bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pros and Cons of Adjuvant Interferon in the Treatment of Melanoma
Authors: Sabel Michael S. , Sondak Vernon K. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Define the indication for and administration of IFN-α in the adjuvant treatment of melanoma. Explain the rationale both for and against the use of adjuvant interferon. Discuss areas of ongoing research for adjuvant therapy of melanoma.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Should interferon alpha (IFN-α) be considered the standard of care for the adjuvant therapy of high-risk malignant melanoma? For 2003, it was estimated that 51,400 cases of invasive melanoma would be diagnosed. The risk of recurrence after surgery is reported to be approximately 60% for patients with thick primary lesions (T4N0M0, American Joint Committee on Cancer [AJCC] stage IIB) and 75% for patients with regional nodal metastases (T1-4N1M0, AJCC stage III). The observation that melanoma is susceptible to attack by the host's immune system has resulted in the testing of a remarkably broad spectrum of immunotherapies in the adjuvant setting. Many of these approaches failed to demonstrate a significant clinical impact, until the use of adjuvant IFN-α. Conflicting data from several large, randomized clinical trials resulted in a rapid rise and then decline in the use of IFN-α in the adjuvant setting. This roller coaster has left many clinicians still hesitant to strongly recommend it, and the use of adjuvant IFN-α in high-risk melanoma remains controversial. This manuscript reviews the leading arguments for and against its routine use and addresses questions regarding its role in the management of high-risk malignant melanoma.
The Melanoma Epidemic: Res Ipsa Loquitur
Authors: Beddingfield Frederick C. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the factors suggesting the melanoma epidemic is real and not artificial. List the major risk factors for melanoma and preventative measures. Describe the relationships between age and gender and melanoma risk.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Many have debated whether or not we are in the midst of a melanoma epidemic. Some facts are clear and helpful to this debate, while others are less clear. The incidence and mortality of melanoma have increased over the last several decades, but the incidence has risen faster than the mortality. The incidence has risen 3%–7% on average over several decades and even more rapidly among Caucasian men and the elderly. In the U.S., the incidence in men is higher than in women after the age of 40, and the difference between men and women increases from age 40 until the end of life. The incidence in the U.S. has risen most rapidly among in situ and localized lesions, but distant and regional disease have increased as well. Among localized disease, in the U.S. from 1988–1997, all stages increased by comparable amounts. This strongly argues against the idea that the increase in incidence of melanoma is only due to early detection of thin lesions or biologically benign lesions, at least during the time period studied. On the other hand, early detection of thin lesions may well account for lower increases in mortality than incidence and improvements in survival. Survival has increased from approximately 60% in the 1960s to 89% in recent years. Improvements in survival appear to be related to earlier diagnosis, rather than an improvement in survival of a given stage.
Studies consistently point to a major role for UV light exposure as the most important risk factor for those individuals with a phenotypic susceptibility. Public health efforts aim at primary and secondary prevention strategies. Primary prevention strategies attempt to prevent people from developing melanoma, primarily through avoiding exposure to UV light. There is a particular emphasis on avoidance of UV light exposure in childhood and young adulthood, when it appears the risk is greatest. When strict avoidance cannot be adhered to, sunscreens have been logically recommended. Secondary prevention strategies include screening campaigns and educational campaigns. Many of these strategies appear promising but require further rigorous testing. The melanoma epidemic has arisen for a variety of reasons including: a true increase in melanomas of malignant behavior, a particularly high increase in localized and in situ lesions, and an increase in the number of biopsies performed, which may have resulted in an increased detection of less aggressive lesions. The contribution of possible changes in the diagnostic criteria for melanoma to the increased incidence remains unknown.
Genetics and the Management of Women at High Risk for Breast Cancer
Authors: Mincey Betty A. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify appropriate candidates for consideration of genetic testing for mutations in BRCA1 or BRCA2. Explain the importance of appropriate patient counseling prior to proceeding with genetic testing for mutations in BRCA1 or BRCA2, including genetic counseling and education regarding interpretation and implications of test results. Discuss risk management options for BRCA mutation carriers and the available evidence regarding their effectiveness.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
It is estimated that 5%–10% of all breast cancers in women are associated with hereditary susceptibility due to mutations in autosomal dominant genes, such as BRCA1 and BRCA2, p53, pTEN, and STK11/LKB1. Another 15%–20% of female breast cancers occur in women with a family history but without an apparent autosomal dominant inheritance pattern, and are probably due to other genetic factors with environmental influence. Approximately 7%–10% of ovarian cancers occur in women with hereditary susceptibility, primarily secondary to mutations in BRCA1 and BRCA2, with smaller contributions from mutations in mismatch repair genes associated with the hereditary nonpolyposis colorectal cancer and other, as yet undiscovered, genes.
Andropause: Symptom Management for Prostate Cancer Patients Treated With Hormonal Ablation
Authors: Thompson Carrie A. , Shanafelt Tait D. , Loprinzi Charles L. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Explain the side effects of hormonal ablation therapy for prostate cancer. Provide a list of potential non-hormonal therapies for treatment of vasomotor symptoms. Appreciate the impact of hormonal ablation therapy on bone mineral density.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.comAndropause, or the age-related decline in serum testosterone, has become a popular topic in the medical literature over the past several years. Andropause includes a constellation of symptoms related to lack of androgens, including diminished libido, decreased generalized feeling of well-being, osteoporosis, and a host of other symptoms. The andropause syndrome is very prominent in men undergoing hormonal ablation therapy for prostate cancer. Most significant in this population are the side effects of hot flashes, anemia, gynecomastia, depression, cognitive decline, sarcopenia, a decreased overall quality of life, sexual dysfunction, and osteoporosis with subsequent bone fractures. The concept of andropause in prostate cancer patients is poorly represented in the literature. In this article, we review the current literature on the symptoms, signs, and possible therapies available to men who cannot take replacement testosterone.
The Kenneth B. Schwartz Center at Massachusetts General Hospital Hematology-Oncology Department: Hope for the Homeless
Authors: Penson Richard T. , Fergus Laura A. , Haston Ross J. , Clark John R. , Demotses Andrew , O'Connell James J. , Chabner Bruce A. , Lynch Thomas J. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Explain the personal elements of the barriers to care for homeless patients with cancer. Describe the personal costs and rewards of extraordinary care. Discuss the epidemiology of head and neck cancer and homelessness.
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, which provides hope to the patient and support to caregivers and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum during which caregivers discuss a specific cancer patient, reflect on the important psychological issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members.
A homeless man with head and neck cancer presents to the emergency room: a sad and familiar story. But this story is redeemed by his 35-year friendship with a priest, a man whose unconditional love and support became critical to the patient's care and treatment. The patient had lived for 30 years in homeless shelters, had problems with alcohol abuse, and was notoriously noncompliant with medical caregivers. He could not speak due to his disease, was illiterate with limited intellectual capacity, and had neither a job nor a family. Despite huge and apparently insurmountable problems for the patient, the oncology team was able to carve out a package of care, successfully communicate, and mobilize a support network to allow successful completion of chemoradiation therapy. The team developed a strong commitment to his care and an affectionate bond, which very positively affected all of those involved. We discuss issues of access to cancer care, and the special problems presented by homeless patients.
The Molecular Perspective: Epidermal Growth Factor
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 epidermal growth factor and its role in cancer development and treatment.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Goals and Objectives in the Management of Metastatic Breast Cancer
Authors: Chung Cathie T. , Carlson Robert W. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the natural history of untreated breast cancer. Identify the characteristics of women with metastatic breast cancer who may have especially favorable prognoses. Balance physician and patient perspectives in the selection of treatments for metastatic breast cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Patients with metastatic breast cancer consist of a heterogeneous group of patients whose prognoses and clinical courses can vary depending on host factors, such as comorbidity and age, and on tumor factors, such as hormone-receptor status, grade, and anatomical site of disease. Although the median survival time for patients with metastatic breast cancer is 2–4 years, subsets of patients with either indolent or limited metastatic disease may have prolonged survival times. Further, expectations of treatment, both in terms of efficacy and of toxicity, vary greatly based upon the specific treatment, patient characteristics, and tumor characteristics. Thus, the goals of treatment for patients with metastatic breast cancer are influenced by estimates of prognoses as well as a balance between physician and patient preferences regarding efficacy and toxicity considerations. Traditionally, objective measures of response and survival have been the targeted end points in clinical trial design and in physician selection of therapy for metastatic breast cancer. More recently, issues of quality of life have surfaced as important end points, especially from the perspective of the patient. The decision-making process in selecting the optimal treatment for patients with metastatic breast cancer is, therefore, a multidimensional process involving subjective as well as objective goals of treatment. Ultimately, the benefits of treatment must justify the risks and toxicities of the treatment, and the impact of treatment should be measured in relation to specified goals. Both physician and patient perspectives are important in establishing the objectives of treatment, and this process is optimally an interactive and ongoing process throughout the course of disease.
Update on Locally Advanced Breast Cancer
Authors: Giordano Sharon H. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Discuss the heterogeneity of locally advanced breast cancer. Explain the rationale for the multidisciplinary coordination of care for patients with locally advanced breast cancer. Identify the current standard of care for the treatment of locally advanced breast cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Locally advanced breast cancer remains a clinical challenge as the majority of patients with this diagnosis develop distant metastases despite appropriate therapy. Patients with locally advanced disease encompass a wide range of clinical scenarios including advanced primary tumors (stage T4), advanced nodal disease (fixed axillary nodes or involvement of ipsilateral supraclavicular, infraclavicular, or internal mammary nodes), and inflammatory carcinomas. The prognoses of women with locally advanced breast tumors are also heterogeneous and depend on tumor size, extent of lymph node involvement, and the presence or absence of inflammatory carcinoma. Women with locally advanced disease require multimodal therapy, and coordinated treatment planning among the medical oncologist, surgical oncologist, and radiation oncologist is necessary to optimize patient care. In this article, the epidemiology, evaluation, prognostic factors, and treatment for locally advanced breast cancer are discussed. Inflammatory cancer is also reviewed, but is considered separately due to its distinct biology and clinical behavior.
Activation of Tyrosine Kinases in Cancer
Authors: Vlahovic Gordana , Crawford Jeffrey 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify the advantages of small molecule inhibitors. Explain the significant role that tyrosine kinase plays in signal transduction. Describe the tyrosine kinase inhibitors clinical data.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Receptor and nonreceptor tyrosine kinases (TKs) have emerged as clinically useful drug target molecules for treating certain types of cancer. Epidermal growth factor receptor (EGFR)-TK is a transmembrane receptor TK that is overexpressed or aberrantly activated in the most common solid tumors, including non-small cell lung cancer and cancers of the breast, prostate, and colon. Activation of the EGFR-TK enzyme results in autophosphorylation, which drives signal transduction pathways leading to tumor growth and malignant progression. Randomized clinical trials of the EGFR-TK inhibitor gefitinib have demonstrated clinical benefits in patients with advanced non-small cell lung cancer whose disease had previously progressed on platinum- and docetaxel-based chemotherapy regimens. Bcr-Abl is a constitutively activated nonreceptor TK enzyme found in the cytoplasm of Philadelphia chromosome-positive leukemia cells. STI571 (imatinib mesylate) inhibits the Bcr-Abl TK, blocks the growth of these leukemia cells, and induces apoptosis. STI571 also inhibits other TKs, including the receptor TK c-kit, which is expressed in gastrointestinal stromal tumors. As TK inhibitors become available for clinical use, new challenges include predicting which patients are most likely to respond to these targeted TK inhibitors. Additional clinical trials are needed to develop the full potential of receptor and nonreceptor TK inhibitors for cancer treatment.
Cancer Survival and Incidence from the Surveillance, Epidemiology, and End Results (SEER) Program
Authors: Gloeckler Ries Lynn A. , Reichman Marsha E. , Lewis Denise Riedel , Hankey Benjamin F. , Edwards Brenda K. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Describe the role and significance of the NCI Surveillance and End Results (SEER) Program. Discuss the evolving changes in cancer mortality statistics in the U.S. Explain some of the important definitions of population science as they relate to cancer.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.comAn overview of data on cancer at all sites combined and on selected, frequently occurring cancers is presented. Descriptive cancer statistics include average annual Surveillance, Epidemiology, and End Results (SEER) Program incidence, U.S. mortality and median age at diagnosis, and death for the period 1996–2000. Changes during the time period 1992–2000 are summarized by the annual percent change in SEER incidence and U.S. mortality data for this period. Five-year relative survival for selected cancers is examined by stage at diagnosis, based on data from 1990–1999. In addition, 5-year conditional survival for patients already surviving for 1–3 years after diagnosis is discussed as well as relative survival for other time periods. These measures may be more meaningful for clinical management and prognosis than 5-year relative survival from time of diagnosis.The likelihood of developing cancer during one's lifetime is 1 in 2 for males and 1 in 3 for females, based on 1998–2000 data. It is estimated that approximately 9.6 million people in the U.S. who have had a diagnosis of cancer are alive. Five-year relative survival varies greatly by cancer site and stage at diagnosis, and tends to increase with time since diagnosis. The median age at cancer diagnosis is 68 for men and 65 for women. The 5-year relative survival rate for persons diagnosed with cancer is 62.7%, with variation by cancer site and stage at diagnosis. For patients diagnosed with cancers of the prostate, female breast, corpus uteri, and urinary bladder, the relative survival rate at 8 years is over 75%.
An Update on Hepatic Arterial Infusion Chemotherapy for Colorectal Cancer
Authors: Cohen Adam D. , Kemeny Nancy E. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Explain the rationale for using HAI chemotherapy in patients with isolated liver metastases from colorectal cancer. Summarize the data from randomized clinical trials using HAI chemotherapy in patients with both unresectable and resectable metastases. Describe current approaches combining HAI chemotherapy with newer systemic chemotherapeutic or biologic agents.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Hepatic metastases are a frequent complication of colorectal cancer (CRC), affecting over half of all CRC patients. Resection of isolated metastases can result in long-term survival, but the majority of patients relapse, and most have unresectable disease. Hepatic arterial infusion (HAI) chemotherapy delivers high concentrations of cytotoxic agents directly to liver metastases with minimal systemic toxicities. Advances in surgical techniques, development of fully implantable pumps, and modification of drug regimens have decreased complications and improved patient tolerability. Randomized trials comparing HAI with systemic chemotherapy have demonstrated superior response rates and times to hepatic progression for unresectable disease, and have shown better times to progression and overall survival rates in the adjuvant setting following hepatic resection. HAI chemotherapy has unique toxicities, including chemical hepatitis and biliary sclerosis, which can be mitigated by the addition of dexamethasone to therapy. In an attempt to prevent extrahepatic progression, combinations of HAI with systemic chemotherapy, including newer agents such as irinotecan and oxaliplatin, are currently being investigated, with promising early results.
Chronic Pain Following Treatment for Cancer: The Role of Opioids
Authors: Ballantyne Jane C. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Explain the principles of chronic pain management in cancer patients. Discuss the principles of opioid use in patients with chronic pain. Recognize and prevent substance-related disorders in cancer patients treated with opioids.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Opioids are the most effective analgesics for severe pain and the mainstay of acute and terminal cancer pain treatments. In those settings, opioids are used over a limited time period so that opioid tolerance, if it develops, is relatively easy to overcome, and other problems of opioid use, including substance abuse, are unlikely to be problematic. As cancer treatments improve and increasing numbers of cancer patients experience long remissions, chronic pain due to cancer, or to cancer treatment, becomes a clinical problem that oncologists will encounter. Chronic pain differs from acute and terminal pain in several fundamental respects. In the case of chronic pain, functional restoration is a predominant goal of treatment. Because it is often due to neuronal damage, the pain may be particularly sensitive to nonopioid medications, and opioids can be reserved for refractory pain. If opioids are chosen, tolerance, dependence, and addiction can interfere, and safeguards designed to minimize these must be built into the treatment plan. This article reviews the principles of chronic opioid therapy for non-cancer pain and how these principles may be adapted for patients with chronic pain due to cancer.
Small-Molecule Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors
Authors: Janmaat Maarten L. , Giaccone Giuseppe 
Published: August 2004

Abstract
The growth and proliferation of cells are usually tightly regulated processes that are activated by stimuli from their environment. Epidermal growth factor (EGF)-related peptides represent a class of molecules that can trigger cell proliferation, among several cellular processes, such as differentiation, migration, and survival. Binding of EGF-like peptides to the EGF receptor (EGFR) at the cell surface leads to a cascade of intracellular reactions that transduce signals to the nucleus, resulting in particular gene expression patterns. However, in many tumor cells, the regulation of EGFR activity is lost, due to increased or aberrant expression of the receptor or its ligands, and this contributes to many processes important for tumor growth, including cell proliferation, survival, angiogenesis, invasion, and metastasis. Many strategies have been developed that specifically target the EGFR and inhibit its activity. Of these, small-molecule tyrosine kinase inhibitors represent one of the most promising classes of anticancer agents. Here, we describe the status of small-molecule EGFR tyrosine kinase inhibitors in preclinical and clinical development.