bluuebunny/crossref_metadata_2025 huggingface dataset:
Inferior Vena Cava Filters in the Cancer Patient: Current Use and Indications
Authors: Getzen Todd M. , Rectenwald John E.
Published: April 2017

Deep venous thrombosis and thromboembolism are significant health risks, with high rates of morbidity and mortality. Chronically ill and hospitalized patients, particularly those with cancer, have a high risk for developing these conditions. Mechanical inferior vena cava (IVC) filtration has been standard care for patients with these conditions in whom anticoagulation therapy is contraindicated or has failed. This article reviews caval filters and the current indications for using mechanical IVC filters, including retrievable versus permanent filters, focusing on their use in treating venous thromboembolism in cancer patients.
Catheter-Related Thrombosis: Risks, Diagnosis, and Management
Authors: Linenberger Michael L.
Published: April 2017

Symptomatic thromboembolic complications of central venous catheters (CVCs) occur in 5% or less of general oncology patients. Asymptomatic CVC-related thrombi are more common, but their clinical significance is unclear. Thrombotic risk may be increased by primary thrombophilic disorders, especially the factor V G1691A (Leiden) mutation, thrombogenic catheter material, larger catheter diameter and greater number of lumens, catheter tip malposition, left-sided placement, percutaneous or multiple insertion attempts, a previous CVC or preexisting venous obstruction, prothrombotic therapeutic agents, catheter-associated infections, and fibrinous catheter lumen occlusion. Three recent randomized, prospective, placebo-controlled trials observed no benefit of routine low-dose warfarin or low-molecular-weight heparin in preventing catheter-associated thrombosis. Nevertheless, thromboprophylaxis may be appropriate and safe for selected high-risk patients. Duplex ultrasound can accurately detect CVC-related thrombi involving the jugular, axillary, distal subclavian, and arm veins. Contrast venographic imaging is required for indeterminate duplex findings and to evaluate the deep central veins and pulmonary arteries. Therapeutic anticoagulation, with or without catheter removal, is indicated for patients with acute deep vein thrombosis (DVT) or pulmonary embolism who have no contraindications. Catheter removal alone, with close follow-up, may be sufficient when bleeding risk precludes safe anticoagulation. Approaches to managing catheter-associated thrombosis, including the use of thrombolytic agents, are guided by limited published experience and extrapolation from practices used for lower-extremity DVT. Prospective, randomized, controlled trials are needed to identify the safest and most effective anticoagulant agents, treatment durations, and alternative venous access strategies for cancer patients who develop catheter-associated thrombosis.
Surgical Management of Upper Tract Transitional Cell Carcinoma
Authors: Lake Alison M. , Roberts William W.
Published: April 2017

Upper tract transitional cell carcinoma (TCC) accounts for approximately 5% of urothelial tumors. Surgical therapy for upper tract TCC is based on tumor grade, stage, location, and confounding factors of individual cases. Options for treatment range from minimally invasive procedures, such as ureteroscopy, to open nephroureterectomy. Laparoscopic nephroureterectomy is progressively eclipsing open nephroureterectomy in the surgical management of upper tract TCC. This article discusses the surgical options for managing upper tract TCC and their considerations for use.
Optimal Management of Small Renal Masses
Authors: Hauke Ralph
Published: April 2017

The incidence of small renal masses is increasing. Limited data suggest that although most are malignant, they are also likely to show indolent behavior. The tendency of these tumors to occur in older patient populations with multiple comorbidities raises important issues. Retrospective and prospective studies suggest that a substantial proportion of these small renal masses can be observed without compromising the opportunity for cure or subjecting patients to invasive procedures that might impact negatively on quality of life. Less-invasive treatment modalities, including partial nephrectomy and energy ablation techniques, provide multiple options for some patients. This article reviews selected aspects of the management of small renal masses, including their natural history, imaging, diagnostic biopsies, and treatment options. (
Antiemesis
Authors: _ _
Published: April 2017

Chemotherapy-induced nausea and vomiting (emesis) can significantly affect a patient's quality of life, leading to poor adherence with further chemotherapy treatment. In addition, nausea and vomiting can result in other serious complications and deterioration of the patient's status. These guidelines explore the prevention, treatment, and management of various types of emesis experienced by cancer patients, such as breakthrough, radiation-induced, and anticipatory.

For the most recent version of the guidelines, please visit NCCN.org
Behavioral Interventions in Treating Anticipatory Nausea and Vomiting
Authors: Figueroa-Moseley Colmar , Jean-Pierre Pascal , Roscoe Joseph A. , Ryan Julie L. , Kohli Sadhna , Palesh Oxana G. , Ryan Elizabeth P. , Carroll Jennifer , Morrow Gary R.
Published: April 2017

Anticipatory nausea and vomiting (ANV) is associated with a significant reduction in the quality of life for many chemotherapy patients. The use of 5-hydroxytryptamine type 3 receptor antagonists provides some relief for chemotherapy-induced nausea and vomiting, but does not seem to control ANV. Nonpharmacologic approaches, which include behavioral interventions, may provide the greatest promise in relieving symptoms. Little evidence supports the use of complementary and alternative methods, such as acupuncture and acupressure, in relieving ANV. Behavioral interventions, especially progressive muscle relaxation training and systematic desensitization, should be considered important methods for preventing and treating ANV.
Prevention of Emesis from Multiple-Day and High-Dose Chemotherapy Regimens
Authors: Navari Rudolph M.
Published: April 2017

The prevention of chemotherapy-induced nausea and vomiting (CINV) has improved significantly with the introduction of the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists combined with dexamethasone. Most studies have reported on patients undergoing single-day highly or moderately emetogenic chemotherapy. There have been fewer studies and much less success in preventing CINV in patients undergoing multiple-day chemotherapy or high-dose chemotherapy with stem cell transplant. Current practice guidelines suggest the use of a first-generation 5-HT3 receptor antagonist and dexamethasone daily for each day of the multiple-day chemotherapy regimens. This practice seems to control acute CINV, but delayed CINV remains poorly controlled with a complete response (e.g., no emesis, no rescue) of less than 50% in most studies. Three new agents—palonosetron, aprepitant, and olanzapine— have shown high efficacy in preventing acute and delayed CINV in patients undergoing single-day chemotherapy. These agents have high potential for preventing CINV in patients undergoing multiple-day chemotherapy. This article proposes recommendations for their use in clinical trials and in practice.
Implementation of NCCN Distress Management Guidelines by Member Institutions
Authors: Jacobsen Paul B. , Ransom Sean
Published: April 2017

Up to half of all adults with cancer experience clinically significant psychological distress and much of this distress goes unrecognized and untreated. As part of an effort to improve the care of cancer patients, the National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines for distress management that include recommendations about the evaluation and treatment of distress. These authors conducted a study to evaluate the implementation of these distress management guidelines by NCCN member institutions. The NCCN member institutions that treat adults were asked in April and May 2005 to describe their distress management practices, and 15 (83%) provided responses. Of these, 8 (53%) conduct routine distress screening for at least some patient groups, with 4 additional institutions (27%) pilot-testing screening strategies. However, only 20% of surveyed member institutions screened all patients as the guidelines recommend. In addition, whether institutions that conduct routine distress screening do so through standardized assessment methods is unclear, because 37.5% of institutions that conduct screening rely only on interviews to identify distressed patients. Findings suggest that most institutions consider screening patients' mental health concerns important and worthwhile, but that greater implementation of guideline recommendations is needed.
Role of Bone Marrow Transplantation in the Disease Pathway of Myeloma
Authors: Harousseau Jean-Luc , Moreau Philippe
Published: April 2017

In multiple myeloma, autologous stem cell transplantation (ASCT) has been considered a standard of care in younger patients. The introduction of novel agents (i.e., thalidomide, lenalidomide, and bortezomib) may change this scenario. These agents can be administered before or after ASCT with the goal of increasing the complete remission (CR) rate and prolonging remission. For instance, thalidomide given as maintenance therapy after double ASCT increases CR rate, event-free survival (EFS), and overall survival. Moreover, combinations of conventional chemotherapy with novel agents such as thalidomide or bortezomib yield CR rates and EFS comparable to those achieved with standard single ASCT. Prospective randomized studies are needed to evaluate the impact of novel agents versus or in combination with ASCT. Myeloablative conditioning regimens before allogeneic stem cell transplantation are being replaced with concurrent autologous-transplantation and reduced-intensity conditioning allogeneic stem cell transplantation. Transplant-related mortality associated with this procedure is lower, but more follow-up is needed before definite conclusions can be drawn.
Managing Systemic Light-Chain Amyloidosis
Authors: Comenzo Raymond L.
Published: April 2017

Amyloidosis is a rare disease in which a specific protein is deposited as aggregated interstitial fibrils that can compromise organ function and lead to death. Immunoglobulin (Ig) light-chain amyloidosis (AL), caused by the monoclonal gammopathy of a plasma cell dyscrasia, is the most common type. A hereditary type is also caused by mutant transthyretin and other proteins. Rarely, a patient with amyloid has both a monoclonal gammopathy and a hereditary protein. In AL, circulating monoclonal Ig light chains can be measured with the free light-chain (FLC) assay and provide a target for therapy to eliminate the underlying plasma cell dyscrasia while supporting the patient's organ function. Amyloid deposits can be resorbed and organ function restored if the amyloid-forming precursor FLC is eliminated. For patients with limited organ involvement, intravenous melphalan in doses from 100 to 200 mg/m2 with autologous stem cell support (SCT) is an effective approach and, when followed at 3 months post-SCT with adjuvant thalidomide and dexamethasone for persistent plasma cell disease, has a 1-year hematologic response rate of 77%. Monthly oral melphalan and dexamethasone for 1 year can also be effective therapy for patients too sick for SCT (67% response rate). Hematologic complete responses are usually durable and result in long-term survival and a variable degree of organ recovery. For patients with advanced cardiac involvement, the prognosis remains guarded even with treatment. Drugs effective in multiple myeloma are usually active in AL, depending on side effects. New agents such as bortezomib and lenalidomide have shown promising activity, and novel antibody-based approaches for imaging amyloid and accelerating removal of deposits are being actively investigated.
Growth Factors in Leukemia
Authors: Frankfurt Olga , Tallman Martin S.
Published: April 2017

The role of myeloid growth factors, such as granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, in the management of acute myeloid and acute lymphoblastic leukemias has been evaluated extensively in multiple clinical trials. Growth factors have been given before, concurrently, or sequentially with chemotherapy with the goal of reducing the duration of neutropenia and consequently the incidence and severity of infections, and improving the rate of remissions and overall survival. They also have been studied as chemotherapy-sensitizing agents in an effort to recruit dormant myeloid stem cells into the sensitive phase of the cycle. Additionally, growth factors, shown to stimulate proliferation and differentiation of leukemia cells in vitro, were evaluated as monotherapy in patients with acute leukemia. Most studies show modest improvement in the duration of the neutropenia, which does not consistently correlate with the severity of infection, rate or duration of remissions, or disease-free and overall survival. Attempts to enhance the chemosensitivity of the leukemic cells and decrease drug resistance failed to improve the rate of remission and survival in several large series. However, more recent reports suggested an improved outcome in younger patients with acute myeloid leukemia with normal karyotype. Several anecdotal case reports have shown that growth factor monotherapy can induce a complete remission in patients with acute leukemia. Data from the published clinical trials do not seem to support emergence of drug-resistant leukemia, worsening toxicity, and bone marrow failure with growth factor administration.
Phyllodes Tumors of the Breast: Natural History, Diagnosis, and Treatment
Authors: Telli Melinda L. , Horst Kathleen C. , Guardino Alice E. , Dirbas Frederick M. , Carlson Robert W.
Published: April 2017

Phyllodes tumors of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior. These tumors are categorized as benign, borderline, or malignant based on a combination of histologic features. The prognosis of phyllodes tumors is favorable, with local recurrence occurring in approximately 15% of patients overall and distant recurrence in approximately 5% to 10% overall. Wide excision with a greater than 1 cm margin is definitive primary therapy. Adjuvant systemic therapy is of no proven value. Patients with locally recurrent disease should undergo wide excision of the recurrence with or without subsequent radiotherapy.
Evidence and Controversies in the Use of Post-Mastectomy Radiation
Authors: Fernando Shaneli A. , Edge Stephen B.
Published: April 2017

Radiation after mastectomy is recommended for women with positive nodes, larger tumors, or positive margins. In addition to its role in reducing the risk for locoregional recurrence, it has an additive effect to the survival benefit seen with adjuvant systemic therapy. This article reviews the role of post-mastectomy radiation (PMRT) based on the recommendations in the 2007 NCCN Breast Cancer Clinical Practice Guidelines in Oncology and addresses the risk factors for recurrence after mastectomy. The data supporting both improvement in locoregional failure and survival are reviewed in detail. This article also discusses controversial areas in PMRT, including regional nodal radiation in women with 1 to 3 positive lymph nodes, PMRT in node-negative women with large tumors, and inclusion of internal mammary nodes. The final section discusses radiation field design and potential complications.
Point: Hyperthermia with Radiation for Chest Wall Recurrences
Authors: Jones Ellen L. , Marks Lawrence B. , Prosnitz Leonard R.
Published: April 2017

Treatment of a locoregional recurrence of breast cancer after mastectomy remains a clinically challenging problem. Often these patients have undergone prior radiotherapy and chemotherapy. Therapeutic options usually include resection or additional radiation; however, the long-term control rates are often suboptimal with these approaches. Data from several randomized trials suggest that the addition of hyperthermia to radiation can increase the response rate for such local recurrences. Therefore, in settings where the available therapies are unlikely to yield local control (e.g., local/regional recurrence after prior radiation), a reasonable option to consider is radiation with hyperthermia as a radiation sensitizer. This article reviews the rationale and supporting literature for this recommendation.
Guidelines for Improving Breast Health Care in Limited Resource Countries: The Breast Health Global Initiative
Authors: Anderson Benjamin O. , Carlson Robert W.
Published: April 2017

Breast cancer is an increasingly urgent problem in low- and mid-level resource regions of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care when diagnostic or treatment resources are lacking. For this reason, it is important to identify which resources most effectively fill health care needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made to maximize improvement in outcome. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for countries with limited resources to improve breast health outcomes. The BHGI serves as a program for international guideline development and as a hub for linkage among clinicians, governmental health agencies, and advocacy groups to translate guidelines into policy and practice. The BHGI collaborated with 12 national and international health organizations, cancer societies, and nongovernmental organizations to host 2 BHGI international summits. The evidence-based BHGI guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast health care. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in health care delivery, based on outcomes, cost, cost-effectiveness, and use of health care services.
Soft Tissue Sarcoma Guidelines
Authors: _ _
Published: April 2017

Soft tissue sarcomas are the most frequent sarcomas; the annual incidence for 2007 in the United States is estimated at about 9220 cases, with an overall mortality rate of approximately 3560 cases per year. Important updates for the 2007 version of the guidelines include the addition of epirubicin (single agent) and the combination of epirubicin, ifosfamide, and mesna as generally accepted systemic therapy. Imatinib was added as an option for desmoid tumors.

For the most recent version of the guidelines, please visit NCCN.org
Imaging of Bone Sarcomas
Authors: Cummings Judd E. , Ellzey J. Andrew , Heck Robert K.
Published: April 2017

Identification, staging, and treatment of bone sarcomas rely on both clinical and imaging evaluations. Although conventional radiography remains the primary imaging modality for characterizing bone tumors, bone scintigraphy, computed tomography, magnetic resonance imaging, and positron emission tomography can each add information for staging and treatment planning.
Chronic Myelogenous Leukemia Guidelines
Authors: _ _
Published: April 2017

Chronic myelogenous leukemia (CML) accounts for 15% of adult leukemias. In 2007, an estimated 4500 cases will be diagnosed and 900 patients will die of the disease. The goal of CML therapy is complete remission, which typically progresses from hematologic to cytogenetic remission. These updated 2007 guidelines include changes to several treatment recommendations, including considerations for imatinib dosing, the use of interferon, and management of dasatinib toxicity. Recommendations for hematopoetic stem cell transplantation have also been updated.

For the most recent version of the guidelines, please visit NCCN.org
Basal Cell and Squamous Cell Skin Cancers Guidelines
Authors: _ _
Published: April 2017

Basal cell and squamous cell skin cancers, collectively known as non-melanoma skin cancers (NMSCS), are the most common skin cancers. More than 1 million cases of NMSC are estimated to be diagnosed each year in the United States and their incidence is rising rapidly. Although rarely metastatic, basal cell and squamous cell cancers can produce substantial local destruction and disfigurement and may involve extensive areas of soft tissue, cartilage, and bone. Updates in the 2007 guidelines include changes to the principles of treatment for both basal cell and squamous cell skin cancers and changes in the consideration of radiotherapy.

For the most recent version of the guidelines, please visit NCCN.org
Photodynamic Therapy for Non-Melanoma Skin Cancer
Authors: Fien Sari M. , Oseroff Allan R.
Published: April 2017

Photodynamic therapy (PDT) involves the administration of a photosensitizing drug and its subsequent activation by light at wave-lengths matching the absorption spectrum of the photosensitizer. Because the skin is readily accessible to light-based therapies, PDT with systemic and particularly with topical agents has become important in treating cutaneous disorders. Topical PDT is indicated for treating actinic keratosis, superficial or thin non-melanoma skin cancer, including some cases of nodular basal cell carcinoma, and some cutaneous lymphomas. Advantages of aminolevulinic acid/methyl aminolevulinate PDT include the possibility of simultaneous treatment of multiple tumors and large surface areas, good cosmesis, and minimal morbidity, such as bleeding, scarring, or infection.
Dermatofibrosarcoma Protuberans Guidelines
Authors: _ _
Published: April 2017

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, low-grade sarcoma of fibroblast origin with an incidence rate of 0.8 cases per million persons each year. Although it rarely metastasizes, initial misdiagnosis, prolonged time to accurate diagnosis, and large tumor size at diagnosis are common. These updated 2007 guidelines include changes in recommendations for considering radiation therapy, as well as those regarding surgical margins in some patients.

For the most recent version of the guidelines, please visit NCCN.org
Investigational Therapies for Metastatic Thyroid Carcinoma
Authors: Tuttle R. Michael , Leboeuf R.
Published: April 2017

Although traditional chemotherapy has yielded disappointing results in the therapy of progressive metastatic thyroid cancer, the recent development of a wide range of novel therapies targeting critical steps in the pathogenesis of thyroid cancer has led to a renewed interest in thyroid cancer clinical trials. This review provides an overview of the pathogenesis of thyroid cancer with particular emphasis on specific molecular targets that can be modulated with these novel agents. The article reviews the results for the small number of thyroid cancer patients included in published therapeutic trials and critically examines patient selection criteria for inclusion in clinical trials. Given the dramatic increase in availability of thyroid cancer clinical trials, all patients with radioactive iodine-refractory, progressive metastatic thyroid cancer should be considered for inclusion in a novel therapy trial.
Prostate Cancer
Authors: _ _
Published: April 2017

To properly identify and treat patients with prostate cancer, physicians must have an in-depth understanding of the natural history and diagnostic, staging, and treatment options. Prostate cancer is a complex disease, with many controversial aspects of management and a dearth of sound data to support recommendations. Several variables must be considered in tailoring prostate cancer therapy to each individual patient. These guidelines provide a framework on which to base treatment decisions. Important changes to the guidelines since last publication include the introduction of Principles of Life Expectancy Estimation table and changes in recommendations for both hormone and chemotherapy.

For the most recent version of the guidelines, please visit NCCN.org
Point: Open Radical Prostatectomy Should Not Be Abandoned
Authors: Ellis William J. , Lange Paul H.
Published: April 2017

Robotic-assisted laparoscopic radical prostatectomy is now one of the most common ways to treat prostate cancer. Although it is undoubtedly an outstanding procedure, in many contexts the advantages of the laparoscopic approach are overstated. The authors believe that open radical prostatectomy will continue to have an important role. For example, an extensive lymphadenectomy is more easily accomplished with the open technique and may be important in staging and possibly curing patients at high risk for prostate cancer. Also, tactile sensation is a valuable asset in assessing the extent of local tumor, and this cannot yet be replicated with a robotic approach. Furthermore, obese patients, those with a history of extensive prior surgical procedures, and men with extremely large prostates may experience advantages with the open technique. Finally, the open approach has a significant advantage in terms of hospital costs.
Point: TheValue of Predicting Life Expectancy in Men with Clinically Localized Prostate Cancer
Authors: Clayton Douglass B. , Urban Donald A.
Published: April 2017

The prediction of life expectancy in prostate cancer screening and treatment is a controversial topic that evokes various opinions regarding its validity. The authors believe incorporating life expectancy prediction into the treatment algorithms for prostate cancer is important. Using a combination of clinical judgment and specific predictive tools, physicians can estimate the life expectancy of patients with prostate cancer. These estimates can then be used to help guide treatment discussion. Estimating life expectancy benefits older men in whom decisions regarding the best form of treatment may be difficult.
Update on PSA Testing
Authors: Gonzalgo Mark L. , Carter H. Ballentine
Published: April 2017

The use of prostate-specific antigen (PSA) testing for prostate cancer screening has increased dramatically over the past decade. Determining the most efficient way to use PSA testing and how to interpret total PSA levels and changes in PSA values over time remain challenging. Guidelines for early detection of prostate cancer have a direct impact on the number of unnecessary tests performed and are critical for developing a successful screening approach for prostate cancer. The age at which PSA screening should begin, PSA testing intervals, and the importance of understanding fluctuations in PSA values over time are discussed in the framework of recent discoveries in the field. Results from ongoing randomized trials will confirm whether prostate cancer screening is an effective method for reducing deaths from prostate cancer and what approaches will provide the most cost-effective screening strategies.
Barriers to Clinical Trial Participation as Perceived by Oncologists and Patients
Authors: Meropol Neal J. , Buzaglo Joanne S. , Millard Jennifer , Damjanov Nevena , Miller Suzanne M. , Ridgway Caroline , Ross Eric A. , Sprandio John D. , Watts Perry
Published: April 2017

Although clinical trial research is required for the development of improved treatment strategies, very few cancer patients participate in these studies. The purpose of this study was to describe psychosocial barriers to clinical trial participation among oncologists and their cancer patients. A survey was distributed to all medical oncologists in Pennsylvania and a subset of their patients. Relevant background information and assessment of practical and psychosocial barriers to clinical trial participation were assessed. Among 137 oncologists and 170 patients who completed the surveys, 84% of patients were aware of clinical trials, and oncologists and patients generally agreed that clinical trials are important to improving cancer treatment. However, oncologists and patients were more likely to consider clinical trials in advanced or refractory disease. When considering 7 potential barriers to clinical trials, random assignment and fear of receiving a placebo were ranked highly by both patients and oncologists. Patients identified fear of side effects as the greatest barrier to clinical trial participation, whereas oncologists ranked this psychosocial barrier as least important to their patients. Overall, the study found that although oncologists and patients are aware of clinical trials and have favorable attitudes toward them, psychosocial barriers exist for patients that may impact participation in clinical trials. Furthermore, important discrepancies exist between the perceptions of oncologists and those of patients regarding what the psychosocial barriers are. We concluded that characterizing oncologist and patient perceived barriers can help improve communication and decision making about clinical trials, such that participation may be optimized.
Counterpoint: The Argument for Combination Chemotherapy in the Treatment of Metastatic Breast Cancer
Authors: Cianfrocca Mary , Gradishar William J.
Published: April 2017

The question of combination versus single-agent chemotherapy in the setting of metastatic breast cancer (MBC) is an often-debated issue. Many single agents have activity in this setting and the potential for significant synergism between chemotherapy agents has led to many combination chemotherapy trials. This article defends the position that combination chemotherapy is the optimal approach for patients with MBC.
Breast Risk Reduction
Authors: _ _
Published: April 2017

Breast cancer is the most commonly diagnosed cancer in American women, with an estimated 214,640 cases and 41,430 deaths occurring in 2006. Estimating breast cancer risk for individual women is difficult, and most breast cancers are not attributable to risk factors other than female gender and increased age. Developing effective strategies for reducing breast cancer incidence is also difficult because few existing risk factors are modifiable and some potentially modifiable risk factors have social implications. Nevertheless, effective breast cancer risk reduction agents and strategies, such as tamoxifen, raloxifene, and risk reduction surgery, have been identified. These guidelines were developed to help women at increased risk for breast cancer and their physicians apply individualized strategies to reduce breast cancer risk.

For the most recent version of the guidelines, please visit NCCN.org
Colon Cancer
Authors: _ _
Published: April 2017

Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States. An estimated 112,340 new cases of colon cancer will occur in 2007 and an estimated 52,180 people will die from colon and rectal cancer in the same year. Despite these statistics, mortality from colon cancer has decreased over the past 30 years, possibly because of earlier diagnosis through screening and better treatment modalities. These guidelines begin with the clinical presentation of the patient to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, adjuvant treatment, management of recurrent and metastatic disease, and patient surveillance.

For the most recent version of the guidelines, please visit NCCN.org
Pathologic Issues in the Treatment of Endoscopically Removed Malignant Colorectal Polyps
Authors: Cooper Harry S.
Published: April 2017

Endoscopically removed malignant colorectal polyps are early stage cancers for which treatment depends on histopathologic findings. For accurate pathologic evaluation, the polyps should be received in 1 piece because margins cannot be accurately assessed in fragmented polyps. Polyps with grade I or II cancer, no lymphovascular invasion, and a negative resection margin can be successfully treated with endoscopic polypectomy, whereas those with grade III cancer, lymphovascular invasion, or a positive or close margin require definitive surgical resection after endoscopic polypectomy. Potentially new significant parameters for patient management are depth of invasion and tumor budding. The pathology report must be clear and concise, indicating all relevant important parameters. The pathologist must differentiate invasive adenocarcinoma from intramucosal adenocarcinoma and pseudo-invasion.
Pancreatic Adenocarcinoma
Authors: _ _
Published: April 2017

An estimated 33,370 people will die of pancreatic cancer in the United States in 2007, making it the fourth most common cause of cancer-related death among men in the United States. Although incidence is roughly equal among men and women, African Americans appear to have a higher incidence of pancreatic cancer than white Americans. The NCCN Pancreatic Adenocarcinoma Guidelines discuss risk factors, diagnosis and staging, and treatment through palliative care or surveillance for patients with tumors of the exocrine pancreas. Overall, in view of the poor outcome of patients with all stages of pancreatic cancer, the NCCN panel recommends that investigational options be considered in all phases of disease management. Specific palliative measures are recommended for patients with advanced pancreatic adenocarcinoma characterized by biliary or gastric obstruction, severe abdominal pain, or other tumor-associated manifestations of the disease.

For the most recent version of the guidelines, please visit NCCN.org
Implementing the Fatigue Guidelines at One NCCN Member Institution: Process and Outcomes
Authors: Borneman Tami , Piper Barbara F. , Sun Virginia Chih-Yi , Koczywas Marianna , Uman Gwen , Ferrell Betty
Published: April 2017

Fatigue, despite being the most common and distressing symptom in cancer, is often unrelieved because of numerous patient, provider, and system barriers. The overall purpose of this 5-year prospective clinical trial is to translate the NCCN Cancer-Related Fatigue Clinical Practice Guidelines in Oncology and NCCN Adult Cancer Pain Clinical Practice Guidelines in Oncology into practice and develop a translational interventional model that can be replicated across settings. This article focuses on one NCCN member institution's experience related to the first phase of the NCCN Cancer-Related Fatigue Guidelines implementation, describing usual care compared with evidence-based guidelines. Phase 1 of this 3-phased clinical trial compared the usual care of fatigue with that administered according to the NCCN guidelines. Eligibility criteria included age 18 years or older; English-speaking; diagnosed with breast, lung, colon, or prostate cancer; and fatigue and/or pain ratings of 4 or more on a 0 to 10 screening scale. Research nurses screened all available subjects in a cancer center medical oncology clinic to identify those meeting these criteria. Instruments included the Piper Fatigue Scale, a Fatigue Barriers Scale, a Fatigue Knowledge Scale, and a Fatigue Chart Audit Tool. Descriptive and inferential statistics were used in data analysis. At baseline, 45 patients had fatigue only (≥ 4) and 24 had both fatigue and pain (≥ 4). This combined sample (N = 69) was predominantly Caucasian (65%), female (63%), an average of 60 years old, diagnosed with stage 3 or 4 breast cancer, and undergoing treatment (82%). The most common barriers noted were patients' belief that physicians would introduce the subject of fatigue if it was important (patient barrier); lack of fatigue documentation (professional barrier); and lack of supportive care referrals (system barrier). Findings showed several patient, professional, and system barriers that distinguish usual care from that recommended by the NCCN Cancer-Related Fatigue Guidelines. Phase 2, the intervention model, is designed to decrease these barriers and improve patient outcomes over time, and is in progress.
Modifying Cancer-Related Fatigue by Optimizing Sleep Quality
Authors: Berger Ann Malone , Mitchell Sandra A.
Published: April 2017

Cancer-related fatigue is reported by patients to be the most distressing and persistent symptom experienced during and after treatment. Unrelieved fatigue often accompanies other symptoms and leads to decreased physical functioning and lower health-related quality of life. Various factors, including daytime sleepiness and sleep disturbances, have been reported to influence perceptions of fatigue. This article shares current knowledge about the relationships among cancer-related fatigue, sleep disturbances, and daytime sleepiness, and makes recommendations for routine screening, assessment, and interventions to modify fatigue through optimizing sleep quality in adult cancer patients. Evidence is reviewed for nonpharmacologic and pharmacologic interventions for optimizing sleep quality in patients with acute or chronic insomnia secondary to medical illnesses, including cancer. A summary of interventions is presented that focuses on optimizing sleep quality in attempt to lower fatigue. These interventions may be helpful for adult cancer patients experiencing insomnia but will require further testing to establish their efficacy in this population. Recommendations for research are provided, including the need to increase knowledge on the relationships among fatigue, sleep disturbances, daytime sleepiness, and other symptoms in various disease sites, stages, and treatments of cancer and the need for further testing of the measurements used for the evaluation of sleep quality in clinical practice and research.
Prevention and Treatment of Cancer-Related Infections
Authors: _ _
Published: April 2017

Infectious diseases are important causes of morbidity and mortality in patients with cancer. In certain instances, the malignancy itself can predispose patients to severe or recurrent infections. Neutropenia has been recognized for many decades as a major risk factor, and effective strategies to anticipate, prevent, and manage infectious complications in patients with cancer experiencing neutropenia have led to improved outcomes. Reflecting the heterogeneity of immunocompromised conditions in patients with cancer and the spectrum of pathogens to which they are susceptible, NCCN expanded the scope of the Fever and Neutropenia Panel in 2007 to create guidelines on Prevention and Treatment of Cancer-Related Infections. These guidelines, newly updated for 2008, characterize major categories of immunologic deficits in persons with cancer and the major pathogens to which they are susceptible.

For the most recent version of the guidelines, please visit NCCN.org
Broad-Spectrum Antifungal Prophylaxis in Patients With Cancer at High Risk for Invasive Mold Infections: Counterpoint
Authors: Maertens Johan , Buvé Kristel , Anaissie Elias
Published: April 2017

Management of invasive mold infections in patients with prolonged neutropenia and hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) has been hampered by the difficulty in diagnosing these infections. Definite diagnosis invariably centers on histologic identification of hyphae in tissue or on culture from a sterile body site. Therefore, most practitioners have relied on prophylaxis and empiric therapy. Currently, emphasis is shifting from routine prophylaxis and empiric therapy to screening of patients with neutropenia at high risk so that clinicians can administer appropriate antifungal therapy early, when it can potentially improve patient outcome. Non–culture-based microbiologic tools are at the forefront of this paradigm shift. Commercially available methods to detect fungal antigens and sophisticated techniques to detect fungal DNA may be used as screening tools during the highest risk period. Together with assessment of clinical signs, cultures, and especially CT scanning, these methods are useful for starting antifungal therapy preemptively. While awaiting further evaluation of these tools during the postengraftment period of allogeneic HSCT, mold-active prophylaxis targeting the subgroup of patients with severe acute or chronic GVHD may be justified. However, some critical issues have not yet been adequately addressed, including the generalizability of study results, impact of mucositis and gastrointestinal GVHD on drug bioavailability, need for therapeutic drug monitoring, impact of prophylaxis on the performance of diagnostic assays, and optimal treatment of breakthrough invasive fungal infections.
Influenza: Preparedness for an Inevitable “Emergency” for Oncology and BMT Units
Authors: Wingard John R.
Published: April 2017

Influenza is a seasonal and pandemic threat to the general population. The effects can be devastating for cancer patients and those who have undergone blood and marrow transplantation (BMT). However, this impact can be minimized. Emergency preparedness is the key to mitigating the impact on the oncology and BMT services. Having a plan that provides a framework of preparedness and outlines steps to take in the event of a community outbreak is crucial. A vigorous immunization campaign for patients, household contacts, and health care staff early in the season is the single most important action. In the midst of an outbreak, the oncology and BMT teams should act to quickly identify patients with suspected infections, move infected patients and staff away from noninfected patients to prevent contact, and decide which patients require prevention or treatment with antiviral agents. Ongoing engagement by the entire team to evaluate the effectiveness of its actions and modify its plan as necessary will ensure success.
Lung Cancer Screening
Authors: Bach Peter B.
Published: April 2017

Because lung cancer frequently presents in an advanced stage when it is incurable, there has been a sustained search for an early diagnosis approach that could detect lung cancer when curable, while having few secondary consequences. Decades of research have evaluated various approaches to lung screening, including routine chest radiograph, sputum cytology, and, most recently, computed tomography (CT) scanning. No study has suggested that any of these approaches will identify life-threatening lung cancers at an earlier disease stage and allow alteration of their natural history. Therefore, no recommending body or professional society recommends using any of these approaches to screen for lung cancer. This general recommendation could change if randomized trials examining CT screening suggest that its benefits outweigh its harms.
Adjuvant Chemotherapy for Lung Cancer: Cisplatin Doublets Only?
Authors: Morgensztern Daniel , Govindan Ramaswamy
Published: April 2017

Lung cancer is the leading cause of cancer-related mortality world-wide. Despite adequate resection, more than half of patients die of recurrent disease, usually at distant sites. Adjuvant systemic chemotherapy is mainly used to eradicate micrometastatic disease. Since the seminal 1995 meta-analysis from earlier studies showed a trend toward improved survival with the use of cisplatin-based adjuvant chemotherapy, several randomized prospective adjuvant trials have addressed this question and eventually established the role for platinum-based adjuvant chemotherapy in patients with stage II or IIIA non–small cell lung cancer who have undergone complete resection. The role of adjuvant chemotherapy in patients with stage I disease remains controversial. Although no clinical or molecular predictors of recurrent disease after surgical resection are reliable, encouraging preliminary data on gene expression studies suggest that identifying, and perhaps treating, only patients at high risk for relapse might be possible in the near future. Furthermore, molecular predictors of resistance may guide the selection of chemotherapy in this setting.
Neoadjuvant Chemotherapy in Stage III NSCLC
Authors: Allen Jeffrey , Jahanzeb Mohammad
Published: April 2017

Non-small cell lung cancer (NSCLC) continues to be the leading cause of cancer-related mortality in the United States. Current standard care for treating NSCLC is surgical resection, when feasible, followed by adjuvant chemotherapy in stages II and III. Neoadjuvant or induction chemotherapy may have several potential advantages compared with adjuvant chemotherapy and has been evaluated in randomized and nonrandomized clinical trials in NSCLC. This article reviews the data for neoadjuvant chemotherapy in NSCLC with a particular focus on regionally advanced disease (stage III) that is still amenable to surgical resection.
Novel Systemic Therapies for Small Cell Lung Cancer
Authors: Rudin Charles M. , Hann Christine L. , Peacock Craig D. , Watkins D. Neil
Published: April 2017

A diagnosis of small cell lung cancer (SCLC) today confers essentially the same terrible prognosis that it did 25 years ago, when common use of cisplatin-based chemotherapy began for this disease. In contrast to past decades of research on many other solid tumors, studies of combination chemotherapy using later generation cytotoxics and targeted kinase inhibitors have not had a significant impact on standard care for SCLC. The past few years have seen suggestions of incrementally improved outcomes using standard cytotoxics, including cisplatin-based combination studies of irinotecan and amrubicin by Japanese research consortia. Confirmatory phase III studies of these agents are ongoing in the United States. Antiangiogenic strategies are also of primary interest and are in late-phase testing. Several novel therapeutics, including high-potency small molecule inhibitors of Bcl-2 and the Hedgehog signaling pathway, and a recently discovered replication-competent picornavirus, have shown remarkable activity against SCLC in preclinical models and are currently in simultaneous phase I clinical development. Novel therapeutic approaches based on advances in understanding of the biology of SCLC have the potential to radically change the outlook for patients with this disease.
Cancer- and Chemotherapy-Induced Anemia
Authors: _ _
Published: April 2017

Anemia is a common condition in patients with cancer, and its correction through either transfusion with packed red blood cells or the administration of erythropoiesis-stimulating agents (ESAs) is a supportive care measure. The purpose of the guidelines is to operationalize the evaluation and treatment of anemia in cancer patients and to enable patients and clinicians to evaluate treatment options in the context of risks and benefits. The updated guidelines include a number of important changes that respond to new FDA recommendations limiting the use of ESAs in cancer patients. Updates also include new tables on the risks and benefits of ESAs versus red blood cell transfusion and recommendations for administering parenteral iron products.

For the most recent version of the guidelines, please visit NCCN.org
Establishing an Anemia Clinic for Optimal Erythropoietic-Stimulating Agent Use in Hematology-Oncology Patients
Authors: Gilreath Jeffrey A. , Sageser Daniel S. , Jorgenson James A. , Rodgers George M.
Published: April 2017

Erythropoietic-stimulating agent (ESA) therapy has significantly impacted the management of chemotherapy-induced anemia (CIA) by decreasing the number of red blood cell transfusions required by patients with cancer. However, managing these patients with ESA therapy has become increasingly difficult since the release of the Centers for Medicare & Medicaid Services' new National Coverage Determination document because of the disparities between this document and recommendations from expert-reviewed national clinical guidelines on the treatment of anemia. This article describes a collaborative practice agreement between pharmacists and physicians as one approach to managing CIA in hematology-oncology patients in an anemia clinic. The goal of the pharmacist-managed anemia clinic is to improve patient satisfaction and clinical outcomes associated with the treatment of CIA. This article describes the rationale for the clinic and discusses its design and implementation in managing ESA, iron, folate, and vitamin B12 therapy for CIA in hematology-oncology patients. The pharmacist's role is justified in this clinic model through increased adherence to evidence-based practice guidelines and decreased costs associated with ESA therapy.