played a critical role in delivering quality care and improved survival numbers based on the findings of that research. Therefore, it is logical that these same networks of community-based providers that have helped create survivors now help take the next step in addressing the needs of cancer patients on their journey to a life beyond cancer.
*For a PDF of the full article, click in the link to the left of this introduction.
Since 1971, when President Richard M. Nixon announced the “war on cancer” with the signing of the National Cancer Act, we have seen an increase of 300% in the number of survivors, which is now reaching more than 12 million in the United States, according to the Centers for Disease Control. By 2020, that number will likely approach 20 million. Investment in research, early detection, and prevention has contributed to making these numbers a reality, and community-based oncology centers have played a critical role in delivering quality care and improved survival numbers based on the findings of that research. Therefore, it is logical that these same networks of community-based providers that have helped create survivors now help take the next step in addressing the needs of cancer patients on their journey to a life beyond cancer.
*For a PDF of the full article, click in the link to the left of this introduction.
Since 1971, when President Richard M. Nixon announced the “war on cancer” with the signing of the National Cancer Act, we have seen an increase of 300% in the number of survivors, which is now reaching more than 12 million in the United States, according to the Centers for Disease Control. By 2020, that number will likely approach 20 million. Investment in research, early detection, and prevention has contributed to making these numbers a reality, and community-based oncology centers have played a critical role in delivering quality care and improved survival numbers based on the findings of that research. Therefore, it is logical that these same networks of community-based providers that have helped create survivors now help take the next step in addressing the needs of cancer patients on their journey to a life beyond cancer.
*For a PDF of the full article, click in the link to the left of this introduction.