bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking Bad News: A Patient's Perspective
Authors: Dias Lauren , Chabner Bruce A. , Lynch Thomas J. , Penson Richard T. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Explain the importance of compassionate care and clear communication in oncology. Recognize the advantages and limitations of good communication. Communicate better with patients and families who face life-threatening illness.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.
Clinicians in the field of oncology are unavoidably forced to break bad news. The Schwartz Center Rounds focuses on issues of communication between patients and their caregivers, one of the most difficult aspects of which is breaking bad news. The invited patient, a woman who had been living with a low-grade cancer for many years, spoke about her experiences both as a person living with cancer and as the daughter of a patient diagnosed with cancer. Her father's suicide, precipitated by being told his diagnosis, puts the horror of receiving bad news into stark relief. She provides a fascinating account of how she proactively adjusted to her diagnosis, and fought for optimal quality of life. This article discusses issues of support, abandonment, and how hope is conveyed, and reviews the literature that informs good clinical practice in breaking bad news.
The Molecular Perspective: Protein Farnesyltransferase
Authors: Goodsell David S. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Describe the structure and function of protein farnesyltransferase 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
Recognition and Management of Hereditary Breast Cancer Syndromes
Authors: Thull Darcy L. , Vogel Victor G. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify the most important clinical genetic syndromes that increase the risk of hereditary breast cancer. Describe surgical management options that reduce the risk of developing hereditary breast cancer. Outline the risks and benefits of using chemopreventative interventions in carriers of genetic mutations that increase the risk of hereditary breast cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Clinicians should recognize the genetic syndromes that predispose to the development of breast cancer so that patients may be afforded the opportunity to have genetic testing to assist them and their family members in making medical management decisions. Approximately 80%–90% of hereditary breast cancer cases are caused by mutations in the BRCA1 and BRCA2 genes. Other important clinical genetic predispositions include Cowden syndrome, Li-Fraumeni syndrome, Peutz-Jeghers syndrome, and ataxia-telangiectasia. The key to identifying women who are at risk for a hereditary breast cancer lies in obtaining an adequate, three-generation family history, including ethnic background. For unaffected women, breast cancer risks can be estimated using the quantitative models of Gail and Claus, but there are limitations to these models. Other quantitative models predict the likelihood that a patient is carrying a mutated gene. Genetic testing is available at selected laboratories for each of the hereditary syndromes described, and there are three possible outcomes to testing. These outcomes and their management implications are described in detail. Clinical management options for women at high risk for breast cancer include surveillance, chemoprevention, and prophylactic surgery. Application of these principles can reduce morbidity in women with genetic predispositions to breast cancer.
Anemia in Stage II and III Breast Cancer Patients Treated With Adjuvant Doxorubicin and Cyclophosphamide Chemotherapy
Authors: Kirshner Jeffrey , Hatch Marianne , Hennessy Daniel D. , Fridman Moshe , Tannous Rima E. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify the prevalence and incidence of anemia in early-stage breast cancer patients and the proportion of patients untreated for anemia. Discuss the relationship between certain patient characteristics (i.e., age and prechemotherapy hemoglobin level) and the risk of developing moderate to severe anemia during chemotherapy. Explain how anemia may progress from cycle to cycle of chemotherapy and quantify the drop in hemoglobin levels for different groups of patients.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Purpose. The incidence and severity of prechemotherapy anemia and chemotherapy-induced anemia experienced by women treated with adjuvant doxorubicin and cyclophosphamide (AC) therapy for stage II and III breast cancer are described.
Patients and Methods. Medical charts of 310 breast cancer patients who received chemotherapy at eight oncology practices during 1997 through 2001 were reviewed in this historical case series study. Prechemotherapy anemia was defined as a baseline hemoglobin value &lt;12 g/dl. An anemic event during chemotherapy (used to define chemotherapy-induced anemia) was defined as either a drop in hemoglobin level below the threshold (≤10 g/dl), the receipt of a blood transfusion(s), or treatment with epoetin alfa.
Results. Overall, 40.0% of patients experienced moderate to severe anemia (i.e., their hemoglobin levels dropped to &lt;10 g/dl) and 31.3% (97/310) were anemic prechemotherapy. Of the patients with mild anemia prechemotherapy, 61.9% developed moderate to severe anemia during chemotherapy. Only 47.4% (46/97) of those patients received epoetin alfa therapy during chemotherapy. Of the patients with normal prechemotherapy hemoglobin levels (≥12 g/dl), 88.3% developed some degree of anemia (&lt;12 g/dl) during chemotherapy and 27.7% (59/213) developed moderate to severe anemia (&lt;10 g/dl). Anemic events were experienced by 41.8% (89/213) of the patients with normal prechemotherapy hemoglobin levels.
Conclusions. We conclude that a significant proportion (31.3%) of stage II and III breast cancer patients are anemic prechemotherapy and that the incidence of anemia increases substantially from prechemotherapy through the postchemotherapy period. This evidence appears to warrant earlier evaluation of anemia and an intervention in the prechemotherapy stage.
Ethical Conflict in Providing Informed Consent for Clinical Trials: A Problematic Example from the Gynecologic Cancer Research Community
Authors: Markman Maurie 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the importance of the informed consent process in clinical trials. Discuss the implications of the randomized phase III trial of maintenance paclitaxel chemotherapy in advanced ovarian cancer. Explain the responsibilities of clinical investigators and clinicians to inform their patients of new results that may affect their willingness to participate in clinical trials.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
The principle of respect for patient autonomy and the importance of informed consent are well established in the conduct of clinical research. However, in actual clinical practice, how one applies this concept is not always clear. The provocative results of a randomized trial examining “consolidation/maintenance” therapy in women with advanced ovarian cancer who achieved a clinically defined complete response to primary chemotherapy have raised difficult issues for clinicians and clinical investigators regarding their obligations to provide patients with information that may interfere with the conduct of ongoing or future research studies.
Diagnosis and Treatment of Cholangiocarcinoma
Authors: Anderson Christopher D. , Wright Pinson C. , Berlin Jordan , Chari Ravi S. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Describe the current state-of-the-art treatment of cholangiocarcinoma including the current results of aggressive resection, adjuvant therapies, and neoadjuvant therapies. Outline the criteria for determining resectability. Discuss the roles of chemotherapies and radiation therapies in the palliative care of the patient with unresectable cholangiocarcinoma. Identify the roles of operative bypass and endoscopic or percutaneous stenting in the palliation of cholangiocarcinoma.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.comCholangiocarcinoma presents a formidable diagnostic and treatment challenge. The majority of patients present with unresectable disease and have a survival of less than 12 months following diagnosis. Progress has been made by the appropriate selection of patients for treatment options including resection, with the routine use of more aggressive resections in order to achieve margin-negative resections. This has resulted in longer survival times for these patients. Neoadjuvant and adjuvant therapies have, for the most part, not improved survival in patients with this tumor, and new strategies are needed to improve this line of therapy. The prognosis for unresectable patients is poor, and palliative measures should be aimed at increasing quality of life first and increasing survival second.
The Role of Topotecan in the Treatment of Brain Metastases
Authors: Wong Eric T. , Berkenblit Anna 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Discuss the role of chemotherapy in the treatment of brain metastases. Identify the properties of topotecan that are conducive to treating patients with brain metastases. Discuss the investigation of single-agent topotecan and topotecan in combination with other chemotherapeutic agents or radiotherapy in the treatment of brain metastases.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Despite advances in the treatment of systemic malignancies, the prognosis for patients with brain metastases continues to be dismal. Because the majority of cytotoxic agents seem to be unable to penetrate the blood-brain barrier, the role of chemotherapy in the treatment of brain metastases remains controversial. However, growing amounts of both laboratory and clinical data suggest that a few of the newly developed cytotoxic agents can cross the blood-brain barrier and may have a role in the treatment of patients with brain metastases. Topotecan, a novel topoisomerase I inhibitor, freely crosses the blood-brain barrier and may be clinically effective in both the therapeutic and prophylactic settings in patients with brain metastases. Recent studies have demonstrated the antitumor activity of topotecan against brain metastases, with objective response rates ranging from 33%-63% in patients with various solid tumors. The antitumor response in the central nervous system was often greater and occurred more quickly than the systemic antitumor response to topotecan treatment. This result may be explained by the lack of exposure of brain metastases to previous cytotoxic agents, suggesting a role for topotecan in patients with brain metastases. Early studies have also suggested that topotecan, an apparent radiosensitizer, may be particularly effective in combination with radiotherapy, the current standard of care for patients with brain metastases. In addition, preliminary data suggest that topotecan in combination with temozolomide (another cytotoxic agent that can cross the blood-brain barrier) may have synergistic antitumor activity against brain metastases. This review summarizes the available preclinical and clinical evidence for the role of topotecan in the treatment of brain metastases and concludes with three case studies.
Complementary and Alternative Therapies for Cancer
Authors: Cassileth Barrie R. , Deng Gary 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the differences between complementary and alternative therapies. List common complementary and alternative therapies used by cancer patients. Know where to access reliable information.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit atCME.TheOncologist.com
Many cancer patients use therapies promoted as literal alternatives to conventional medical care. Such “alternative” modalities are unproven or were studied and found worthless. These can be harmful. An even greater proportion of cancer patients uses “complementary” therapies along with mainstream cancer treatment. Most are helpful adjunctive approaches that control symptoms and enhance quality of life. This review describes alternative as well as complementary therapies commonly used today by cancer patients. Herbal remedies also are discussed. Evidence regarding the efficacy and safety of complementary/alternative medicine (CAM) is reviewed, and implications for oncologists are discussed. To encourage open communication of CAM use by patients, oncologists should be knowledgeable about the most popular remedies and know where to find reliable information for themselves and for their patients.
The Role of Selective Estrogen Receptor Modulators in the Prevention of Breast Cancer: Comparison of the Clinical Trials
Authors: Martino Silvana , Costantino Joseph , McNabb Michelle , Mershon John , Bryant Katherine , Powles Trevor , Secrest Roberta J. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Discuss the tamoxifen breast cancer prevention trials and the general risk-benefit profile of tamoxifen for breast cancer prevention. Compare and contrast the tamoxifen breast cancer chemoprevention trials with the ongoing raloxifene chemoprevention trials in terms of study design and baseline patient characteristics. Describe the limitations of the completed and ongoing tamoxifen and raloxifene breast cancer chemoprevention trials and the areas for future breast cancer chemoprevention research.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at http://CME.TheOncologist.com
The role of estrogen in the development of breast cancer is well recognized, and the use of selective estrogen receptor modulators (SERMs) to reduce breast cancer risk continues to be evaluated. Tamoxifen is the only SERM approved for the reduction of breast cancer incidence in women at high risk. This approval was based on results from the Breast Cancer Prevention Trial. Although initial results from the Royal Marsden Hospital tamoxifen trial and Italian Tamoxifen Prevention Study did not show a similar overall effect of tamoxifen, recent updates from these two trials and initial results from the International Breast Cancer Intervention Study are consistent with a risk reduction effect of tamoxifen for estrogen-receptor-positive breast cancer.
Raloxifene, approved for the prevention and treatment of postmenopausal osteoporosis, is another SERM being evaluated for breast cancer risk reduction. The recently completed Continuing Outcomes Relevant to Evista® trial and the Raloxifene Use for The Heart trial, have breast cancer risk reduction as a primary end point. A third, ongoing trial, the Study of Tamoxifen and Raloxifene trial, is evaluating the relative efficacy and adverse event profile of these two agents in a population at high risk. The study populations of these raloxifene breast cancer prevention trials and the four tamoxifen prevention trials are quite diverse in terms of breast cancer risk. Completion of these trials will provide important information about the occurrence of invasive breast cancer in postmenopausal women and the efficacy of raloxifene for breast cancer risk reduction.
Aromatase Inhibitors for Breast Cancer in Postmenopausal Women
Authors: Campos Susana M. 
Published: August 2004

Abstract
Third-generation aromatase inhibitors are potent inhibitors of the aromatase enzyme, which catalyzes the last step in estrogen biosynthesis. These agents are active against breast cancer in hormone-naïve postmenopausal women and in women who have experienced failure of tamoxifen or failure of tamoxifen plus other hormonal therapy. There are two types of aromatase inhibitors, irreversible steroidal activators (e.g., exemestane) and reversible nonsteroidal imidazole-based inhibitors (e.g., anastrozole, letrozole). Recent data suggest that some women who experience failure of one type of aromatase inhibitor can subsequently derive benefit from the other type. The reason for this lack of cross-resistance is unknown. This finding of non-cross-resistance between steroidal aromatase activators and nonsteroidal aromatase inhibitors offers the opportunity to increase the number of lines of hormone therapy before making the inevitable switch to more toxic chemotherapy, thus potentially improving quality of life for postmenopausal women with advanced disease.
Data from postmenopausal women with advanced disease suggest that steroidal and nonsteroidal aromatase inhibitors have similar tolerability profiles; however, emerging data suggest that there may be differences in their effects on end organs, which may become evident with longer term use, such as in the adjuvant or prevention settings. Steroidal agents appear to have beneficial effects on lipid and bone metabolism, whereas nonsteroidal agents may have neutral or unfavorable effects. These differences may be attributed to the androgenic effects of steroidal agents; clinical trials are currently under way to confirm these suspicions.
Multiple Management Modalities in Esophageal Cancer: Epidemiology, Presentation and Progression, Work-up, and Surgical Approaches
Authors: Koshy Mary , Esiashvilli Natia , Landry Jerome C. , Thomas Charles R. , Matthews Richard H. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Describe the epidemiology, work-up, and staging of esophageal cancer. Identify the disease presentation, progression, and prognostic factors for esophageal cancer. Discuss the surgical approach and management of esophageal cancer.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at http://CME.TheOncologist.comAnnually, approximately 13,200 people in the U.S. are diagnosed with esophageal cancer and 12,500 die of this malignancy. Of new cases, 9,900 occur in men and 3,300 occur in women. In part I of this two-part series, we explore the epidemiology, presentation and progression, work-up, and surgical approaches for esophageal cancer. In the 1960s, squamous cell cancers made up greater than 90% of all esophageal tumors. The incidence of esophageal adenocarcinomas has risen considerably over the past two decades, such that they are now more prevalent than squamous cell cancer in the western hemisphere. Despite advances in therapeutic modalities for this disease, half the patients are incurable at presentation, and overall survival after diagnosis is grim. Evolving knowledge regarding the etiology of esophageal carcinoma may lead to better preventive methods and treatment options for early stage superficial cancers of the esophagus. The use of endoscopic ultrasound and the developing role of positron emission tomography have led to better diagnostic accuracy in this disease. For years, the standard of care for esophageal cancer has been surgery; there are several variants of the surgical approach. We will discuss combined modality approaches in part II of this series.
Multiple Management Modalities in Esophageal Cancer: Combined Modality Management Approaches
Authors: Koshy Mary , Esiashvilli Natia , Landry Jerome C. , Thomas Charles R. , Matthews Richard H. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Outline the relative merits of definitive radiation alone or as a preoperative or postoperative treatment for esophageal cancer versus combined chemoradiation in these settings. Discuss the limitations of our understanding of the radiation dose-response relationship in esophageal cancer. Appreciate the merits of chemoradiation as definitive treatment for esophageal cancer versus its use as an adjuvant to surgery.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at http://CME.TheOncologist.com
The overall success rate nationally in treating esophageal carcinomas remains poor, with over 90% of patients succumbing to the disease. In part I of this two-part series, we explored epidemiology, presentation and progression, work-up, and surgical approaches. In part II, we explore the promising suggestions of integrating chemotherapy and radiation therapy into the multimodal management of esophageal cancers.
Alternative approaches to resection alone have been sought because of the overall poor survival rates of esophageal cancer patients, with failures occurring both local-regionally and distantly. Concomitant chemotherapy and radiation therapy (XRT) have been shown, by randomized trial, to be more effective than XRT alone in treating unresectable esophageal cancers and also have shown promise as a neoadjuvant treatment when combined with surgery in the multimodal treatment of this disease. Various studies have also addressed issues such as preoperative chemotherapy, radiation dose escalation, chemotherapy/XRT as a definitive treatment versus use as a surgical adjuvant, and alternative chemotherapy regimens. There are suggestions of some progress, but this remains a difficult problem area in which management is continuing to evolve.