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issues in oncology

Enhanced Electronic Module Aims to Prevent Errors in Oral Chemotherapy Prescribing

An oral chemotherapy prescription-writing module grafted to a shared electronic medical record is part of a series of quality improvement efforts undertaken at Dana-Farber Cancer Institute in Boston to prevent errors in prescribing oral chemotherapy agents. While oncologists have readily accepted...

multiple myeloma

Thalidomide/Prednisone Maintenance after Stem Cell Transplant Improves Progression-free but Not Overall Survival

Maintenance therapy with thalidomide (Thalomid) and prednisone after autologous stem cell transplantation in patients with multiple myeloma improved progression-free survival but not overall survival, according to results of a phase III trial reported in Blood. Patients receiving maintenance...

lung cancer

Modified and Updated Risk-prediction Model Is More Efficient in Identifying Persons for Lung Cancer Screening

An updated and modified lung-cancer risk-prediction model developed from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial “was more sensitive” for lung cancer detection than criteria from the National Lung Cancer Screening Trial (NLST), according to a study in TheNew...

head and neck cancer

Two Studies Focus on Treatment Strategies for Preserving the Larynx While Increasing Survival

Two recent studies in the Journal of Clinical Oncology focused on treatment strategies to preserve the larynx while increasing survival of patients with cancer of larynx. RTOG 91-11 Ten-year results from the Radiation Therapy Oncology Group (RTOG) 91-11 trial found that both chemotherapy regimens...

SIDEBAR: Expect Questions from Your Patients 

Recently reported data from the Prostate Cancer Outcome Study (PCOS) can “serve as a tool for a medical oncologist, a urologic oncologist, or a radiation oncologist to say, ‘Here is what could happen on average at 2, 5, 15 years after treatment with either surgery or radiation,’” according to the...

prostate cancer

Recently Reported Long-term Outcomes Could Motivate More Men with Prostate Cancer to Consider Active Surveillance 

Fifteen years after being treated with radical prostatectomy or external-beam radiation for localized prostate cancer, “the prevalence of erectile dysfunction was nearly universal,” among men enrolled in a long-term functional outcomes analysis of the Prostate Cancer Outcomes Study (PCOS). There...

pain management

Duloxetine Reduced Painful Chemotherapy-induced Peripheral Neuropathy  

The use of duloxetine (Cymbalta) for 5 weeks “was associated with a statistically and clinically significant improvement” in painful chemotherapy-induced peripheral neuropathy when compared with placebo in a phase III randomized, double-blind crossover trial reported in the Journal of the American...

leukemia

Successful Salvage Treatment Possible in Some Patients Who Do Not Have a Transplant in First Remission 

Among 3,919 patients with acute myeloid leukemia (AML) who did not undergo transplantation in first complete remission, 1,271 relapsed and 19% were successfully treated with salvage therapy, according to an analysis of three AML trials in the United Kingdom. This percentage can be improved with a...

leukemia

Bortezomib Added to Standard Induction Therapy Produced Encouraging AML Remission Rate  

Adding bortezomib (Velcade) to standard daunorubicin and cytarabine induction chemotherapy for acute myeloid leukemia (AML) “resulted in an encouraging remission rate” in previously untreated older adults, according to results of Cancer and Leukemia Group B (CALGB/Alliance) study 10502. The...

breast cancer

Progression-free Survival in HER2-positive Metastatic Breast Cancer Improved with T-DM1 

First-line treatment with ado-trastuzumab emtansine (T-DM1) “provided a significant improvement” in progression-free survival when compared to trastuzumab (Herceptin) plus docetaxel in a randomized phase II study among patients with HER2-positive metastatic or recurrent locally advanced breast...

Expect Questions from Younger Women about Breast Cancer  

“SEER data showed a small but statistically significant increase in the incidence of breast cancer with distant involvement for women aged 25 to 39 years,” concluded a study published in the Journal of the American Medical Association.1 “The trajectory of the incidence trend predicts that an...

breast cancer

Increase in Advanced Breast Cancer among Younger Women Is Small but Significant, and Trend Is Likely to Continue 

The incidence of advanced breast cancer among women aged 25 to 39 years increased by an average of 2.07% per year from 1976 to 2009 and the trend seems likely to continue, according to an analysis of data for 936,497 women diagnosed with malignant breast cancer. The small but statistically...

issues in oncology

Access to Care: Who Gets Referred to a Medical Oncologist and/or Another Cancer Specialist and Who Receives Treatment for Advanced Cancer? 

What factors determine who is referred to a medical oncologist and receives treatment for advanced cancers? Several articles in the Journal of Oncology Practice suggest that factors influencing referral and treatment go beyond the patient’s medical condition and preference and include such details...

High Levels of Psychological Distress Are Common among Parents of Children with Advanced Cancer 

High to severe levels of psychological distress are common among parents of children with advanced cancer, according to a study conducted at three children’s hospitals—Boston Children’s Hospital, Children’s Hospital of Philadelphia, and Seattle Children’s Hospital. The cohort study was embedded in...

issues in oncology

Ruxolitinib Results in Clinically Meaningful Symptom Improvement 

Patients with myelofibrosis who received ruxolitinib (Jakafi) therapy experienced “meaningful reductions in symptom burden” and improvements in quality of life in a double-blind, placebo-controlled phase III trial published in the Journal of Clinical Oncology. The COMFORT-I (Controlled...

kidney cancer

Cisplatin and Radiotherapy Linked to Increased Renal Cancer Risk in Childhood Cancer Survivors

Survivors of childhood cancer have an increased risk of subsequent renal cancers compared to the general population, researchers reported in the Journal of the National Cancer Institute. The risk is particularly high among survivors of neuroblastoma and those who have had irradiation involving the...

leukemia

High-dose Liposomal Vincristine Produces Durable Responses in Advanced ALL

High-dose monotherapy with vincristine sulfate liposome injection (Marqibo) resulted in meaningful clinical outcomes, including durable responses and bridging to hematopoietic cell transplantation, in adult patients with advanced, relapsed, and refractory Philadelphia chromosome (Ph)-negative acute ...

gynecologic cancers

Higher Prediagnosis Body Mass Index Raises Mortality Risk in Endometrial Cancer

Higher prediagnosis body mass index (BMI) increases risk of overall and disease-specific mortality among women diagnosed with endometrial cancer, suggested a study published in the Journal of the National Cancer Institute. Physical activity was associated with reduced risk of all-cause, but not...

breast cancer

Exemestane an Adjuvant Option for Postmenopausal Hormone Receptor–positive Breast Cancer

A phase III open-label trial of exemestane vs anastrozole in postmenopausal women with hormone-dependent early breast cancer found that both agents produced similar median rates of event-free survival—91% for exemestane and 91.2% for anastrozole—as well as similar distant disease-free and...

SIDEBAR: Going Public with Ovarian Cancer Outcomes  

Commenting on the study finding that most women with ovarian cancer are not being treated with the recommended standard of care, a New York Times editorial noted, “One of the surest ways to improve performance would be to analyze and make public how well individual doctors and hospitals do in...

Expect Questions about Experience and Outcomes  

“Patients are becoming more sophisticated in their ability and willingness to interrogate the health-care system about their care,” according to Robert E. Bristow, MD, MBA, lead author of the study finding that many women with ovarian cancer are not receiving care consistent with National...

gynecologic cancers

Most Women with Ovarian Cancer Do Not Get Guideline-specified Treatment Linked to Survival Benefits 

Most women with ovarian cancer are not receiving adequate treatment, as specified in National Comprehensive Cancer Network (NCCN) Guidelines,1 and as a result are being deprived of the survival benefits correlated with guideline-recommended treatment, according to a study presented at the Society...

The ASCO Post Up Close: Our Reporters and Contributors

About the Writers Charlotte Bath has been writing about cancer and related fields of medicine since serving as Public Information Director of the American Cancer Society, Long Island Division, from 1975 to 1979. She subsequently worked as a writer for Memorial Sloan-Kettering Cancer Center and...

Managing Female Reproductive Complications after Cancer Treatment in Children and Young Adults 

Follow-up care for female patients treated for cancer as children, adolescents, or young adults should include assessment and management of the late effects that therapy may have on reproductive health, as detailed in updated guidelines from the Children’s Oncology Group. “It is important for...

supportive care

Patients with Cancer Can Have Cachexia-related Poor Prognostic Factors Regardless of Overall Weight 

“Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight,” concluded a study in the Journal of Clinical Oncology. Researchers...

supportive care
palliative care

Older Patients and Those with Comorbidities Are Less Likely to Receive Palliative Radiotherapy 

Older patients and those with comorbid conditions are less likely to receive palliative radiotherapy, according to an analysis of data from 51,610 patients with stage IV breast, prostate, lung, or colorectal cancer. The study also found that black patients with prostate cancer were 20% less likely...

breast cancer
issues in oncology

Smoking Early in Life Is More Strongly Associated with Increased Risk of Breast Cancer 

Analyses of data from 73,388 women in the American Cancer Society’s Cancer Prevention Study II (CPS-II) Nutrition Cohort and from a meta-analysis including 14 other studies “support the hypothesis that active smoking increases the risk of breast cancer, especially when smoking begins at an early...

breast cancer

Black, Asian, and Younger Women at Increased Risk of PTSD after Diagnosis of Localized Breast Cancer 

Nearly one-quarter of women in a large prospective study of racially diverse patients with stage I to III breast cancer reported symptoms consistent with posttraumatic stress disorder (PTSD), with increased risk of PTSD among black, Asian, and younger women. “These potential risk factors can be...

breast cancer

Surgery Delays Longer Than 6 Weeks in Young Women with Breast Cancer Decrease Survival 

Delays of more than 6 weeks from time of diagnosis until surgical treatment of breast cancer among young women significantly decreases survival times compared to those with a shorter treatment delay time, according to a study in JAMA Surgery. “This adverse impact on survival was more pronounced in...

breast cancer
issues in oncology

Some Stage II/III HER2-positive Tumors May Be Treated with Targeted Therapy without Chemotherapy 

Results from a multicenter phase II study of patients with locally advanced HER2-positive breast cancer who receive targeted therapy with trastuzumab (Herceptin) and lapatinib (Tykerb) “support the hypothesis that selected patients with HER2-positive tumors may not need chemotherapy,” investigators ...

Expect Questions from Your Patients 

Patients reading or hearing about the updated draft recommendation statement from the U.S. Preventive Services Task Force (USPSTF) on the use of medications to reduce risk for primary breast cancer1 may ask if and how it applies to them. To help answer those questions, the information presented...

breast cancer

Women at Increased Risk for Breast Cancer Should Be Offered Medications to Reduce Risk, Draft Recommendations Advise 

Clinicians should engage in shared decision-making with women who are at increased risk of breast cancer about using medications, such as tamoxifen and raloxifene (Evista), to reduce risk, and should offer prescriptions to women considered at low risk for adverse effects from these medications,...

issues in oncology

Strength of Patient-Oncologist Alliance Linked to Willingness to Adhere to Treatment in Young Adults 

Among young adults with advanced cancer, developing a strong alliance with their oncologist was associated with greater perceived social support, a greater willingness to adhere to treatment, and greater adherence to oral medication, according to results of a study published in the Journal of...

breast cancer

DCIS Score Quantifies Risk of Recurrence after Excision

The ductal carcinoma in situ (DCIS) Score, a multigene expression assay, quantifies the risk of local recurrence and invasive local recurrence for women with DCIS treated with surgical excision, researchers reported in the Journal of the National Cancer Institute. “The DCIS Score can aid clinical...

breast cancer

No Added Benefit from Radiotherapy after Lumpectomy/Tamoxifen in Older Women 

Long-term follow-up of Cancer and Leukemia Group B (CALGB) 9343 “confirms and extends the earlier report that in women age ≥ 70 years with clinical stage I, [estrogen receptor (ER)]-positive breast cancer treated with lumpectomy followed by tamoxifen, irradiation adds no significant benefit in...

breast cancer
issues in oncology

Chemotherapy-induced Peripheral Neuropathy Results in Dose Limiting and Less Chemotherapy Overall

Chemotherapy-induced peripheral neuropathy events resulted in limiting the dosing of chemotherapy in a significant proportion of women with nonmetastatic breast cancer being treated with paclitaxel, and those who had their dose reduced or discontinued received significantly less cumulative drug,...

colorectal cancer

Liver-first Approach to Colorectal Cancer with Synchronous Hepatic Metastases

“The liver-first approach for patients with colorectal cancer with synchronous liver metastases is possible but is associated with a wide range of survival outcomes, despite protocol similarities between studies,” according to a review of four cohort studies identified by a literature search. “All...

SIDEBAR: Expect Questions about Preventive Double Mastectomies  

For women who are considering prophylactic bilateral mastectomies, “I strongly encourage genetic testing, Todd M. Tuttle, MD, MS, said in an interview with The ASCO Post about the increased interest in preventive double mastectomy following Angelina Jolie’s disclosure that she had the procedure to...

breast cancer

Angelina Jolie's Disclosure of Prophylactic Bilateral Mastectomy: A Positive Example for Women with BRCA Mutations? 

Angelina Jolie, in a New York Times article entitled “My Medical Choice,”1 disclosed that having a BRCA1 mutation and an estimated 87% risk of breast cancer, “I decided to be proactive and minimize the risk as much I could. I made a decision to have a preventive double mastectomy.” She was writing...

lymphoma

Plasma Epstein-Barr Virus DNA a Potential Marker for Treatment Response in Advanced Hodgkin Lymphoma 

Plasma Epstein-Barr Virus (EBV) DNA has prognostic significance in Hodgkin lymphoma, both prior to therapy and at 6 months of follow-up, according to results of a study published in Blood. “Plasma EBV-DNA positivity at month 6 is associated with particularly poor outcomes and may serve as an...

prostate cancer

Replacing Animal Fat with Vegetable Fat May Reduce Mortality Risk in Men with Nonmetastatic Disease

“Among men with nonmetastatic prostate cancer, replacing carbohydrates and animal fat with vegetable fat may reduce the risk of all-cause mortality,” according to a prospective study of 4,577 men with nonmetastatic prostate cancer in the Health Professionals Follow-up Study. Vegetable fat intake...

kidney cancer

Using Quality Indicators Can Improve Outcomes among Patients with Renal Cell Carcinoma

An expert panel of 13 urologic and medical oncologists worked together to identify 23 quality indicators for renal cell carcinoma, as described in an article in the Journal of Oncology Practice. “These 23 [quality indicators] will provide a means of evaluating the quality of [renal cell carcinoma]...

breast cancer

Cognitive Complaints after Breast Cancer Treatment and Neuropsychological Testing

About one in five patients who had completed primary breast cancer treatments but had not started endocrine therapy “had elevated memory and/or executive function complaints that were statistically significantly associated with domain-specific” neuropsychological test performances and depressive...

breast cancer

Survival Benefits of DCIS Management Strategies Compared 

Overall survival benefits of six management strategies for ductal carcinoma in situ (DCIS) are within 1 year of each other, according to a disease simulation model integrating empirical data from published literature and quantifying the tradeoffs among the different management strategies with...

SIDEBAR: Expect Questions about Programmed Death Receptors 

In today’s high-tech, sci-fi–loving culture, “programmed death receptor” seems like a term apt to stir up public interest, particularly when those receptors are being “targeted” by “agents.” In this case, however, the agents are antibodies that target programmed death 1 (PD-1) receptor and disable...

skin cancer

'Spectacular' Results with Immunotherapies in Melanoma Galvanize the Oncology Community 

In the News focuses on media reports that your patients may have questions about at their next visit. This continuing column will provide summaries of articles in the popular press that may prompt such questions, as well as comments from colleagues in the field. Much of the news about immunotherapy ...

Some Excess Cancer Risk in Men May Be Related to Greater Height  

More than one-third of the excess risk for cancers among men may be due to factors associated with height, according to data from the Vitamins and Lifestyle (VITAL) study. As reported in the Journal of the National Cancer Institute, these factors include the “number of susceptible cells in a...

leukemia
geriatric oncology

Lenalidomide Induces Long-lasting Responses in Elderly Patients

Treatment with lenalidomide (Revlimid) as initial therapy induced long-lasting responses in a phase II study of 60 patients with chronic lymphocytic leukemia (CLL). “Overall, 35 patients (58%) patients had responses lasting more than 36 months and were considered long-term responders,” the...

breast cancer

Two Studies Indicate Potential Predictors of Survival Benefit from Endocrine Therapy 

Two studies published in Journal of Clinical Oncology indicate that treatment-related symptoms and mammographic density reduction may predict whether a woman with hormone receptor–positive breast cancer will benefit from adjuvant endocrine therapy. In one study, women who had specific adverse...

prostate cancer

Pain Is More Prevalent and Severe in Men with Metastatic Disease and Use of Docetaxel  

Men who have metastatic castration-resistant prostate cancer and have used docetaxel reported a higher prevalence and greater severity of pain than docetaxel-naive patients, according to results of an anonymous survey conducted at five comprehensive cancer centers in the Prostate Cancer Clinical...

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