bluuebunny/crossref_metadata_2025 huggingface dataset:
A Diagnostic Appraisal of Sorghum Farming in Striga Endemic Areas of Eritrea
Authors: Yohannes Tadesse , Ngugi Kahiu , Ariga Emmanuel , Ahonsi Monday , Yao Nasser , Abraha Tesfamichael
Published: April 2017

Sorghum (Sorghum bicolour (L.) Moench), the most important cereal crop in Eritrea, is grown in more than 210,000 ha annually but its productivity is hampered by many factors including: farmer perception, lack of appropriate varieties, undeveloped seed systems, drought stress and Striga infestation. This study was aimed at understanding the sorghum smallholder livelihoods, farming systems, Striga incidence and infestation levels, and types of varieties grown in Striga infested sorghum growing areas. A semi structured questionnaire and focused group discussions were used to gather information from a total of 136 randomly selected farmers from three Striga endemic sub-regions of Eritrea namely, Hamelmalo, Goluj, and Tesseney. The results indicated that the most important cereal crops in the study area were sorghum, pear millet, ground nut and sesame. The most important constraint to sorghum production was identified as drought stress followed by Striga infestation. The majority of the respondents (81.6%) reported that their sorghum was affected by Striga and the level of infestation varied from mild (10%) to severe (70% and above). Small-holder farmers also indicated that high grain yield, drought tolerance/resistance and Striga resistance were their most important criteria when selecting sorghum varieties. Up to 31 different landraces were listed as the most popular in the study area. The dominant source of seed for cultivation was the local varieties retained by farmers from previous harvests. The information documented from this study may be used in future as a basis for a participatory farmer-oriented sorghum breeding program.
Impact of Management on the Physical Attributes of a Dystrophic Yellow Latosol
Authors: Farias Maryzélia Furtado de , Feitosa Carlos Eduardo Linhares , Rodrigues Khalil De Menezes , Teixeira Liliane Carvalho , Furtado Mariléia Barros , Parra-Serrano Luisa Julieth
Published: April 2017

Soil use and management systems aim to create conditions that are favorable to crop growth. The hypothesis is that areas subject to intensive use of agricultural machinery and animal trampling tend to have a soil structure that is altered by aggregate fragmentation, which causes soil compaction and consequently decreases the soil’s physical and hydraulic properties. The aim of this study was to assess and compare the physical and hydraulic parameters of a dystrophic yellow latosol in an area of Cerrado in the municipality of Chapadinha, Maranhão, Brazil under different use and management systems. The following five use and management systems were studied with five replicates: native forest (control), slash-and-burn agriculture, grassland, no-till crop production and conventional tillage. Data analysis was performed using a completely randomized experimental design. The soil’s density, macroporosity, microporosity, total porosity, hydraulic conductivity, infiltration, water retention curve, penetration resistance and Soil quality assessment index (S index) were assessed for all management systems. The soil use and management systems were found to have a significant effect on the penetration resistance and the water infiltration rate. The native forest and slash-and-burn agriculture areas provided the highest soil water infiltration rates and the lowest soil penetration resistance. A multivariate analysis identified the variables associated with each soil use and management system. The slash-and-burn agriculture area had the highest S index, which means it provided soil of the best physical quality.
Relationships between the Physical Education Course Sportsmanship Behaviors with Tendency to Violence and Empathetic Ability (Note 1)
Authors: Koc Yakup
Published: April 2017

The aim of this study is to examine relationship between the physical education course sportsmanship behaviors, tendency to violence, and empathetic ability for elementary school students. The sample of study consists of randomly selected 919 elementary school students attending state schools in the province of Erzincan in 2013-2014 academic year. “Physical Education Course Sportspersonship Behavior Scale” (PECSBS), “Scale of tendency to violence” and “the scale of Empathetic ability for children” were used in the study. Reliability and validity tests of the scales were done. The scores the students obtained in the scales were reexamined in accordance with independent variables such as their grade level, gender and the type of sports they are interested in most. And relationship between the values of scales was tested. For the assessment of the data, SPSS 15 and LISREL 8.7 programs were employed. In conclusion, physical education course sportsmanship behaviors display a significantly negative relation with tendency to violence and a significantly positive relation with empathetic ability for elementary school students. It is concluded that these relations should be paid attention, measures should be taken and programs should be in place to reduce the tendency to violence and grow empathetic ability in physical education course programs.
On the Effectiveness of Feed-in Tariffs in the Development of Solar Photovoltaics
Authors: Dijkgraaf Elbert , van Dorp Tom P. , Maasland Emiel
Published: April 2017

Growing concern about climate change and rising prices of fossil fuels has prompted governments to stimulate the development of renewables. The most common instrument is a feed-in tariff (FIT). This paper empirically tests whether or not FIT policies have been effective in encouraging the development of photovoltaic solar (PV), explicitly taking into account the structure and consistency of FITs. Panel data estimations are employed for 30 OECD member countries in the period 1990-2011. We find a positive effect of the presence of a FIT on the development of a country's added yearly capacity of PV per capita. This is in line with the results found in the existing literature. However, our study shows that the literature underestimates the potential impact of FITs, as the effect of a well-designed FIT is much larger than the average effect of the currently applied FITs. Not only the height of the tariff is important, but also the duration of the contract and the absence/presence of a cap have an impact. We also show that consistency greatly affects the effectiveness of FITs. Consistency is especially important when the tariff of a FIT is low. The total effect of a FIT can be seven times larger if it is well designed. Our results are robust for differences between countries with respect to the availability of other policy instruments, the use of nuclear or hydro power and the level of CO2 emissions.
Validation of the Smooth Test of Goodness-of-Fit for Proportional Hazards in Cancer Survival Studies
Authors: Odhiambo Collins , Odhiambo John , Omolo Bernard
Published: April 2017

In this study, we validate the smooth test of goodness-of-fit for the proportionality of the hazard function in the two-sample problem in cancer survival studies. The smooth test considered here is an extension of Neyman’s smooth test for proportional hazard functions. Simulations are conducted to compare the performance of the smooth test, the data-driven smooth test, the Kolmogorov-Smirnov proportional hazards test and the global test, in terms of power. Eight real cancer datasets from different settings are assessed for the proportional hazard assumption in the Cox proportional hazard models, for validation. The smooth test performed best and is independent of the number of covariates in the Cox proportional hazard models.
Improving the Efficiency of Outpatient Services at Benue State University Teaching Hospital using the Queuing Theory
Authors: Bako Ishaku Ara , Utoo Priscilla M. , Ikughur Jonathan
Published: April 2017

Introduction: Long client waiting time is a characteristic of poor performance of the health care delivery and is a major challenge for healthcare services all over the world, especially in developing countries. The study was aimed at developing a model that optimizes performance of the general outpatient department of the Benue State University Teaching Hospital, Makurdi, Benue State Nigeria.
Methodology: Data was collected through observation and interviews with doctors at the general outpatient clinic of the Benue State University Teaching Hospital. The average number of clients seen per day was calculated by determining the average of daily attendants for five consecutive working days. The data obtained was used to create a five capacity scenarios using the queuing theory software.
Result: The Average Daily Attendance (ADA) was 73.2 clients while the Average Daily Arrival Rate was 10.47 clients per hour. There were six doctors working on any given day in the clinic and a doctor spends an average of 16.2 minutes per patient, representing an average of 3.7 patients per hour. The model showed that the optimum system performance can be achieved with four doctors (with 70.7% server utilization rate, average of 1.065 clients on the queue and 0.102 hours waiting time).
Conclusion: Four doctors working at the same time at the general outpatient clinic is required for optimal performance. The queuing theory should be used regularly at GOPD BSUTH and in all health facilities experiencing long queues to optimize operational efficiency.
Predictors of High Blood Pressure in South African Children: Quantile Regression Approach
Authors: Matizirofa Lyness , Kuhudzai Anesu Gelfand
Published: April 2017

Objective: To identify predictors of blood pressure (BP) in children and explore the predictors` effects on the conditional quantile functions of systolic blood pressure and diastolic blood pressure.
Methods: A secondary data analysis was performed using data from the South African National Income Dynamics Study (2014-2015). From this particular secondary data, data for children aged between 10-17 years were extracted for analysis. The variables used in the study were systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), age, smoking, alcohol consumption, exercises, gender and race. Two parameter estimation methods were used, ordinary least squares (OLS) and quantile regression (QR).
Results: BMI had positive statistically significant estimated OLS and conditional quantile functions with both the BP measures except the 95th quantile for SBP. Age had also positive statistically significant estimated OLS and QR coefficients except for the 95th percentile, with both DBP and SBP respectively. Gender was found to be inversely related to both DBP and SBP except the 10th quantile for DBP. Race was partially significant to DBP. Smoking, alcohol consumption and exercises did not present any statistically significant relations with both DBP and SBP for all the estimated OLS and QR coefficients.
Conclusion: BMI, age, gender and partially race were found to be predictors of BP in South African children using both OLS and QR techniques. Exercises, smoking and alcohol consumption did not present any statistically significant relations with both DBP and SBP probably because few participants exercise regularly, smoke and drink alcohol to bring out a significant change in both BP measurements.
Academic Skills in High-Functioning and Low-Functioning Chinese Children with Autism
Authors: Layton Thomas , Hao Grace
Published: April 2017

Early academic skills among Chinese speaking children with ASD were compared to age matched peers who were typically developing and with intellectual disabilities. In general, children with ASD do perform less well on reading comprehension, writing, and math skills. The purpose of the current study was to gather preliminary data on the early academic skills of Chinese children with ASD. The findings indicated that HFA and LFA had less difficulty in acquiring beginning basic-academic skills, but had more difficulty in acquiring advanced academic skills compared to their peers. Yet, the two groups of Chinese students with HFA and LFA performed remarkably alike across the academic skills.
Oncology Drug Review Process
Authors: Farrell Ann T. , Pazdur Richard
Published: April 2017

The U.S. Food and Drug Administration facilitates the development of drugs intended to treat cancer and other serious or life-threatening diseases. This article describes the new drug application (NDA) process, endpoints used in oncologic trials, and recent initiatives to expedite the review of drugs used to treat serious and life-threatening diseases. The Food and Drug Administration can grant either regular or accelerated marketing approval for oncology drugs. Regular approval is based on endpoints demonstrating that the drug provides a clinical benefit, such as longer life, enhanced quality of life, or a favorable effect on an established surrogate for longer or better life, such as long-term complete responses. Accelerated approval is based on a surrogate endpoint that is less well established but is reasonably likely to predict a longer or better life and can be granted for drugs that are intended to treat a serious or life-threatening illness and that provide meaningful therapeutic benefit to patients over existing therapies. The Agency classifies an NDA as either a priority or a standard application. Drugs that receive priority review are agents that appear to represent significant improvements over existing therapies. A priority NDA is reviewed by the Agency within 6 months; a standard review is accomplished within 10 months. The Agency communicates with sponsors throughout the drug development process, suggesting appropriate trial designs and meaningful endpoints.
Decision-Making For Patients With Resectable Breast Cancer: Individualized Decisions For and By Patients and Their Physicians
Authors: Loprinzi Charles L. , Ravdin Peter M.
Published: April 2017

Decisions regarding the use of adjuvant cytotoxic and hormonal therapies for women with breast cancer ideally should be made jointly by the patient and oncologist. For patients to be adequately involved in this decision-making process, they must be provided with appropriate education regarding the potential benefits and risks of adjuvant therapies. The recommended steps for doing this are: 1) understand baseline prognosis with locoregional therapy (surgery, radiation, or both) alone for the individual patient at hand; 2) determine the estimated benefit afforded by adjuvant therapy options for the individual patient; 3) estimate the risk of side effects of adjuvant therapy options; 4) convey the above information to the individual patient; 5) facilitate the individual patient's decision regarding adjuvant systemic therapy; and 6) support the patient's decision. Two computer-based tools (Numeracy and Adjuvant!) are available to facilitate this process.
Point: Sentinel Lymph Node Biopsy Is Indicated for Patients With DCIS
Authors: Cody Hiram S. , Van Zee Kimberly J.
Published: April 2017

Sentinel lymph node (SLN) biopsy, a new standard of care for staging invasive breast cancer, remains controversial for ductal carcinoma in situ (DCIS). Although DCIS has a natural history in which long-term distant disease-free survival (DDFS) is 98% to 99% and axillary node metastases are historically rare, three recent DCIS series have found SLN metastases in a surprising 6% to 13% of patients. The strongest argument for SLN biopsy in DCIS is the diagnostic uncertainty and inherent sampling error of conventional pathologic techniques. Definitive surgery (excision or mastectomy) reveals invasive cancer in 10% to 21% of patients with a preoperative core needle or surgical biopsy diagnosis of DCIS, all of whom become conventional candidates for SLN biopsy. In the absence of proven invasion, most positive SLN in DCIS are micrometastases detected by hematoxylin and eosin– and immunohistochemical-stained serial sections. An increasing body of evidence suggests that these are prognostically significant, not artifactual. We propose that DCIS patients with positive SLN have occult invasive cancers, and that the same may have been true for the 1% to 2% of DCIS patients who go on to develop distant metastasis, either after an invasive local recurrence or as a first event. We further suggest that the diagnosis of DCIS encompasses two patient populations: 1) a majority (perhaps 90%) with true in situ disease (or prognostically insignificant invasion), negative SLNs, and an expected DDFS of 100%; and 2) a minority (perhaps 10%) with occult invasion, positive SLNs, and an expected DDFS of perhaps 90%. Pending the development of predictive models for preoperative identification of this SLN-positive minority of DCIS patients, SLN biopsy is indicated in any DCIS patient who may have an underlying invasive cancer, especially those who require mastectomy. In DCIS, SLN biopsy may ultimately prove to be a more sensitive screening test for occult invasion than examination of the breast itself.
An Overview of Mammography: Benefits and Limitations
Authors: Smith Robert A.
Published: April 2017

Although broad consensus exists that mammography is beneficial, there has been persistent and evolving debate over the extent of the benefit, as well as concerns about cost-effectiveness. Ongoing evaluation of the world's randomized clinical trials as well as new evaluations of population service screening (ie, organized, community-based screening) clearly show that mammography is beneficial and that the benefit of modern mammography among women who attend screening exceeds what has conventionally been estimated from the trials. Limitations of mammography include human and financial costs associated with missed cancers and false-positive results. However, it is important to distinguish those limitations of mammography that are inherent limitations of the technology from those that can be reduced through greater attention to quality assurance.
Seeking Drug Treatment for Oxycontin Abuse: A Chart Review of Consecutive Admissions to a Substance Abuse Treatment Facility in Kentucky
Authors: Hays Lon , Kirsh Kenneth L. , Passik Steven D.
Published: April 2017

The abuse of prescription opioids has been reported to be on the rise and has gained much public attention, especially given the recent media coverage devoted to the abuse of sustained-release oxycodone (OxyContin, Purdue Pharma LP, Stamford, CT). We tracked admissions to our substance abuse program to put OxyContin abuse into perspective as a presenting problem in the region. A total of 258 admissions to a psychiatric facility for opioid dependence over a 15 month period, for the treatment of prescription opioid abuse, were examined in this chart-review study. A total of 162 patients (62.8%) were admitted for problems related to OxyContin, and the remaining 96 (37.2%) were admitted for abusing other prescription opioids (not including OxyContin). Those abusing OxyContin were found to be younger, more often from a rural background, and more likely to be male compared with those abusing other prescription opioids. In addition, more than half met the criteria for an additional chemical dependency diagnosis and had an additional psychiatric diagnosis. Polysubstance abuse, including OxyContin abuse, was a significant presenting problem to our Addictive Disease Unit between October 2000 and December 2001. Although this chart-review study is not designed to be indicative of the epidemiology of OxyContin abuse, it offers some insight into the nature of this phenomenon in a particular region during the height of public attention paid to it. A follow-up prospective study to examine this phenomenon in multiple regions, further away chronologically from the increased media attention, is underway.
Assessment of Pain Caused by Invasive Procedures in Cancer Patients
Authors: Portnow Jana , Lim Christine , Grossman Stuart A.
Published: April 2017

Invasive procedures are commonly required in the diagnosis and management of cancer in adults. However, little is known regarding the prevalence and severity of procedure-related pain in this patient population. This prospective study was conducted to determine the frequency and types of invasive procedures performed in a large comprehensive cancer center, the intensity of pain associated with these procedures, the types of periprocedural analgesics administered, and how these patients would like their procedural pain to be managed in the future. During a 6-week period, 102 cancer patients were interviewed immediately after undergoing an invasive procedure. They were asked to rate the pain they experienced before, during, and after their procedure using a verbal descriptor scale (VDS) ranging from 0 to 10. They also were asked if they would want more, less, or the same amount of pain medication if they were to undergo the same procedure again. The most frequently performed procedures were bone marrow aspirates and biopsies (68%), lumbar punctures (14%), and placements of central venous catheters (10%). The average pain rating during these procedures was 4.2 (standard deviation [SD], 3.0). However, 26% of patients experienced severe pain (VDS score [threesuperoir]7) during the procedures. Twenty-four percent of patients surveyed received conscious sedation for their procedure. There was no statistical relationship between patients' pain ratings and their satisfaction with the pain control they received during the procedures. This study represents the largest descriptive study of procedural pain in adult cancer patients. As more than 50% of these patients experienced moderate to severe pain during procedures, further studies are needed to improve the control of procedure-related pain in patients with cancer.
The Selection of Hormonal Therapy in Prostate Cancer: Who, When, and for How Long?
Authors: Ryan Charles J. , Small Eric J.
Published: April 2017

Androgen deprivation is the foundation for the systemic therapy of advanced prostate cancer. Multiple trials have tested combined androgen blockade versus androgen deprivation alone in patients with advanced disease. These studies suggest a slight advantage to the combined approaches that contain flutamide and bicalutamide, but the lack of dramatic differences in outcome makes monotherapy reasonable, especially in patients with more indolent disease. Intermittent androgen deprivation is an alternative that may allow patients to reduce the total time on androgen suppression as well as possibly delay the onset of androgen independence. A number of secondary hormonal therapies, including deferred and secondary antiandrogens, ketoconazole, and estrogens have shown modest response proportions. Patients with less advanced disease such as a rising prostate-specific antigen have varied outcomes, and no standard approach exists. In this group, noncastrating forms of hormonal therapy are being evaluated. Patients undergoing definitive local therapy who have high-risk features may benefit from early, as opposed to deferred, androgen deprivation. This review examines the evidence for the current state of the art in hormonal therapy in patients with prostate cancer and focuses, in particular, on treatment composition and timing as well as the rationale for the use of hormonal therapy in early stage disease.
Prevention, Diagnosis, and Treatment of Invasive Fungal Infections in Patients with Cancer and Neutropenia
Authors: Cumbo Thomas A. , Segal Brahm H.
Published: April 2017

Invasive fungal infections are a major cause of morbidity and mortality in patients with prolonged neutropenia and in allogeneic hematopoietic stem cell transplant recipients. The degree and duration of neutropenia influence the risk of opportunistic fungal infections. Because Candida and Aspergillus species are the major causes of invasive fungal infections in neutropenic patients, the fungal section of the NCCN guidelines focus on these two pathogens. Effective prevention and therapy of invasive fungal pathogens is a priority in highly immunocompromised patients with cancer. Three strategies in preventing and treating patients at high risk for fungal infection will be considered: (1) prophylaxis; (2) empirical therapy; and (3) treatment for probable or proven fungal infection. In addition to more effective antifungal agents, growing interest has been noted in novel non-culture detection methods to facilitate early diagnosis of invasive fungal infections.
High Risk Human Papillomavirus Testing: Guidelines for Use in Screening, Triage, and Follow-up for the Prevention and Early Detection of Cervical Cancer
Authors: Moore Kathleen N. , Walker Joan L.
Published: April 2017

The changes in cervical cytology characterization agreed on by the Bethesda committee meeting in 2001 created a category of atypical findings that has caused some management confusion. By description, the characterization of cervical cytology as only atypical implies a less worrisome prognosis. However, more than 40% of high-grade (CIN II or III or cancer) will be discovered within this category. The development and Food and Drug Administration approval of the Hybrid Capture 2 (HC-2; Digene Corporation, Gaithersburg, MD) for detecting high-risk human papillomavirus (HR-HPV) subtypes and the subsequent level I evidence supporting use of this test in the triage of women with atypical cytology has revolutionized the management of this cytology. With this success has come numerous additional uses for HR-HPV testing in the treatment and follow-up of women with a variety of cytologic abnormalities. This article reviews the literature on uses of HR-HPV testing in this population, with reference to currently accepted guidelines.
Radical Cystectomy and Surgical Quality of Care
Authors: Hollenbeck Brent K. , Montie James E. , Wei John T.
Published: April 2017

Defining surgical quality is an imperative and substantial undertaking before its measurement and ultimate improvement. This article defines quality of care and a rationale for its measurement. In the context of radical cystectomy for bladder cancer, we describe a conceptual model for measuring quality of care. Finally, we provide a framework for future research by presenting an overview of recent work pertaining to cystectomy and quality of care.
The Integration of Chemotherapy and Surgery for Bladder Cancer
Authors: Galsky Matthew D. , Herr Harry W. , Bajorin Dean F.
Published: April 2017

Despite surgery with curative intent, approximately 50% of patients with muscle-invasive transitional cell carcinoma of the bladder will develop distant metastases and succumb to their disease. Attempts to improve outcomes have focused on refining surgical techniques and integrating perioperative chemotherapy. This review summarizes the available literature addressing the role of pelvic lymphadenectomy, neoadjuvant chemotherapy, and adjuvant chemotherapy in the management of patients with muscle-invasive transitional cell carcinoma of bladder.
Controversies in the Surgical Management of Renal Cancer
Authors: Porter Michael P. , Lange Paul H.
Published: April 2017

Renal tumors are a common cause of cancer, and renal cell carcinoma accounts for the vast majority of the renal tumors in the United States. The past two decades have produced numerous advances in the treatment of localized and metastatic renal cell carcinoma. Nephron-sparing surgery, laparoscopic nephrectomy, and energy-ablative techniques are now in the armamentarium of the urologist. The role of adrenalectomy and lymphadenectomy are better understood today than in decades past, and recent advances in the understanding of immunotherapy, cytoreductive nephrectomy, and metastatic disease have also improved treatment for this disease. As is often the case as technology and knowledge evolve, controversies regarding the surgical treatment of renal cancer exist. This article outlines some of these controversies and reviews the evidence surrounding each.
Role of New Chemotherapy Agents in Soft Tissue Sarcoma
Authors: von Mehren Margaret
Published: April 2017

Medical management of soft tissue sarcomas (STS) has been restricted by the limited availability of active drugs. A plethora of new oncologic agents are now available, many of which have specific therapeutic targets. Gemcitabine and docetaxel is a combination of drugs that have limited single-agent activity. Yondelis, a novel chemotherapeutic that binds DNA and functions partially by inhibiting transcription, is being tested alone and in combination with doxorubicin. Inhibitors of mTOR, a serine/threonine kinase that regulates cell cycle activation and cell growth, are also being tested. Growth factor receptor inhibitors are being evaluated in a variety of sarcomas that have been found to express the targets. In addition, a variety of agents are being assessed in gastrointestinal stromal tumors (GIST). Single agents and agents combined with imatinib are being tested in imatinib-refractory and in metastatic GIST. The increased use of targeted agents underscores the need for understanding sarcoma biology.
Local Excision for Rectal Cancer
Authors: Skibber John M.
Published: April 2017

Local excision can be a definitive surgical procedure for some early cancers of the rectum, and it is an appealing technique in many ways. It reduces overall surgical trauma and can assure sphincter preservation. It is also associated with low morbidity. However, this technique has a number of limitations also. This article discusses the results of local excision for rectal carcinoma, including histologic features that impact survival and local recurrence-free rates, the importance of careful patient selection, and the potential role of adjuvant and salvage therapies. Technical considerations and alternative therapies are also discussed.
Older Patients, Cognitive Impairment, and Cancer: An Increasingly Frequent Triad
Authors: Extermann Martine
Published: April 2017

The incidence of both cancer and cognitive impairments from various origins increases with age. Oncologists are increasingly being confronted with cancers occurring in patients with cognitive impairment, yet very few studies have addressed the problem. Cognitive impairment affects a patients' survival to an extent similar to an average cancer, and this can be an important thing to consider, especially in the adjuvant setting. Cognitive impairment also predisposes patients to delirium in the surgery setting or during hospitalization. Because effective preventive measures exist, careful attention should be paid to identifying patients at risk. Cognitive impairment does not automatically mean inability to consent, but particular precautions should be taken. For outpatient treatments such as chemotherapy, a comprehensive multidisciplinary approach is key for a good outcome. Proper caregiver support should be ensured upfront, and aggressive supportive care should be used. In the setting of an experienced geriatric oncology team, patients with cognitive impairment appear more likely to receive standard oncologic therapies. Cancer patients with cognitive impairment are at high risk of concomitant depression.
Benefits Associated with an Early Hemoglobin Response to Epoetin Alfa Therapy in the Treatment of Chemotherapy-Related Anemia
Authors: Campos Susana M. , Duh Mei Sheng , Lefebvre Patrick , Rosberg James
Published: April 2017

Although previous studies have recognized that timely correction of anemia is desirable, no published research quantifies the association between the timeliness of the hemoglobin rise and patients' outcomes. This study evaluates whether anemic patients with cancer who are receiving chemotherapy and who experienced an early response to epoetin alfa (≥ 1 g/dL hemoglobin increase at the end of 4 weeks of treatment) experienced better clinical and drug utilization outcomes compared with patients who did not experience an early response. Three large, open-label, community studies of epoetin alfa for the treatment of chemotherapy-related anemia were retrospectively analyzed to assess the association of early hemoglobin response to subsequent transfusion requirements, subsequent hemoglobin response, quality of life, and epoetin alfa dosage administered over the study. Two epoetin alfa dosing regimens were evaluated: 10,000 units 3 times weekly with potential escalation to 20,000 units, and 40,000 units once weekly with potential escalation to 60,000 units. In all studies, patients who experienced an early hemoglobin response had statistically lower subsequent transfusion requirements, higher rates of subsequent hemoglobin response, shorter time to hemoglobin response, better improvements in quality of life scores, and lower average weekly epoetin alfa dose than patients who did not experience an early hemoglobin response. Similar proportions of patients experienced early response in the 3-times weekly and once-weekly epoetin alfa regimens. This ad hoc analysis found that early hemoglobin response to epoetin alfa therapy was associated with improved clinical benefits and drug utilization. Early hemoglobin response may therefore be considered as a desired goal of epoetin alfa therapies.
Myelodysplastic Syndromes: Iron Overload Consequences and Current Chelating Therapies
Authors: Greenberg Peter L.
Published: April 2017

Chronic red blood cell transfusion support in patients with myelodysplastic syndromes (MDS) is often necessary but may cause hemosiderosis and its consequences. The pathophysiologic effects of iron overload relate to increased non-transferrin bound iron generating toxic oxygen free radicals. Studies in patients with MDS and thalassemia major have shown adverse clinical effects of chronic iron overload on cardiac function in patients who underwent polytransfusion. Iron chelation therapy in patients with thalassemia who were effectively chelated has prevented or partially reversed some of these consequences. A small group of patients with MDS who had undergone effective subcutaneous desferrioxamine (DFO) chelation for 1 to 4 years showed substantial hematologic improvements, including transfusion independence. However, because chronic lengthy subcutaneous infusions of DFO in elderly patients have logistic difficulties, this chelation therapy is generally instituted late in the clinical course. Two oral iron chelators, deferiprone (L1) and deferasirox (ICL670), provide potentially useful treatment for iron overload. This article reviews data indicating that both agents are relatively well tolerated, were at least as effective as DFO for decreasing iron burdens in comparative thalassemia trials, and (for deferiprone) were associated with improved cardiac outcomes. These outcomes could potentially alter the tissue siderosis-associated morbidity of patients with MDS, particularly those with pre-existing cardiac disease.
Genetic/Familial High-Risk Assessment: Breast and Ovarian Clinical Practice Guidelines
Authors: _ _
Published: April 2017

Recent advances in molecular genetics have identified several genes associated with inherited susceptibility to cancer and have provided a means to begin identifying individuals and families with an increased risk of cancer. This rapid expansion of knowledge about cancer genetics has implications for all aspects of cancer management, including prevention, screening, and treatment. These guidelines specifically address hereditary breast/ovarian cancer syndrome (HBOC), Li-Fraumeni syndrome, and Cowden syndrome. These guidelines were developed understanding that much of our knowledge of how the rapidly emerging field of molecular genetics can be applied clinically is preliminary and that flexibility is needed when applying these guidelines to individual families.

For the most recent version of the guidelines, please visit NCCN.org
Bilateral Risk-Reducing Oophorectomy in BRCA1 and BRCA2 Mutation Carriers
Authors: Domchek Susan M. , Stopfer Jill E. , Rebbeck Timothy R.
Published: April 2017

Bilateral risk-reducing oophorectomy (BRRO) is widely used for cancer risk reduction in women with BRCA1 and BRCA2 (BRCA1/2) mutations. BRRO significantly reduces breast cancer risk by approximately 50% and ovarian cancer risk by 85% to 95%, but it may be accompanied by menopausal symptoms, impaired quality of life, and accelerated bone loss. Therefore, decisions regarding the timing of BRRO, the risks and benefits of a simultaneous hysterectomy, and the use of hormone replacement therapy (HRT) must be made in concert with the patient and individualized to their circumstances. However, recent data demonstrate that HRT after BRRO in unaffected premenopausal women does not negate the breast cancer risk reduction that BRRO provides. This article reviews the studies regarding BRRO in BRCA1/2 mutation carriers, with particular focus on the use of HRT.
Documentation of Chemotherapy Infusion Preparation Costs in Academic- and Community-Based Oncology Practices
Authors: Brixner Diana I. , Oderda Gary M. , Nickman Nancy A. , Beveridge Roy , Jorgenson James A.
Published: April 2017

Significant changes in Medicare reimbursement for outpatient oncology services were proposed as part of the Medicare Modernization Act of 2003. The purpose of this study was to identify the “true cost” associated with drug-related handling for the preparation and delivery of chemotherapy doses to estimate the impact of changing reimbursement schema by Medicare. Two academic medical outpatient infusion centers and 2 community cancer centers provided data used to estimate all costs (excluding drug cost) associated with the preparation of chemotherapy doses. The data included both fixed costs (drug storage, space, equipment, and information resources) and variable costs (insurance management, inventory, waste management, pharmacy staff payroll, supplies, and shipping). The average cost for the preparation of chemotherapy doses across all sites was $34.27 (range, $32.08–$41.23). A time-and-motion study was also performed to determine what tasks were conducted by pharmacy staff and how much time was spent in the preparation of the top 15 chemotherapeutic drugs and regimens used in the 4 sites. Data from the 4 centers was projected to show that if 3,990,495 million chemotherapy infusions were administered to a national Medicare population in 2003, when multiplied by the average cost of preparation for infusions determined by the current study ($34.27), the estimated total annual cost to Medicare for chemotherapy preparation by pharmacists is $136,754,263.65. The pharmacists spent most of their days (90% or more) performing tasks directly related to the preparation of these agents. These data provide scientific support for the consideration of appropriate reimbursement for chemotherapy services provided by pharmacists to Medicare beneficiaries.
Favorable Early-Stage Hodgkin Lymphoma
Authors: Yahalom Joachim
Published: April 2017

The category of favorable early-stage Hodgkin lymphoma (HL) includes patients with Ann Arbor stages I or II disease with no bulky disease or B symptoms. The precise definition of favorable versus unfavorable early-stage disease may vary among American and European cooperative groups. The overall 10-year survival rate of patients with favorable early-stage HL exceeds 90%. Indeed, effective treatments for this group of patients have been available for more than 4 decades. However, treatment strategies have radically changed over the past 15 years and focus now on maintaining the high cure rate while reducing the risk of treatment-related long-term morbidity. The optimal treatment is still evolving, and more recently, reduction in the total amount of chemotherapy and in radiation field and dose has shown excellent results. Combined modality therapy is the preferred treatment for patients with classical favorable early-stage HL (nodular sclerosis or mixed cellularity histology). Patients with early-stage lymphocyte predominance HL are highly curable using involved-field radiation therapy (IFRT) alone and do not require chemotherapy. Classical favorable HL is also curable with radiotherapy alone or with chemotherapy alone, but larger fields and higher-dose radiation or longer chemotherapy is required compared with combined modality. The freedom from treatment failure rate is significantly better with a combination of short chemotherapy and IFRT than with either chemotherapy or radiotherapy alone. Although combined modality is the standard preferred treatment for favorable disease, radiation therapy alone or chemotherapy alone could be considered under special circumstances or as part of an investigational protocol.
Management of Advanced Stage Hodgkin Lymphoma
Authors: Advani Ranjana , Ai Weiyun Z. , Horning Sandra J.
Published: April 2017

Although advanced Hodgkin lymphoma is highly curable, balancing the high cure rate with long-term toxicity is challenging. ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, dacarbazine) is the standard chemotherapy regimen, producing a high cure rate with acceptable toxicity. Stanford V and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) are new regimens with encouraging results and are undergoing randomized clinical trials. The International Prognostic Score provides a clinical tool that may help identify patients with high-risk disease who may require a more aggressive regimen. Consolidative radiation's role in managing advanced Hodgkin lymphoma is still controversial, but it is most accepted for bulky or residual disease or after brief chemotherapy. The development and integration of newer imaging tools, such as fluorodeoxyglucose–positron emission tomography imaging, may allow a more precise evaluation of disease and help define which patients might benefit from consolidative treatment.
Breast Cancer Screening and Diagnosis Clinical Practice Guidelines
Authors: _ _
Published: April 2017

The lifetime risk of a woman developing breast cancer has increased over the past 5 years in the United States: of every 7 women, 1 is at risk based on a life expectancy of 85 years. An estimated 214,640 new cases (212,920 women and 1,720 men) of breast cancer and 41,430 deaths (40,970 women and 460 men) from this disease will occur in the United States in 2006. However, mortality from breast cancer has decreased slightly, attributed partly to mammographic screening. Early detection and accurate diagnosis made in a cost-effective manner are critical to a continued reduction in mortality. These practice guidelines are designed to facilitate clinical decision making.

For the most recent version of the guidelines, please visit NCCN.org
Adjuvant Treatment in Non-Small Cell Lung Cancer: Where Are We Now?
Authors: Juergens Rosalyn A. , Brahmer Julie R.
Published: April 2017

Lung cancer is the most common cancer worldwide, accounting for 1.2 million new cases annually. Despite aggressive local management of patients diagnosed with early-stage disease (stages I–IIIA), more than half of patients who have undergone surgical resection will die from complications caused by recurrent lung cancer. Over the past 5 years, results from several large trials assessing the use of adjuvant platinum-based chemotherapy in non-small cell lung cancer have become available. This article reviews the data from the most prominent of these trials and focuses on how the combination of cisplatin and etoposide has been evaluated for use in the adjuvant setting. Cisplatin-based therapy has now been shown to provide a significant survival benefit in several trials and recent meta-analyses. These data have changed the paradigm for how early-stage lung cancer is managed.
Can Therapy of Hepatitis C Affect the Development of Hepatocellular Carcinoma?
Authors: Kulik Laura M.
Published: April 2017

Chronic inflammation induced by viral infections and their role in carcinogenesis is well recognized. Two hepatotropic viruses, hepatitis B and hepatitis C (HCV), have been linked worldwide to the development of hepatocellular carcinoma (HCC). Although orthotopic liver transplant offers the best chance for cure and long-term survival, the demand for organs far outweighs the supply. The incidence of HCC in the United States has increased over the past 3 decades. HCV-induced cirrhosis is believed to play a significant role in the rising rate of HCC. Therefore, primary measures to prevent HCC in HCV-infected patients are urgently needed. Numerous studies of the HCV HCC patient have considered primary treatment with interferon-based therapy. However, secondary prevention currently seems to carry more promise. This article evaluates and assesses various treatments for primary and secondary chemoprevention in the setting of HCV.
Ovarian Cancer
Authors: _ _
Published: April 2017

Ovarian neoplasms consist of several histopathologic entities, and treatment depends on the specific tumor type. Epithelial ovarian cancer comprises most malignant ovarian neoplasms; however, other pathologic subtypes (such as less common ovarian histopathologies) must be considered. These guidelines discuss epithelial ovarian cancer as well as less common ovarian histopathologies, including germ cell neoplasms, mixed müllerian tumors of the ovary, and ovarian stromal tumors.

For the most recent version of the guidelines, please visit NCCN.org
Rational Use of Cytotoxic Chemotherapy for Recurrent Ovarian Cancer
Authors: Liu Joyce , Matulonis Ursula
Published: April 2017

Ovarian cancer remains the leading cause of death among women with gynecologic malignancies, and the fifth leading cause of cancer mortality in women in the United States. Although many patients respond to first-line platinum-based therapy, most will experience disease recurrence. The role of further therapy in the setting of recurrent ovarian cancer is palliative, and large randomized phase III trials on treatment options for recurrent ovarian cancer are rare. Controversies exist as to the optimal timing and duration of treatment, and many issues regarding treatment of recurrent disease remain.
Adjuvant Endocrine Therapy in Hormone Receptor-Positive Postmenopausal Breast Cancer: Evolution of NCCN, ASCO, and St Gallen Recommendations
Authors: Carlson Robert W. , Hudis Clifford A. , Pritchard Kathy I.
Published: April 2017

Endocrine therapy has a firm role in adjuvant treatment of women with hormone receptor–positive invasive breast cancer. Until recently, tamoxifen was the most commonly used adjuvant endocrine therapy in premenopausal and postmenopausal women. Several randomized clinical trials have studied the third-generation selective aromatase inhibitors (AIs) (anastrozole, letrozole, and exemestane) as adjuvant endocrine therapy in postmenopausal women. These studies compared therapy with an AI alone versus tamoxifen alone; 2 to 3 years of tamoxifen followed by switching to an AI versus continuation of tamoxifen; or extended therapy with an AI after approximately 5 years of tamoxifen therapy. No statistically significant differences in overall survival were observed. A single trial using extended treatment with an adjuvant AI suggests a small, statistically significant survival advantage in women with axillary lymph node–positive disease while showing no statistically significant decrease in survival with the use of an AI. The toxicities of the AIs are generally acceptable, with fewer endometrial cancers, gynecologic complaints, and thromboembolic events, but more bone fractures and arthralgias compared with tamoxifen alone. Three widely disseminated treatment guidelines, the National Comprehensive Cancer Network Breast Cancer Clinical Practice Guidelines in Oncology, the American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors, and the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer, now incorporate AIs in the adjuvant therapy of postmenopausal women with estrogen receptor–positive breast cancer.
Bladder Cancer
Authors: _ _
Published: April 2017

An estimated 61,420 new cases of urinary bladder cancer will be diagnosed in the United States in 2006, making it the fourth most common cancer in men and the ninth most common neoplasm in women. Because the median age of diagnosis is 65 years, medical comorbidities are a frequent consideration. The clinical spectrum of bladder cancer can be divided into 3 categories: noninvasive tumors, invasive lesions, and metastatic lesions. These categories differ in prognosis, management, and therapeutic goals, and these guidelines discuss management strategies to achieve the best possible outcomes.

For the most recent version of the guidelines, please visit NCCN.org