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issues in oncology
global cancer care
health-care policy

Delivering Cancer Care in Low-Income Countries

In eealthy industrialized nations like the United States, escalating costs of cancer care have put the term “cost-effective care” on the forefront of health-care policy discussions. However, the cost issues we wrestle with in our $3 trillion health-care system are vague abstractions for much of the ...

National Cancer Institute Launches the National Clinical Trials Network to Expedite Scientific Advances

In March, the National Cancer Institute (NCI) transformed its Cooperative Group Program into the National Clinical Trials Network (NCTN). Spurred by recommendations in the Institute of Medicine (IOM) 2010 report, A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI...

palliative care

Timing and Meaning of Do-Not-Resuscitate Orders in the Palliative Care Setting

Although a do-not-resuscitate (DNR) order does not mean “do not treat,” that is how it is often interpreted, according to a study examining the level of care oncology inpatients at a tertiary care hospital received.1 The study found that the interpretation of DNR orders among oncology nurses and...

September Is Conquer Cancer Foundation Challenge Month

At the 50th Annual Meeting of the American Society of Clinical Oncology, Conquer Cancer Foundation Board Member Raj Mantena, RPh, announced that for the coming year he would match individual donations to the Conquer Cancer Foundation up to $1 million, allowing meeting attendees the opportunity to...

Issue Highlights

Career and Training Transitioning From Fellowship to Career: Expectations vs Reality Start Expanding Your Oncology Network Today: Five Tips to Get You Networking Mentoring for New Community Physicians: The Toledo Clinic Experience Don’t Call Your Program Director “Dude”… and Other Tips for...

Pros and Cons of Early Chemohormonal Therapy

There is considerable debate about moving chemohormonal therapy to an earlier point in the treatment of prostate cancer, at the time of initial diagnosis of metastases, according to Dr. Yu. In the pro column, “You might hit those de novo testosterone-independent clones if they exist.” Additionally, ...

prostate cancer

Studies Help Refine Management of Prostate Cancer

Several studies reported at this year’s ASCO Annual Meeting address gray areas in the management of prostate cancer, according to Evan Y. Yu, MD, Associate Professor at the University of Washington and the Seattle Cancer Care Alliance. “In prostate cancer, probably the most excitement has happened...

issues in oncology

Will Oncologists Be the First to Cure Heart Disease?

Oncologists love jargon—a language peculiar to a particular trade, profession, or group that facilitates communication among members. Our day-to-day communications, medical notes, and journal reports are filled with this type of jargon. Other definitions of jargon are less flattering, including...

LIVESTRONG Narrows Finalists in ‘Big C’ Competition: Winner to Be Announced This Month

Newly launched in 2014 by LIVESTRONG, “The Big C” is a one-of-a-kind global competition to generate innovations that improve the daily quality of life for the 32.5 million people around the world living with cancer now. The competition was open to entrepreneurs, trailblazers, technology whizzes,...

issues in oncology

Fear

The following essay by Michael Feinstein, MD, is excerpted from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories, which was co-edited by Stan Winokur, MD, and Vincent Coppola and published in May 2014. The book is available on Amazon.com and thebigcasino.org....

100 Years of Progress in Oncology Treatment

In his powerful 2010 best-seller, The Emperor of All Maladies: A Biography of Cancer (Scribner), Siddhartha Mukherjee, MD, chronicles the evolution of cancer from the oldest known description of the disease written on a papyrus from about 1600 BC to the present day’s understanding of the biology of ...

issues in oncology
palliative care

Helping Patients Talk to Their Children About Cancer

Although the focus of an oncologist’s attention is understandably attuned to the needs of the patient, when a patient is a parent, quality oncology care should also include attention to the patient’s role as a parent and to the needs of the patient’s children, according to Paula K. Rauch, MD,...

global cancer care
breast cancer

Book Review: Breast Cancer, Break the Silence

This date has a special place in my heart, as well as the hearts of my children, my family and my loved ones. It was the day when my life—and my priorities—took a whole new direction.” So begins Breast Cancer, Break the Silence, a slim yet powerful and highly revealing booklet by Saudi Arabian...

issues in oncology

On Being A Mentee and the Value of the Conquer Cancer Foundation’s Career Development Award

At the ASCO Annual Meeting in June, the Conquer Cancer Foundation presented the 2014 recipients of prestigious grants and awards, including the Young Investigator Award, Career Development Award, and the Advanced Clinical Research Award in Breast Cancer. In announcing the awards, Charles W. Penley, ...

issues in oncology

The Value of Lifelong Mentorship in Career Development

While the development of mentorship relationships is critical in launching and nurturing the academic careers of young investigators, it is also an essential component for continued success throughout their careers, according to Jennifer R. Brown, MD, PhD. Dr. Brown, Director of the CLL Center at...

sarcoma

Treating Sarcomas in 2014

In 2014, about 15,000 people in the United States will be diagnosed with some form of sarcoma, and of those, approximately 5,000 adults and children are expected to die of the disease. Sarcomas are a heterogeneous group of mesenchymal malignancies that have historically been difficult to diagnose...

issues in oncology

Fellows’ Expectations of Work-Life Balance Not in Line With Realities of Practice

Oncology fellows just years away from entering the profession full time may have unrealistic expectations of their future career, according to data published recently in the Journal of Clinical Oncology. The study by Tait D. Shanafelt, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues...

breast cancer
survivorship

Testosterone/Anastrozole Implants Relieve Menopausal Symptoms in Breast Cancer Survivors

Subcutaneous implants containing testosterone in combination with a low dose of anastrozole can relieve menopausal symptoms in breast cancer survivors, according to research presented at the 2014 ASCO Breast Cancer Symposium.1 “Menopausal symptoms can be quite severe in breast cancer survivors in...

Expert Point of View: Harold Burstein, MD

Harold Burstein, MD, Associate Professor of Medicine at Dana-Farber Cancer Institute, Boston, spoke to The ASCO Post about the multidisciplinary discussion of margin assessment during the 2014 Breast Cancer Symposium. Should Oncologists Be Concerned? “There is a real art to being a good...

breast cancer

Pathologic Complete Response: Understanding the Subtleties

In the neoadjuvant treatment of breast cancer, the importance of achieving a pathologic complete response (pCR) varies substantially by breast cancer subtype. Patients are increasingly interested in this outcome, but it means different things to different patients, according to two breast cancer...

issues in oncology

Best of ASCO Seattle Proves Engaging, Provocative

This year’s Best of ASCO meeting held in Seattle featured topics that both riveted attendees and pushed their buttons, according to program chair Alan P. Venook, MD, of the University of California, San Francisco. “I am extremely pleased with the quality of the presentations from the faculty, but...

Determining Androgen-Deprivation Therapy

Determining an appropriate course of androgen-deprivation therapy in patients with prostate cancer is complex. For patients with high-risk features, 4 to 6 months of androgen-deprivation therapy helps, but 28 to 36 months is better in terms of disease control and overall survival. In the study by...

lymphoma

Radiation Therapy Improves 10-Year Survival for Patients With Early Hodgkin Lymphoma, but Frequently Omitted in Treatment Plans

Adding consolidation radiation therapy to chemotherapy significantly improves 10-year survival in patients with stage I and II Hodgkin lymphoma, according to a large observational study based on the National Cancer Database (NCDB). Yet over that same 10-year period, radiation therapy use declined...

Expert Point of View: Benjamin Movsas, MD

Benjamin Movsas, MD, Chair of Radiation Oncology at Henry Ford Hospital in Detroit, served as moderator at a press conference where the two SBRT studies by Timmerman et al and Ashworth et al were reported.1,2 Dr. Movsas said that SBRT is a promising approach, noting that the therapy facilitates...

lung cancer

Stereotactic Body Radiation Therapy Benefits Patients With Early-Stage Inoperable or Advanced Oligometastatic Lung Cancer

The door is open for expanded use of stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage lung cancer and for patients with oligometastatic stage IV non-small cell lung cancer (NSCLC), according to results of two studies presented at the 56th Annual Meeting of the...

health-care policy
cost of care

Tough Questions About Health-Care Reform Put Economist in Hot Seat

Although diverse stakeholders agree that health reform is needed, there is little consensus on the specifics of that reform. Best of ASCO Seattle attendees put a number of pointed questions to health economist Rena Conti, PhD, of the University of Chicago, asking about thorny issues such as cost...

health-care policy

Health-Care Reform Is Changing the Oncology Landscape

Value-based health-care reform is happening. We have to get on board,” Rena Conti, PhD, a health economist at the University of Chicago, advised attendees of the Best of ASCO Seattle meeting. She discussed highlights from Annual Meeting sessions that addressed the impact of the Affordable Care Act...

Expert Point of View: Benjamin Movsas, MD

Benjamin Movsas, MD, Chair of Radiation Oncology at Henry Ford Hospital in Detroit, served as moderator at a press conference where the two SBRT studies by Timmerman et al and Ashworth et al were reported.1,2 Dr. Movsas said that SBRT is a promising approach, noting that the therapy facilitates...

In Memoriam: Kelly Traw

Regretfully, The ASCO Post has learned that Kelly Traw, 49, passed away on September 2, 2014, at Johns Hopkins Hospital in Baltimore. While her obituary did not mention a cause of death, it said that, “She will be greatly missed by her extended family and by the many friends who supported her...

solid tumors

Treating Testicular Cancer in 2014

Testicular cancer is one of oncology’s true success stories. It is a highly treatable disease, usually curable, that most often develops in young and middle-aged men. Despite the success in testicular cancer, there are still clinical challenges ranging from staging to optimum therapeutic...

breast cancer

Variety of Adjuvant Strategies Explored in HER2‑Positive and Other Breast Cancer Types

Adjuvant trastuzumab (Herceptin) was shown to be effective in patients with breast cancers ≤ 2 cm, regardless of estrogen receptor status, in a meta-analysis1 of five chemotherapy trials, but a “pressing question” remaining is whether T1a/b, N0 tumors warrant the use of adjuvant trastuzumab, Andrew ...

Despite Potential to Overwhelm, Surveys Still Essential Research Tool

The age of the Internet and worldwide connectivity has made it easier than ever to send out surveys to a wide audience quickly and easily. This ease of access can make surveys an affordable and readily available research tool for independent investigators, but it can also make surveys an...

prostate cancer

Radiotherapy Should Be Added to Hormone Therapy in Node-Positive Prostate Cancer

Node-positive prostate cancer has typically been excluded from clinical trials, leaving oncologists with little evidence to guide management for this group of patients. A study presented at the European Society for Medical Oncology (ESMO) 2014 Congress sheds light on this issue, providing the...

lung cancer
palliative care

Novel Oral Agent Treats Cachexia in Patients With Non–Small Cell Lung Cancer

For the first time, studies show that a drug is effective in treating several domains of cancer-related cachexia. Oral anamorelin increased lean body mass, achieved weight gain, and improved quality of life in patients with cancer-related cachexia in two pivotal phase III studies presented together ...

skin cancer

BRAF/MEK Inhibitor Combinations Impressive in Melanoma Trials

For advanced/metastatic melanoma patients with BRAF mutations, two pathway inhibitors are better than one, according to studies presented at the European Society for Medical Oncology (ESMO) 2014 Congress that demonstrated improved progression-free and overall survival for regimens combining a BRAF...

issues in oncology

Partnering With Community Centers to Advance Oncology Care

Last fall, Richard R. Barakat, MD, FACS, the Ronald O. Perelman Chair in Gynecologic Surgery at Memorial Sloan Kettering Cancer Center, was named to the new position of Deputy Physician-in-Chief for the Memorial Sloan Kettering Regional Care Network and Cancer Alliance, a new initiative meant to...

breast cancer

Impressive Survival Data for Women With HER2-Positive Breast Cancer Increase First-Line Use of Pertuzumab/Trastuzumab

"Impressive,” “outstanding,” and “unprecedented” are among the terms used to describe the 56.5-month overall survival for women with HER2-positive metastatic breast cancer receiving first-line treatment with pertuzumab (Perjeta) in combination with trastuzumab (Herceptin) and docetaxel in the...

issues in oncology
lymphoma

The Power of Laughter

The following essay by Julie Vose, MD, MBA, FASCO, is adapted from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories (May 2014), coedited by Stan Winokur, MD, and Vincent Coppola. The book is available on Amazon.com and thebigcasino.org.   When I met Cindy, she was...

cns cancers

A Candidly Humorous Approach to the Cancer Journey

BOOKMARK Title: Shrinkage: Manhood, Marriage, and the Tumor That Tried to Kill MeAuthor: Bryan BishopPublisher: Thomas Dunne BooksPublication date: April 29, 2014Price: $25.99; hardcover, 336 pages   At 30 years old, Bryan Bishop was having the time of his life. Known to millions of radio fans as...

survivorship

Addressing Patients’ Sexual Dysfunction Throughout Survivorship

Studies show that all cancers and related treatments have the potential to affect sexuality and sexual function. Surgery, chemotherapy, hormonal therapy, bone marrow transplantation, and radiation therapy can physically impact sexual health in myriad ways, including vaginal dryness, dyspareunia,...

pancreatic cancer

Study Sheds Light on Factors That May Contribute to Pancreatic Cancer

New research that provides a better understanding of pancreatic cancer may help identify individuals at increased risk. The findings were recently published early online in Cancer.1 Pancreatic cancer is usually detected at a very late stage and has a 5-year survival rate of less than 5%. Strategies ...

multiple myeloma

Treatment of Newly Diagnosed Multiple Myeloma With Lenalidomide Plus Low-Dose Dexamethasone

The FIRST trial—reported by Benboubker and colleagues in The New England Journal of Medicine and summarized in this issue of The ASCO Post (page 93)—is a landmark study.1 It is one of the largest randomized trials in multiple myeloma ever conducted. More importantly, it is a well-designed trial...

Expert Point of View: Hope S. Rugo, MD

Hope S. Rugo, MD, Professor of Medicine and Director of Breast Oncology and Clinical Trials Education for the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discussed the two studies on maintenance bevacizumab (Avastin) for metastatic breast cancer...

Expert Point of View: Axel Grothey, MD

Putting the maintenance trials into context was Axel Grothey, MD, Professor of Oncology at the Mayo Clinic, Rochester, Minnesota, who commented, “These studies inform our clinical practice and have a meaningful impact on how we treat our patients.” DREAM Trial In the DREAM Trial, Dr. Grothey...

Expert Point of View: Andrés Cervantes, MD, PhD

During a special session at the European Society for Medical Oncology (ESMO) 2014 Congress, additional analyses from the FIRE-3 and Cancer and Leukemia Group B ­(CALGB)/SWOG 80405 trial were presented, and an expert panel was charged with putting the findings into context. Role of Subsequent...

issues in oncology
cost of care

Tackling the Complexity of Cancer: Finding Common Ground on Value and Progress

To kick off the second national Turning the Tide Against Cancer conference, sponsored by the American Association for Cancer Research, Personalized Medicine Coalition (PMC), and Feinstein Kean Healthcare, Edward Abrahams, PhD, President of PMC, noted that U.S. health-care costs are unsustainable...

issues in oncology

Young Adults With Cancer: Unique Issues Highlight Importance of Patient-Centered Care

Suleika Jaouad, a journalist, was 22 and had just gotten her first chance to cover a major news story—the revolution underway in Tunisia—when she was diagnosed with myelodysplastic syndrome that had evolved into acute myeloid leukemia (AML). Months into her treatment, she began to write again, but...

cost of care

Financial Toxicity Potentially Harmful Treatment‑Related Effect

It turns out that in addition to treatment-related toxicity, cancer patients commonly experience “financial toxicity,” a phrase that is increasingly coming into parlance in the cancer community. Patients should be assessed for financial toxicity as early as possible following diagnosis so that they ...

geriatric oncology

The ‘Silver Oncologic Tsunami’: Rise in Elderly Cancer Patients Brings New Challenges to Oncology Workforce

The “graying of America” poses increasing challenges for the cancer community in terms of rising numbers of cases of cancer and costs associated with geriatric care. The scope of this problem and potential solutions were explored by Andrew E. Chapman, DO, FACP, at the ASCO Quality Care Symposium in ...

issues in oncology

Choosing Wildly: A Patient’s Perspective on Overtreatment and Quality Care

Over the past decade, there has been growing concern in the oncology community about overdiagnosis and overtreatment of cancers that prove to be indolent and nonlethal, resulting in unnecessary and sometimes harmful procedures.  At this year’s ASCO Quality Care Symposium in Boston, this important...

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