bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating Palliative Care in Oncology
Authors: Weinstein Sharon M.
Published: August 2017

Background

Cancer is the second leading cause of death among Americans. The World Health Organization has mandated an integrated approach to palliative care in the treatment of patients with cancer. However, medical decision making in the setting of life-threatening disease remains complicated.

Methods

An integrated palliative care approach depends on the skillful blend of antineoplastic, supportive, and palliative interventions. For standardizing care plans, documenting palliative interventions, and tracking and improving outcomes, palliative care elements are defined. At our institute, medical symptom management, psychosocial support, and advance care planning are incorporated into routine cancer care.

Results

Although progress is being made toward integrating palliative care in the field of oncology, further efforts are needed to ensure that cancer patients and their families who need palliative care receive it.

Conclusions

If fully implemented, the integrated palliative care approach will result in quaternary prevention, ie, the prevention of suffering.
Enhancing Caregiver Outcomes in Palliative Care
Authors: Mccorkle Ruth , Pasacreta Jeannie V.
Published: August 2017

Background

Families are increasingly replacing skilled health care workers in the delivery of unfamiliar complex care to their relatives with cancer, despite other obligations and responsibilities that characterize their lives.

Methods

The authors review the needs of cancer caregivers and describe intervention strategies not only presented in the literature, but also implemented in their own program of research to address those needs during the palliative phase of cancer.

Results

Research suggests that developing interventions that teach caregivers to become proficient in the physical and psychological aspects of patient care will benefit both patients and caregivers.

Conclusions

Despite the fact that a cancer diagnosis can cause major changes in family roles and functioning, as well as increased responsibility for complex care being absorbed by family caregivers, data supporting the effectiveness of caregiver interventions have been limited.
Cultural Issues and Ethical Dilemmas in Palliative and End-of-Life Care in Spain
Authors: Olarte Juan M. Núñez , Guillén D. Gracia
Published: August 2017

Background

The concept of palliative care differs according to cultures and traditions. In Spain, palliative care programs have expanded in recent years. The European Commission Research Project in Palliative Care Ethics has sponsored ongoing research to analyze and clarify the conceptual differences in providing palliative care to patients in European countries with diverse cultures and backgrounds.

Methods

The authors present key ethical issues in clinical practice in palliative and end-of-life care in Spain and how these issues are influenced by Spanish culture. They discuss typical characteristics of the Spanish conceptual approach to palliative care, which might be relevant in an even larger Latin palliative care context.

Results

The cultural tradition in Spain influences attitudes toward euthanasia, sedation, the definition of terminality, care in the last 48 hours of life, diagnosis disclosure, and information. The overall care of terminally ill patients with an Hispanic background includes not only the treatment of disease, but also the recognition and respect of their traditions and culture.

Conclusions

The Spanish palliative care movement has shifted its focus from starting new programs to consolidating and expanding the training of the professionals already working in the existing programs. Although there is a general consensus that a new philosophy of care is needed, the interpretation and application of this general philosophy are different in diverse sociocultural contexts.
Transrectal Ultrasound and Biopsy in the Early Diagnosis of Prostate Cancer
Authors: Applewhite Jeffrey C. , Matlaga Brian R. , Mccullough David L. , Hall M. Craig
Published: August 2017

Background

Historically, the prostate was evaluated for cancer by simple digital rectal examination, and biopsy to obtain a tissue diagnosis of cancer was performed blindly. The advent of ultrasound technology offered a new way to evaluate the prostate, and biopsy techniques were soon developed to incorporate ultrasound guidance.

Methods

The authors review the role of transrectal ultrasound (TRUS) of the prostate and ultrasound-guided biopsy of the prostate in the diagnosis of prostate cancer. These techniques are traced from their origins to the current standards of care, with attention paid to developments and controversies in recent literature.

Results

Early experience with TRUS led to the description of “classic” sonographic findings of prostate cancer. To obtain a tissue diagnosis of cancer, these regions were initially targeted in ultrasound-guided biopsies. Concomitant with the development of TRUS, though, was the development of the prostate-specific antigen (PSA) assay. Over the past decade, there has been a profound stage migration due to earlier detection of prostate cancer. Most patients now diagnosed with prostate cancer have no palpable abnormality or specific sonographic findings. In response, ultrasound-guided biopsies have become more systematic, rather than lesion-specific, in nature.

Conclusions

TRUS continues to play an important role in the evaluation of the prostate when malignancy is suspected. Although the optimal method of prostate biopsy is controversial, ultrasound is critical in ensuring accurate sampling of the gland.
Magnetic Resonance Imaging of the Breast
Authors: Goscin Christopher P. , Berman Claudia G. , Clark Robert A.
Published: August 2017

Background

Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of invasive breast cancer. In clinical studies, breast MRI has often altered the course of patient care. Although promising results have been generated, MRI of the breast is currently in a development stage.

Methods

The authors reviewed the literature on the potential indications, sensitivity, specificity, and limitations of MRI of the breast.

Results

Reported advantages of MRI of the breast over conventional imaging techniques include improved staging and treatment planning, enhanced evaluation of the augmented breast, better detection of recurrence, and improved screening of high-risk women. Contrast-enhanced breast MRI is a sensitive modality for detecting breast cancer, but its variable specificity is a major limitation.

Conclusions

MRI of the breast is emerging as a valuable adjunct to mammography and sonography for specific clinical indications. Additional clinical studies that define indications, interpretation criteria, imaging parameters, and cost effectiveness are needed. A multi-institutional study designed to address these issues is in progress.
Postmastectomy Breast Reconstruction: Current Techniques
Authors: Shons Alan R. , Mosiello Gerard
Published: August 2017

Background

The techniques of breast reconstruction have evolved and matured over the past 25 years. Recent studies have proven the benefit of breast reconstruction for breast cancer patients.

Methods

The authors reviewed the recent literature on the techniques of breast reconstruction and the effects of reconstruction on patients following surgery for breast cancer. The findings in recent studies are correlated with the experience of the authors.

Results

A better understanding has been gained regarding surgical techniques of breast reconstruction as well as the proper indications for the various methods. The criteria of patient benefit have been defined by recent long-term studies.

Conclusions

Breast reconstruction following mastectomy has been proven to be a safe and beneficial procedure.
The Effect of Sentinel Node Selective Axillary Lymphadenectomy on the Incidence of Postmastectomy Pain Syndrome
Authors: Miguel Rafael , Kuhn Ann M. , Shons Alan R. , Dyches Patricia , Ebert Mark D. , Peltz Eric S. , Nguyen Keoni , Cox Charles E.
Published: August 2017

Background

Postmastectomy pain syndrome (PMPS) has been reported following procedures involving complete lymph node dissection (CLND). Since the triggering event is probably related to nerve injury, sentinel lymph node dissection (SLND) should decrease the incidence of PMPS. The purpose of this report is to determine the impact of SLND on the number of patients referred to the pain clinic for PMPS treatment.

Methods

The records of all breast surgical patients with a diagnosis of PMPS referred to the Moffitt Cancer Center pain clinic were reviewed. The criterion for diagnosis of PMPS was a history of postoperative pain in the upper anterior chest wall, upper extremity, axilla, and/or shoulder in the absence of recurrent disease.

Results

A total of 55 patients with a diagnosis of PMPS were seen in the pain clinic since 1991. Treatments included local anesthetics/corticosteroid injection, stellate ganglion block, and tricyclic antidepressants. A decrease from 15 patients in 1991 to 3 in 1998 was observed. All but one of the 55 patients with PMPS had CLND, and none referred to the pain clinic had undergone SLND.

Conclusions

PMPS is a complication of CLND. The increased use of SLND in our center has reduced the number of referrals to the pain clinic for treatment of PMPS. This benefit of SLND reduces suffering in the postoperative breast patient.
Urinary Incontinence following Treatment of Localized Prostate Cancer
Authors: Grise Philippe , Thurman Scott
Published: August 2017

Background

Urinary incontinence (UI) following treatment for localized prostate cancer is a significant adverse consequence most commonly seen after radical prostatectomy. UI can significantly impair the quality of life of patients who can otherwise expect a long survival.

Methods

The authors review past and present literature on UI following treatment for localized prostate cancer. Special focus is placed on the rate of UI following different modes of therapy, the effect of posttreatment UI on patients’ quality of life, and the success of different methods used to treat the incontinence.

Results

Postprostatectomy UI has been reported in 25%-70% of cases, but few patients report being significantly bothered by the symptom. Postradiation adverse effects are mainly acute inflammatory, while late complications are rare but usually more serious. Comparative studies estimate UI following prostatectomy to be two times more common than following radiation, and surgical patients are three times more likely to continue to use pads. Watchful waiting carries a risk of incontinence related to prostate tumor progression. Several interventions can improve UI.

Conclusions

UI is the most common adverse consequence from treatment for localized prostate cancer. All of the possible treatment modalities carry some risk of UI. Providing accurate information to patients allows them to make informed decisions regarding treatment and can improve the quality of life in the posttreatment period.
Microscopic Paraseptal Sphenoidotomy Approach for Pituitary Tumors
Authors: Vrionis Frank D. , Saatman Donna , Sorenson Jeffrey , Brem Steven
Published: August 2017

Background

Dissection of mucosa from the nasal septum during a transsphenoidal approach may lead to significant morbidity. Endoscopic techniques that obviate this dissection and its complications have been successful for pituitary operations. These techniques, however, are generally not stereoscopic, can add significant costs, and in many instances require additional surgical personnel.

Methods

We have exposed 11 sella lesions with the operating microscope without intranasal dissection or use of endoscopy. A paraseptal approach was utilized by following the middle turbinate to the nasopharynx and performing a bilateral sphenoidotomy.

Results

Of the 11 sella lesions addressed through this approach, 6 were macroadenomas (2 secreting and 4 nonsecreting), 1 was a craniopharyngioma, 1 was a Rathke's cleft cyst, and 2 were cerebrospinal fluid leaks into the sphenoid sinus. In 1 case, an ectopic pituitary adenoma was biopsied. Subtotal or near total tumor resection or successful repair of cerebrospinal fluid leaks was achieved. In all cases, the exposure was satisfactory. A fat graft was used in 6 cases. Postoperatively, no nasal packing was used and there were no nasal complications. Vision improved in all 5 cases with preoperative visual impairment. Complications included diabetes insipidus (1), impaired taste (1), and delirium tremens (1), all of which were transient.

Conclusions

Microscopic sphenoidotomy is a safe and effective alternative to traditional transseptal or endoscopic exposures of the sella.
Use of Complementary/Integrative Nutritional Therapies during Cancer Treatment: Implications in Clinical Practice
Authors: Kumar Nagi B. , Hopkins Keandra , Allen Kathy , Riccardi Diane , Besterman-Dahan Karen , Moyers Susan
Published: August 2017

Background

The objectives of this study were to determine the prevalence and characterize the use of complementary/integrative nutritional therapies (CINTs) by patients during cancer treatment.

Methods

This retrospective review used data collected as a part of standard clinical care provided by the registered clinical dietitians and included nutritional history, demographic variables, anthropometrics, prevalence of use, and the specific integrative nutritional therapies used by these patients during cancer treatment.

Results

Twenty-nine percent of 820 patients reported use of CINTs not prescribed by their physician. Caucasians and patients over age 60 were the principal users of CINTs during treatment. Modular vitamins were the most frequently reported additive (86.9%), followed by botanicals/biologics (43.8%) and mineral supplements (28.6%).

Conclusions

A considerable proportion of cancer patients use unproven CINTs during cancer treatment. The health professional should become more aware of the complementary/integrative therapies that their patients are using during cancer treatment.
Evaluation and Management of Oropharyngeal Dysphagia in Head and Neck Cancer
Authors: Gaziano Joy E.
Published: August 2017

Background

Dysphagia is a common symptom of head and neck cancer or sequelae of its management. Swallowing disorders related to head and neck cancer are often predictable, depending on the structures or treatment modality involved. Dysphagia can profoundly affect posttreatment recovery as it may contribute to aspiration pneumonia, dehydration, malnutrition, poor wound healing, and reduced tolerance to medical treatments.

Methods

The author reviewed the normal anatomy and physiology of swallowing and contrasted it with the commonly identified swallowing deficits related to head and neck cancer management. Evaluation methods and treatment strategies that can be used to successfully manage the physical and psychosocial effects of dysphagia are also reviewed.

Results

Evaluation of dysphagia by the speech pathologist can be achieved with instrumental and non-instrumental methods. Once accurate identification of the deficits is completed, a range of treatment strategies can be applied that may return patients to safe oral intake, improve nutritional status, and enhance quality of life.

Conclusions

To improve safety of oral intake, normalize nutritional status, reduce complications of cancer treatment and enhance quality of life, accurate identification of swallowing disorders and efficient management of dysphagia symptoms must be achieved in an interdisciplinary team environment.
Ductal Lavage for Breast Cancer Risk Assessment
Authors: Newman Lisa A. , Blake Cassann
Published: August 2017

Background

Effective chemoprevention is available for breast cancer, but it is associated with the potential for life-threatening adverse events. Accurate identification of women facing increased risk of breast cancer is therefore essential. Atypical hyperplasia is a histopathologic pattern that has been consistently associated with an elevated future risk of breast cancer.

Methods

The literature was reviewed to assess the strength of the association between atypical hyperplasia and breast cancer. The rationale for developing a nonsurgical modality to document the presence of atypia is discussed.

Results

Ductal lavage identifies atypical hyperplasia by retrieving epithelial cells shed into the ductal system with a specially designed catheter. Women with clinical evidence of increased breast cancer risk may consider ductal lavage as a means of determining whether abnormal proliferative activity is occurring in their breasts at a given point in time from ducts yielding fluid.

Conclusions

Ductal lavage is a minimally invasive procedure that facilitates the detection of atypia via retrieval of breast ductal fluid that can be evaluated cytologically. It can facilitate the selection of women who may benefit from breast cancer risk reduction intervention.
Endocrine and Clinical Endpoints of Exemestane as Neoadjuvant Therapy
Authors: Miller William R. , Dixon J. Michael
Published: August 2017

A series of in vitro and in vivo studies have been performed to establish the endocrine and clinical endpoints of the type I anti-aromatase agent exemestane in neoadjuvant therapy. In vitro studies demonstrated a dose-related inhibition of aromatase activity with exemestane, even when activity was measured in a system in which the aromatase enzyme was induced in fibroblasts preincubated with exemestane but assayed in the absence of the drug. In contrast, type II anti-aromatase agents (eg, aminoglutethimide, anastrozole, and letrozole) often caused a paradoxical increase in aromatase activity when measured under similar conditions.

In vivo and in situ studies were performed in 12 postmenopausal women with untreated large or locally advanced estrogen receptor-rich tumors. The effect of exemestane 25 mg daily for 3 months on aromatization peripherally and in breast cancer and surrounding normal tissue was determined. Immediately before starting therapy, patients received an 18-hour infusion of radioactively labeled androgen and estrogen, followed by a wedge biopsy. This procedure was repeated after 3 months of treatment with exemestane, and the data were used to calculate peripheral and local aromatization. Changes in tumor volume were based on clinical examination, ultrasound, and mammography. Exemestane treatment was associated with a marked reduction in aromatization peripherally and in nonmalignant breast tissue in every patient and in breast tumor in all but one patient. Median reduction in tumor volume was 85.5% for clinical examination, 82.5% for ultrasound, and 84% for mammography. Eight of 10 patients who would have required mastectomy before treatment were able to undergo breast-conserving surgery after treatment. Clinical benefits were accompanied by a marked reduction in cellular proliferation and progesterone receptor expression. These data support the use of exemestane in neoadjuvant therapy of breast cancer in postmenopausal women.
Clinical Experience with Angiogenesis Signaling Inhibitors: Focus on Vascular Endothelial Growth Factor (VEGF) Blockers
Authors: Rosen Lee S.
Published: August 2017

Angiogenesis is required for tumor growth and metastasis and, therefore, represents an exciting target for cancer treatment. Angiogenesis is a complex process that is tightly regulated by pro- and anti-angiogenic growth factors. Physiologic angiogenesis takes place during tissue growth and repair, during the female reproductive cycle, and during fetal development. Pathologic angiogenesis is characterized by either excessive (eg, cancer) or inadequate (eg, coronary artery disease) neovascularization. Angiogenesis occurs in a series of complex and interrelated steps that involve the release of pro-angiogenic growth factors, such as vascular endothelial growth factor (VEGF). VEGF regulates both vascular proliferation and permeability, and functions as an anti-apoptotic factor for newly formed blood vessels. The biological effects of VEGF are mediated by two receptors, VEGF-1 and VEGF-2, whose expression is largely limited to the vascular endothelium. VEGF is often expressed in tumors at substantially increased levels. It is expressed in response to hypoxia, oncogenes, and other cytokines, and its expression is associated with poor prognosis in several types of cancer. Several different strategies have been used to inhibit VEGF, including anti-VEGF monoclonal antibodies (eg, bevacizumab) and agents that inhibit the VEGF receptor (eg, SU5416). Both types of agents have tolerable side effects and have shown promise when evaluated in a wide range of tumor types. Angiogenesis, the role of VEGF in angiogenesis and malignancy, and strategies for cancer treatment with VEGF inhibitors are discussed.
Nonmyeloablative Allogeneic Stem-Cell Transplantation for Hematologic Malignancies: A Systematic Review
Authors: Djulbegovic Benjamin , Seidenfeld Jerome , Bonnell Claudia , Kumar Ambuj
Published: August 2017

Background

Increasingly, clinicians advocate the use of nonmyeloablative allogeneic stem-cell transplants (NM-allo-SCTs, “mini-transplants”) to manage hematologic malignancies. They hypothesize that NM-allo-SCT is equally efficacious to standard allo-SCT but produces less regimen-related toxicity.

Methods

To analyze available evidence on the benefits and harms of “mini-transplants,” we identified 23 manuscripts, 1 abstract, and 1 letter that reported the outcome of mini-transplants in hematologic malignancies.

Results

Data were compiled on 603 treated patients, with 118 transplants using stem cells from matched unrelated donors. All studies were small prospective case series, and most lacked concurrent or historical controls. Outcomes of interest were not uniformly reported. The studies were heterogeneous and used different patient selection criteria, conditioning regimens, and timing of transplant with respect to disease status. The transplant-related mortality rate was 32%, the relapse rate was 15%, and toxicities included acute and chronic graft-vs-host disease and veno-occlusive disease. The aggregate rate of complete remission was 45%. Survival at 1 year or longer ranged from 30% to 60% at 1 to 5 years of follow-up. All studies reported successful chimerism.

Conclusions

Disease-specific studies with longer follow-up are needed to evaluate this potentially promising therapy.
High-Dose Chemotherapy for Breast Cancer: The French PEGASE Experience
Authors: Rochéa Henri , Viens Patrice , Biron Pierre , Lotz Jean-Pierre , Asselain Bernard
Published: August 2017

Background

Early studies of high-dose chemotherapy (HDC) for breast cancer were limited by small numbers and the lack of adequate control groups. The French PEGASE Group was founded to perform larger and properly randomized comparative studies of this approach.

Methods

The program was created to determine the effects of intensive chemotherapy for breast cancer. The seven PEGASE protocols addressed HDC as adjuvant therapy (01 and 06) and as treatment for inflammatory nonmetastatic disease (02, 05, and 07) and metastatic disease (03 and 04). Two of these protocols are ongoing.

Results

The PEGASE 01 adjuvant therapy trial showed that 3-year disease-free survival was significantly better in the HDC arm but overall survival was unchanged. The ongoing phase III 06 trial is studying a higher dosage regimen. The HDC trials for metastatic and inflammatory nonmetastatic disease are encouraging.

Conclusions

Many clinicians no longer subscribe to the concept of HDC for breast cancer. Overall outcomes from management of poor-risk breast cancer remain poor, however, and it is possible that some selected subgroups of patients may benefit from such an approach.
Genetics and Prevention of Pancreatic Cancer
Authors: Vimalachandran Dale , Ghaneh Paula , Costello Eithne , Neoptolemos John P.
Published: August 2017

Background

Pancreatic cancer is an aggressive disease with a poor prognosis. Hereditary factors have been reported in up to 10% of cases of pancreatic cancer. The clinical characteristics and genetic abnormalities have been identified for a proportion of this high-risk group, and the development of preventive strategies for these individuals is now a primary goal of cancer clinicians.

Methods

A review of the current literature regarding the genetics, screening, and prevention of pancreatic cancer and its precursor lesions was undertaken.

Results

Risk factors for pancreatic cancer include smoking, chronic pancreatitis, and a genetic predisposition. The role of diabetes or a diet high in fat or meat remains unclear. The genetic mutations that accompany pancreatic cancer appear to occur in a temporal sequence, beginning in the earliest of precursor lesions. These mutations are detectable in pancreatic juice and, in conjunction with imaging, form the basis of screening programs for high-risk individuals. Not all precursor lesions will undergo malignant transformation, and testing is currently limited in its ability to determine which lesions will undergo transformation.

Conclusions

Avoiding tobacco smoking and minimizing risk factors associated with chronic pancreatitis are recommended to reduce the risk of pancreatic cancer. Individuals with a high-risk genetic background require counseling, genetic testing if appropriate (BRCA2 mutation or p16INK4Ainactivity) and secondary screening for pancreatic cancer in specialist centers. Risk stratification will improve as more genetic abnormalities causing pancreatic cancer are defined.
Surgical Management of Early-Stage Pancreatic Cancer
Authors: Zervos Emmanuel E. , Rosemurgy Alexander S. , Al-Saif Osama , Durkin Alan J.
Published: August 2017

Background

Pancreatic cancer remains a difficult disease to treat. Diagnosis at an early stage may allow curative treatment with resection. In the past, the mortality associated with surgical treatment of pancreatic carcinoma was prohibitive but mortality associated with resection is now commensurate with all other major oncologic resections. Thus, the focus of surgical management has shifted to address several issues: the diagnosis and evaluation of patients with suspected pancreatic cancer, the role of preoperative endobiliary stenting, the role of laparoscopy, the extent of resection, the role of adjuvant and neoadjuvant treatment, and the role of specialized centers in treating the disease.

Methods

The current literature is reviewed to address these issues and help guide physicians who first encounter patients with suspected pancreatic cancer as well as surgeons who ultimately resect them. Practical evidence-based information to guide the decision-making process is provided.

Results

Surgical morbidity and mortality have achieved parity with other types of major oncologic resection, and a distinct survival advantage is possible when such therapy is applied early in the disease stage. Issues regarding the use of stents, extent of resection, and pre- vs post-operative chemoradiation therapy are becoming clearer as our collective experience broadens.

Conclusions

Surgical treatment of pancreatic cancer should be aggressively pursued given the clearly established survival advantage and relief of symptoms achieved when it is applied appropriately.
Molecular-Targeted Agents in Pancreatic Cancer
Authors: Saad Everardo D. , Hoff Paulo M.
Published: August 2017

Background

Despite the acceptance of gemcitabine as the standard first-line agent for the treatment of advanced pancreatic cancer as well as the improved response rates seen with gemcitabine combinations, novel therapies are needed for this disease, which has one of the lowest survival rates. The growing understanding of the molecular basis of pancreatic cancer and the recent introduction of targeted therapeutic agents have initiated novel studies that have the potential to improve on existing treatments.

Methods

We review the rationale and the clinical studies of therapeutic agents that target some of the molecular abnormalities commonly found in pancreatic cancer.

Results

Matrix metalloproteinase inhibitors (MMPIs), farnesyltransferase inhibitors (FTIs), and tyrosine-kinase inhibitors and monoclonal antibodies against growth factors or their receptors are novel agents that have undergone phase II or III trials. Phase III studies of MMPIs, alone or in combination with gemcitabine, and phase III studies of FTIs have produced disappointing results. Other agents in earlier phases of clinical development remain promising.

Conclusions

Despite the negative studies of MMPIs and FTIs, the results of phase II trials of other drugs are encouraging. Targeted agents may improve the prognosis of pancreatic cancer.
5-Fluorouracil–Induced Coronary Vasospasm
Authors: Shoemaker Laura K. , Arora Umesh , Lima Caio Max S. Rocha
Published: August 2017

Background

Cardiotoxicity is a rare but well-documented adverse effect of 5-fluorouracil (5-FU). The underlying cause of this side effect of 5-FU is uncertain.

Methods

We present a case report of a 63-year-old man treated for metastatic colon cancer who experienced chest pain while being treated with the FOLFIRI regimen. This case report documents coronary artery spasm on catheterization observed with the continuous infusion of 5-FU.

Results

Cardiac catheterization obtained within 36 hours of the onset of chest pain revealed marked coronary vasospasm in the obtuse marginal coronary artery and a right coronary artery with a critical obstructive atherosclerotic plaque. Electrocardiogram revealed the myocardium area associated with the event was diffuse rather than localized to the right coronary artery.

Conclusions

This observation supports the vasospastic hypothesis for 5-FU–induced angina. Although rare, this type of cardiotoxicity with 5-FU is a potentially lethal side effect. Therapy with 5-FU should be discontinued and patients should be promptly treated.
The Role of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma in Situ or with Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy
Authors: Pendas Solange , Jakub James , Giuliano Rosemary , Gardner Mary , Swor Gray Bowen , Reintgen Douglas S.
Published: August 2017

Background

A significant number of patients who are initially diagnosed with pure DCIS will harbor missed or occult invasive disease at their definitive surgery. To provide more accurate staging information and to avoid a second operation, some investigators believe that SLN mapping should be performed in DCIS patients. The role of SLN biopsy after neoadjuvant chemotherapy in patients with advanced breast cancer is controversial.

Methods

A review of the literature was performed to determine the role of SLN biopsy in patients with DCIS or advanced breast cancer receiving neoadjuvant chemotherapy. The success rate of SLN biopsy after neoadjuvant chemotherapy was investigated as well as the percentage of positive SLNs in patients with DCIS.

Results

Two consecutive studies revealed metastatic disease to the regional lymph nodes in up to 13% of DCIS patients. In addition, 10% of DCIS patients were upstaged to infiltrating ductal carcinoma at their definitive therapy. The ability of the SLN to predict the status of the remaining non-SLNs after neoadjuvant chemotherapy is unknown. False-negative rates range from 0% to 33%. The success rate for SLN identification for the combined series varies from 84% to 97%.

Conclusions

SLN biopsy is a minimally invasive technique that can be used to evaluate the regional nodal status of DCIS patients. Performing a SLN biopsy during the initial surgical procedure may avoid a second operation in some DCIS patients who are diagnosed with invasive disease at their definitive operation. The success rate of sentinel node identification does not seem to be altered after neoadjuvant therapy. However, the ability of the SLN to predict the pathologic status of the adjacent non-SLNs remains unknown. Therefore, until further prospective randomized trials are conducted, it cannot be assumed that all the regional nodes have the same biologic response to chemotherapy as the SLN.
Enhancing the Readability of Materials Describing Genetic Risk for Breast Cancer
Authors: Thompson Hayley S. , Wahl Erica , Fatone Anne , Brown Karen , Kwate Naa Oyo A. , Valdimarsdottir Heiddis
Published: August 2017

Background

The number of individuals contemplating genetic testing is increasing, but the current materials and overall subject matter remain complex and not easily understood by many. The goal of this project was to evaluate efforts to revise and increase the readability of an existing information packet describing genetic risk for breast cancer.

Methods

Evaluation was conducted in two stages through two related studies. In Study 1, a focus group of multiethnic breast cancer survivors was assembled to obtain feedback on images included in the revised breast cancer genetics information packet. In Study 2, African American adult students in a literacy program evaluated the revised images (based on the feedback of the focus group in Study 1) and text of the information packet and provided ratings on readability, format, and appearance.

Results

Responses from Study 1 participants suggested that some of the images created for the packet needed to be clearer in the concepts they were intended to convey. In Study 2, ratings of adult learners suggested difficulty with word comprehension in spite of the inclusion of definitions and a glossary. The reading level achieved was markedly lower than the college reading level required by the original information packet and other patient-directed cancer genetics materials.

Conclusions

Although efforts to clarify written materials in order to better serve patients with low literacy received generally favorable responses, continued efforts to create more user-friendly patient education materials are warranted.
Culture, Black Men, and Prostate Cancer: What is Reality?
Authors: Woods V. Diane , Montgomery Susanne B. , Belliard Juan Carlos , Ramírez-Johnson Johnny , Wilson Colwick M.
Published: August 2017

Background

The worldwide incidence of prostate cancer is higher among American black men than any other male group. In the United States, lack of participation in screening for prostate cancer by black men is influenced by several cultural factors, including knowledge, health beliefs, barriers, and relationships with primary healthcare providers.

Methods

We used the qualitative and paralleling descriptive quantitative findings of a mixed-method longitudinal study exploring prostate cancer screening behaviors among 277 black men.

Results

Five themes were identified as critical elements affecting men's screening for prostate cancer: lack of knowledge, communication, social support, quality of care, and sexuality. These themes were associated with a sense of disconnectedness by black men from the healthcare system and contributed to nonparticipation in prostate cancer early detection activities.

Conclusions

Lack of discussion about the decision to screen for prostate cancer and general lack of culturally appropriate communication with healthcare providers has engendered distrust, created fear, fostered disconnect, and increased the likelihood of nonparticipation in prostate cancer screening among black men.
Targeted Therapy for Hematologic Malignancies
Authors: Kuriakose Philip
Published: August 2017

Background:

The introduction of monoclonal antibodies, either as native molecules or conjugated to radioisotopes or other toxins, has led to new therapeutic options for patients with hematologic malignancies. In addition, the use of small molecules against specific cell surface receptors, enzymes, and proteins has become an important strategy in the treatment of such disorders.

Methods:

The author reviewed the published clinical trials of monoclonal antibody and other targeted therapies in hematologic malignancies.

Results:

Results from several trials demonstrate a therapeutic benefit for the use of monoclonal antibodies (either native or conjugated) and other targeted therapies, used alone or in combination with standard cytotoxic chemotherapy.

Conclusions:

Targeted therapy of hematologic malignancies seems to be an effective and less toxic approach to the treatment of such disorders. Nevertheless, additional studies are needed to determine where and when such management fits into a therapeutic regimen for any given disorder, whether upfront or as salvage therapy, alone or in combination with chemotherapy (concurrent or sequential).
Understanding Quality-of-Life Issues in Chinese Women with Breast Cancer: A Qualitative Investigation
Authors: Wong-Kim Evaon , Sun Angela , Merighi Joseph R. , Chow Edward A.
Published: August 2017

Little is known about the cultural beliefs and quality of life (QOL) of US-born and foreign-born Chinese women with breast cancer. We conducted individual semistructured qualitative interviews to explore the meaning of QOL, identify beliefs about cancer, and make comparison between US-born and foreign-born survivors. Women in this study identified the stigma of breast cancer that exists in the Asian community. They also described interpersonal support as central to a good QOL. However, when describing QOL, foreign-born Chinese women referred to wealth more frequently, while US-born Chinese women indicated friendship more frequently. The study findings support the need for culturally appropriate interventions that take into consideration the cancer-related beliefs and QOL of breast cancer survivors in the Chinese community.
Readiness and Capacity of Librarians in Public Libraries to Implement a Breast Cancer Outreach and Screening Campaign in Medically Underserved Communities
Authors: Goytia Elliott J. , Rapkin Bruce , Weiss Elisa S. , Golub David , Guzman Vivian , O'connor Maureen ,   the New York Health Literacy Task Force
Published: August 2017

Community-based partnerships are an important means of addressing cancer health disparities in medically underserved communities. Public libraries may be ideal partners in this effort. To assess the readiness and capacity of a public library system to implement cancer recruitment and outreach campaigns, 58 librarians in the Queens Borough Public Library System in New York completed self-administered questionnaires before and after a training on breast health, cancer, and screening. Results indicate that they are interested in participating in a cancer outreach campaign and feel it is a critical need in their community. Many librarians lacked the knowledge about cancer and cancer information resources needed to participate optimally. Nevertheless, librarians provide a cultural bridge to medically underserved communities. Partnering with a public library system to improve access to care has great potential, yet a number of challenges need to be overcome.
Lessons Learned from Community-Based Participatory Research in Indian Country
Authors: Burhansstipano Linda , Christopher Suzanne , Schumacher Ann
Published: August 2017

The purpose of this article is to share lessons learned from implementing community-based participatory research (CBPR) in Indian Country that may be generalizable to other medically underserved communities. CBPR is currently included in multiple grant announcements by the National Institute of Health and Centers for Disease Control and Prevention, but information about this methodology vs traditional research methodology is often misleading. This article addresses some common mistakes made by academic research institutes by sharing what we have learned about how CBPR can be implemented in a respectful manner. The majority of tribal Nations prefer, if not mandate, that CBPR be used in most proposed studies involving their communities today.
Repeat Mammography Screening among Low-Income and Minority Women: A Qualitative Study
Authors: Fernandez Maria E. , Palmer Richard C. , Leong-Wu Cindy A.
Published: August 2017

Regular mammography screening can reduce breast cancer mortality, yet low-income African American and Hispanic women underutilize mammography screening and are often diagnosed at a later stage, resulting in increased mortality. We used qualitative research methods to identify factors influencing regular breast cancer screening among African American and Hispanic women. Predisposing factors (including fear of mastectomy and lack of knowledge), enabling factors (including cost and social support) and a reinforcing factor were identified and categorized utilizing the PRECEDE framework. The study identified factors associated with the decision to complete regular mammography screening, and examined differences between African American and Hispanic women who participated in the interviews. Future research should seek to better understand the influence of family/friends, risk perception, and fatalistic beliefs on the decision to obtain regular mammograms.
The Role of External-Beam Radiation Therapy in the Treatment of Clinically Localized Prostate Cancer
Authors: Torres-Roca Javier F.
Published: August 2017

Background

The treatment of clinically localized prostate cancer is controversial. Options include radical prostatectomy, external-beam radiation therapy (EBRT), brachytherapy, cryotherapy, and watchful waiting.

Methods

The author reviews EBRT as treatment for clinically localized prostate cancer, with particular emphasis on the technological advances that have allowed dose escalation and fewer therapy-related side effects.

Results

Technological advances in the last two decades have significantly improved the delivery of EBRT to the prostate. This has resulted in an overall increase in the total dose that can be safely delivered to the prostate, which has led to modest improvements in biochemical outcome. An alternative approach of combining androgen suppression therapy and EBRT has also been successful in improving clinical outcomes. However, establishing the optimal therapy for prostate cancer remains controversial.

Conclusions

Recent progress has led to improvements in clinical outcomes in patients treated with EBRT for prostate cancer. It is hoped that the next decades will bring continued advances in the development of biologicals that will further improve current clinical outcomes.
Survival after Surgical Resection of Isolated Pulmonary Metastases from Malignant Melanoma
Authors: Andrews Stephanie , Robinson Lary , Cantor Alan , Deconti Ronald C.
Published: August 2017

Background

The overall prognosis for patients with metastatic malignant melanoma remains poor. However, careful staging and identification of patients with limited metastatic disease offers the opportunity for surgical salvage and improved survival for selected patients.

Methods

We reviewed the experience over the last 17 years at our institute with isolated pulmonary metastasectomy in 86 patients with advanced malignant melanoma.

Results

Our data demonstrate an overall median time to relapse of approximately 8.4 months and a median survival of 35 months. The 5-year survival rate is estimated at 33%, and 16% remain continuously free of disease after a median follow-up of 35 months. Resection of properly staged and evaluated patients with limited pulmonary metastases appears to convey a significant survival benefit. Patients with a single metastasis fare best.

Conclusions

These encouraging results offer a rationale for the careful follow-up of resected patients. One third of all relapses will be limited and additional surgery contributes to their overall survival.
Aging, Frailty, and Chemotherapy
Authors: Balducci Lodovico
Published: August 2017

Background

In many cases, elderly individuals have not been offered life-saving interventions due to the assumption that these treatments would be too toxic to tolerate.

Methods

This article offers an overview of the biology of aging, reviews the assessment of an individual's physiologic age, and explores the medical definition of frailty and its implications in cancer treatment.

Results

The definition of frailty is controversial. Rather than chronologic age, a more accurate assessment relies on individual estimates of life expectancy and functional reserve, including serum levels of interleukin 6 and D-dimer, the levels of a number of inflammatory cytokines, and the circulating level of C-reacting protein. Decision making for optimal cancer treatment in the older-aged patient benefits from a comprehensive geriatric assessment, a functional test, and a laboratory evaluation to determine a patient's life expectancy and functional reserve.

Conclusions

Most older patients appear to benefit from cancer treatment to an extent comparable to that of younger individuals, and only a minority of these patients should be excluded from treatment due to reducedtolerance.
Tolerance to Chemotherapy in Elderly Patients with Cancer
Authors: Wedding Ulrich , Honecker Friedemann , Bokemeyer Carsten , Pientka Ludger , Höffken Klaus
Published: August 2017

Background

Due to demographic changes, the number of elderly people with cancer will increase in the next decades. In the past, elderly patients with cancer were often excluded from clinical trials. Chronological age has been considered a risk factor for increased toxicity and reduced tolerance to chemotherapy.

Methods

We present a review on toxicity of chemotherapy and factors associated with toxicity in elderly patients with cancer, and we discuss chemotherapeutic agents and treatment options in treating this patient population.

Results

Age is a risk factor for increased toxicity to chemotherapy and decreased tolerance. However, few trials have been reported with adjustment for age-associated changes such as impairment of functional status and increased comorbidity, which also show an independent association with increased toxicity. Published data may include several biases, such as referral and publication bias.

Conclusions

Decision making in elderly cancer patients should be based on the results of a geriatric assessment. Patients with few or no limitations should be treated as younger patients are treated. Data with a high level of evidence are unavailable for patients showing moderate or severe limitations in a geriatric assessment.
Current and Future Directions of Clinical Trials for Ovarian Cancer
Authors: Gardner Ginger J. , Jewell Elizabeth L.
Published: August 2017

Background

The management of ovarian cancer includes a combination of surgery and chemotherapy. The majority of clinical trials have historically addressed questions pertaining to the selection, dosing, and schedule of chemotherapy agents.

Methods

In this report, a comprehensive review of the major clinical trials in ovarian cancer is performed. The increasing data and clinical experience in the management of ovarian cancer, as it sets the stage for currently active protocols and future clinical trial design, are emphasized.

Results

Paclitaxel plus carboplatin is the primary intravenous treatment strategy in the front-line setting. Recent data show an improvement in overall survival for intravenous dose-dense treatment. Multiple randomized controlled trials support the use of intraperitoneal treatment. For recurrent disease, a growing number of new agents including targeted therapeutics are now available. Increasingly, surgical approach, biologic targets, and quality of life endpoints are included in clinical trial design.

Conclusions

Over the last several decades, clinical trials have defined the current therapeutic approach for ovarian cancer. Paclitaxel with a platinum-based agent is currently the preferred front-line therapy, with encouraging data to support either dose-dense or intraperitoneal drug delivery. Future trials will determine the role of biologic agents and vaccine therapies, as well as their impact on quality of life.