bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behavioral Risk Factors in Breast Cancer: Can Risk Be Modified?
Authors: McTiernan Anne 
Published: August 2004

AbstractThe International Agency for Research on Cancer estimates that 25% of breast cancer cases worldwide are due to overweight/obesity and a sedentary lifestyle. The preponderance of epidemiologic studies indicates that women who engage in 3–4 hours per week of moderate to vigorous levels of exercise have a 30%-40% lower risk for breast cancer than sedentary women. Women who are overweight or obese have a 50%-250% greater risk for postmenopausal breast cancer. Alcohol use, even at moderate levels (two drinks per day) increases risk for both premenopausal and postmenopausal breast cancer. Certain dietary patterns, such as high fat, low vegetables/fruits, low fiber, and high simple carbohydrates, may increase risk, but definitive data are lacking. These lifestyle factors are likely associated with breast cancer etiology through hormonal mechanisms. The worldwide trends of increasing overweight and obesity and decreasing physical activity may lead to an increasing incidence of breast cancer unless other means of risk reduction counteract these effects. Thus, adoption of lifestyle changes by individuals and populations may have a large impact on the future incidence of this disease.
Advances in Endocrine Treatments for Postmenopausal Women with Metastatic and Early Breast Cancer
Authors: Buzdar Aman U. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Define appropriate candidates for various endocrine therapies. Discuss the choices of therapies for patients with advanced breast cancer. Assess the options for adjuvant endocrine therapy for postmenopausal women.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
For the past 25 years, the estrogen antagonist tamoxifen has been the hormonal treatment of choice for postmenopausal patients with hormone-sensitive metastatic and early breast cancer (EBC). However, tamoxifen is associated with certain tolerability and safety concerns. In addition, the hormonal options after progression are limited, and thus, alternative endocrine treatments have been developed. This review provides a synopsis of the newer alternatives in endocrine therapy of breast cancer: the aromatase inhibitors (AIs) and fulvestrant Faslodex®, the estrogen receptor antagonist that downregulates estrogen and progesterone receptors and has no known agonist activity. The third-generation AIs, anastrozole and letrozole, have been shown to be as effective or more effective than megestrol acetate and tamoxifen as second- and first-line therapies for the treatment of postmenopausal patients with metastatic breast cancer, and exemestane has been approved for second-line use. Fulvestrant has been shown to be as effective as anastrozole as second-line therapy for metastatic breast cancer and has been approved in the U.S. for the treatment of postmenopausal women with hormone-receptor-positive metastatic breast cancer following progression on antiestrogen therapy. Anastrozole is the only AI with published clinical trial data and U.S. Food and Drug Administration approval for adjuvant therapy of postmenopausal women with EBC. The ‘Arimidex,’ Tamoxifen, Alone or in Combination (ATAC) trial, a double-blind, multicenter trial with 9,366 patients, compared tamoxifen with anastrozole, alone and in combination, as adjuvant endocrine treatment for postmenopausal patients with operable, invasive, EBC. The first analysis (at a median follow-up of 33.3 months) showed longer disease-free survival and, in general, better tolerability with anastrozole than with tamoxifen. This pattern was maintained at later analyses with a median follow-up of 47 months for efficacy and 37 months for safety and tolerability. Although longer follow-up is warranted, anastrozole appears to be a well-documented choice of endocrine adjuvant therapy for postmenopausal women with hormone-responsive breast cancer.
Health-Related Quality of Life in Female Long-Term Colorectal Cancer Survivors
Authors: Trentham-Dietz A. , Remington P.L. , Moinpour C.M. , Hampton J.M. , Sapp A.L. , Newcomb P.A. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Appreciate that female long-term colorectal cancer survivors commonly achieve quality of life comparable with that of similarly aged women without a personal history of cancer. Identify age and comorbid conditions, particularly greater body mass, as two strong factors related to quality of life in female long-term colorectal cancer survivors. Recognize that colorectal cancer can be associated with long-term levels of both physical and mental health.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Although the number of women who survive treatment for colorectal cancer is growing, little is known about the quality of life of long-term survivors. The purpose of analyses presented in this paper is to describe the overall health-related quality of life of female long-term colorectal cancer survivors and the factors that may modify their levels of quality of life. A population-based sample of 726 Wisconsin women diagnosed with colorectal cancer from 1990–1991 was recontacted. Of the 443 women alive in 1999, 307 (69%) completed a follow-up questionnaire including the Medical Outcomes Study Short-Form 36 Health Status Survey, which is comprised of 36 items that generate nine domain scale scores and two summary scores: the Physical Component Summary score and the Mental Component Summary score. The mean follow-up was 9 years (range 7–11), and the mean age at follow-up was 72 years (range 43–85). The mean Physical Component Summary score was lower for participants with greater ages, greater numbers of comorbidities, and greater body masses at the time of follow-up. The mean Mental Component Summary score also was lower for participants with greater numbers of comorbidities. Differences associated with degree of comorbidity were observed for all eight domain scales. Female long-term survivors of colorectal cancer appear to report health-related quality of life comparable with that of similarly aged women in the general population. These data suggest that, over the long term, factors attributable to aging, body weight, and chronic medical conditions play more dominant roles in determining physical and mental health than factors related to the initial colorectal cancer diagnosis.
Intensive Concurrent Chemoradiotherapy for Head and Neck Cancer with 5-Fluorouracil- and Hydroxyurea-Based Regimens: Reversing a Pattern of Failure
Authors: Argiris Athanassios , Haraf Daniel J. , Kies Merrill S. , Vokes Everett E. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Discuss the results of multicenter trials with chemoradiotherapy with 5-FU- and hydroxyurea-based regimens for the treatment of locoregionally advanced head and neck cancer. Explain the rationale for the combination treatment of radiation, 5-FU, and hydroxyurea. Recognize the toxicities and potential functional impairment for patients treated with aggressive concurrent chemoradiotherapy. Discuss the experimental role of induction chemotherapy in the management of locoregionally advanced head and neck cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Combined modality programs that were developed over the past two decades demonstrated that the nonsurgical therapy of locoregionally advanced head and neck cancer is feasible and produces survival outcomes that are at least comparable with surgery. The systemic therapy of head and neck cancer has gained momentum in recent years. Several randomized studies have shown that the concurrent administration of chemotherapy and radiation therapy is superior to radiation therapy alone. In consecutive clinical studies since 1986, we have developed multiagent chemoradiotherapy regimens based on initial observations with the 5-fluorouracil (5-FU), hydroxyurea, and concomitant radiotherapy combination. Three consecutive multicenter phase II trials reported that the combination of 5-FU and hydroxyurea with either cisplatin or paclitaxel along with twice daily radiation therapy administered every other week is a highly effective regimen with local control rates that approach 90% and 3-year survival rates of approximately 60% in patients with stage IV disease. The vast majority of patients in these studies achieved anatomical organ preservation. A reversal of the historical pattern of failure was evident, with distant sites becoming the predominant site of failure in each trial. The paclitaxel-containing regimen was better tolerated than the cisplatin-containing regimen and was advanced to further clinical testing. The incorporation of induction chemotherapy may improve the results of treatment by targeting systemic micrometastatic disease.
Thrombotic Thrombocytopenic Purpura Associated with Bone Marrow Metastasis and Secondary Myelofibrosis in Cancer
Authors: Chang Jae C. , Naqvi Tahir 
Published: August 2004

Abstract
To examine the relationship between cancer and development of thrombotic microangiopathy (TM), the medical records of patients with known TM were examined in one institution from January 1981 to December 2002. Nine out of 93 patients with the established diagnosis of TM had active cancer. All nine of those patients had thrombotic thrombocytopenic purpura (TTP). Among those patients, two patients received chemotherapy prior to the development of TTP. Six of the seven patients who received no chemotherapy had extensive bone marrow metastasis and secondary myelofibrosis. There were two patients each with breast cancer, lung cancer, and stomach cancer. Severe anemia and thrombocytopenia with leukoerythroblastosis were prominent clinical features in all six patients. Four patients had neurological (mental) changes and three developed fever, but none had significant renal dysfunction. Upon establishing the diagnosis of TTP, four patients were treated with exchange plasmapheresis (EP) and two patients were treated with chemotherapy because there were no neurological changes. Three patients achieved complete remission of TTP, one with EP alone and two with chemotherapy. The one patient who achieved remission with EP alone was later treated with chemotherapy and survived for 2 1/2 years. The other three patients treated with EP alone died within 2 months after the diagnosis of TTP. Since TTP occurred in association with bone marrow metastasis and myelofibrosis in six patients among seven chemotherapy-untreated cancer patients, this marrow change was considered to be the possible cause of the development of TTP. It is recommended that all cancer patients with unexplained anemia and thrombocytopenia be evaluated for the coexistence of bone marrow metastasis and TTP.
Venous Thrombosis in Cancer Patients: Insights from the FRONTLINE Survey
Authors: Kakkar Ajay K. , Levine Mark , Pinedo H.M. , Wolff Robert , Wong John 
Published: August 2004

Abstract
Background. Venous thromboembolism (VTE) is a common complication in cancer patients and a significant cause of morbidity and mortality. However, little information is available on oncologists' perceptions of the risk of VTE and its management. The Fundamental Research in Oncology and Thrombosis (FRONTLINE) study is the first comprehensive global survey of thrombosis and cancer. The study was designed to collect data on the perceived risk and patterns of practice with regard to VTE in cancer patients undergoing surgical and medical management of their malignancy and to provide information on international and regional practice patterns, allowing for the design of research studies to answer the concerns of practicing clinicians.
Methods. Literature reviews were performed to provide a current evidence base against which to compare the findings, and a survey was developed under the guidance of an advisory board. A paper-based reply-paid questionnaire was distributed globally between July and November 2001 to clinicians involved in cancer care and was made available on a dedicated website.
Findings. A total of 3,891 completed responses were available for analysis. Brain and pancreatic tumors were considered to carry a high risk for VTE, and 80% of respondents considered the use of central venous lines to be associated with a high risk of VTE. Marked differences were seen in the use of thromboprophylaxis for surgical and medical cancer patients, with over 50% of surgeons reporting that they initiated thromboprophylaxis routinely, while most medical oncologists reported using thromboprophylaxis in less than 5% of medical patients. Low molecular weight heparin (LMWH) was the most popular method of thromboprophylaxis employed in both surgical and medical patients and was more favored by European than U.S. clinicians. Some 20% of respondents reported using aspirin for prophylaxis, despite there being no reliable evidence for this agent as effective in prevention in this population. For the treatment of VTE, LMWH was again the most common initial treatment, although, for the long-term, oral anticoagulation therapy was widely adopted. Many patients were treated for VTE on an outpatient basis, and secondary prevention of VTE was typically continued for 3 to 6 months after an episode of deep vein thrombosis or for longer in the case of pulmonary embolism.
Interpretation. The results of the FRONTLINE survey demonstrate a need for guidelines to direct clinical practice in line with evidence-based data concerning cancer and VTE. Oncologists need to be educated regarding the true risks of VTE associated with certain cancers and on strategies for prevention and treatment to reduce the morbidity and mortality associated with VTE in all cancer patients. The study has also helped identify areas for future research.
The Molecular Perspective: Histone Deacetylase
Authors: Goodsell David S. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify the structure and function of histone deacetylase and its role in cancer treatment.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Diagnosis and Management of Central Nervous System Metastases from Breast Cancer
Authors: Chang Eric L. , Lo Simon 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Select appropriate diagnostic tests for brain, spinal, leptomeningeal, and ocular metastases from breast cancer. Select appropriate therapy for brain, spinal, leptomeningeal, and ocular metastases from breast cancer. Discuss the efficacy and toxicities of therapy for brain, spinal, leptomeningeal, and ocular metastases from breast cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
The brain, cranial nerves, leptomeninges, spinal cord, and eye compose the central nervous system (CNS) and are at risk for the development of metastases from breast cancer. Such metastases are diagnosed on the basis of clinical suspicion and substantiated by neuroimaging, resection when indicated, and sampling of cerebrospinal fluid when leptomeningeal metastasis (LM) is suspected. Treatment is aimed at palliation of symptoms and preservation of neurologic function. Historically, conventional radiation therapy has been the mainstay of palliative treatment for brain, cranial nerve, spinal cord, and ocular metastases. However, additional treatment options for brain metastases have been brought about by technological advances in surgery to resect brain metastases, and stereotactic radiosurgery (SRS) to focally irradiate metastases, both of which have been substantiated by data from randomized trials. Ongoing research is aimed at refining criteria to select which patients with brain metastases should undergo surgery and SRS and how these focal therapies should be optimally integrated with whole-brain radiotherapy. Therapy for LM must carefully balance the potential risks and perceived benefits associated with CNS-directed therapies. Despite advances in neuroimaging, surgery, and radiation therapy, novel treatments are needed to improve the effectiveness of treatments for CNS metastases, especially LM, while reducing attendant neurotoxicity.
The Role of ABC Transporters in Clinical Practice
Authors: Leonard Gregory D. , Fojo Tito , Bates Susan E. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Discuss the function of ABC transporters. Outline the levels of expression of MDR in tumors. Determine the role of P-gp inhibitors in clinical practice.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Drug resistance remains one of the primary causes of suboptimal outcomes in cancer therapy. ATP-binding cassette (ABC) transporters are a family of transporter proteins that contribute to drug resistance via ATP-dependent drug efflux pumps. P-glycoprotein (P-gp), encoded by the MDR1 gene, is an ABC transporter normally involved in the excretion of toxins from cells. It also confers resistance to certain chemotherapeutic agents. P-gp is overexpressed at baseline in chemotherapy-resistant tumors, such as colon and kidney cancers, and is upregulated after disease progression following chemotherapy in malignancies such as leukemia and breast cancer. Other transporter proteins mediating drug resistance include those in the multidrug-resistance-associated protein (MRP) family, notably MRP1, and ABCG2. These transporters are also involved in normal physiologic functions. The expressions of MRP family members and ABCG2 have not been well worked out in cancer.
Increased drug accumulation and drug resistance reversal with P-gp inhibitors have been well documented in vitro, but only suggested in clinical trials. Limitations in the design of early resistance reversal trials contributed to disappointing results. Despite this, three randomized trials have shown statistically significant benefits with the use of a P-gp inhibitor in combination with chemotherapy. Improved diagnostic techniques aimed at the selection of patients with tumors that express P-gp should result in more successful outcomes. Further optimism is warranted with the advent of potent, nontoxic inhibitors and new treatment strategies, including the combination of new targeted therapies with therapies aimed at the prevention of drug resistance.
Chemoembolization in the Management of Liver Tumors
Authors: Stuart Keith 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Explain the anatomic and biologic rationale for using chemoembolization to treat tumors localized to the liver. Identify appropriate candidates for this treatment based upon tumor biology and patient characteristics. Anticipate and manage the toxicities and complications of chemoembolization. Discuss the variability in results reported in the literature from different centers and in different tumor types.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.comThe dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver. While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations.
PET Scans in the Staging of Lymphoma: Current Status
Authors: Friedberg Jonathan W. , Chengazi Vaseem 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Define the role of diagnostic PET in the staging of patients with lymphoma. Discuss the role of PET in the evaluation of residual masses in patients with lymphoma. Explain the limitations of PET scanning and the special situations where PET scanning has been used in the evaluation of patients with lymphoma.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Positron emission tomography (PET) is a novel functional imaging technique that provides several inherent advantages over conventional nuclear scintigraphy. Several studies have suggested a role for PET using the positron emitter fluorine-18 in the diagnosis and follow-up of patients with lymphoma. This review summarizes the existing data evaluating the role of 2-fluoro-2-deoxy-D-glucose (FDG)-PET in both the staging and follow-up of patients with lymphoma. Most studies of PET involve patients with either Hodgkin's disease or diffuse large B-cell non-Hodgkin's lymphoma. PET detects more disease sites above and below the diaphragm on staging of lymphoma than gallium scintigraphy and may have particular utility in the evaluation of the spleen. Moreover, persistently positive PET scans during and after chemotherapy appear to have a high sensitivity for predicting subsequent relapse. A negative PET scan at the end of therapy provides very favorable prognostic information. Persistently positive PET scans at the end of therapy warrant close follow-up or additional diagnostic procedures, since some of those patients may remain in prolonged remission. Clearly, additional studies, including prospective blinded trials and cost-effectiveness analyses, are warranted to determine which subsets of patients with lymphoma ultimately will benefit from this modality.