bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Staff Dialogue on Aggressive Palliative Treatment Demanded by a Terminally Ill Patient: Psychosocial Issues Faced by Patients, Their Families, and Caregivers
Authors: Lintz Kathleen C. , Penson Richard T. , Cassem Ned , Harmon David C. , Chabner Bruce A. , Lynch Thomas J. 
Published: August 2004

Abstract
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, 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 psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members.
In this article, the case presentation and verbatim dialogue from the rounds are discussed with an emphasis on staff psychosocial issues. The case presented was of a 32-year-old man, who developed small cell osteosarcoma and was treated at MGH. He died after undergoing multiple courses of relatively ineffective chemotherapy. The case is made all the more poignant because of the pleasures, hopes, and stresses of having a child late in the course of his illness. Staff identified closely, both with him and his family, and their concern for him brought joy and meaning to their work, yet this complicated their ability to deal with his impending death. They felt that his unwillingness to admit defeat prevented them from saying goodbye to someone whom they loved and admired. Despite this, staff recognized that, ultimately, the patient's emotional needs and wishes had to be respected as a first priority and that constructive closure can be worked toward, if not achieved. In such situations, it is vital to have a colleague support system and a forum for discussion of such issues in order to defuse distress and reassure staff that they are doing all that can be done as professionals and caregivers.
A Staff Dialogue on Do Not Resuscitate Orders: Psychosocial Issues Faced by Patients, Their Families, and Caregivers
Authors: O'Shea Elizabeth M. , Penson Richard T. , Stern Theodore A. , Younger Jerry , Chabner Bruce A. , Lynch Thomas J. 
Published: August 2004

Abstract
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 non-profit organization dedicated to supporting and advancing compassionate health care delivery which 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.
The following case of a woman who developed lymphoma was discussed at the July and August, 1997 Schwartz Center Rounds. There were considerable delays and uncertainties in the diagnosis, which was followed by an unpredictably chaotic clinical course. Although she had made it clear to her doctor that she did not want “heroic measures,” she had unexpectedly rallied so many times that her son and her husband wanted her doctors to do everything possible to keep her alive, including the performance of cardiopulmonary resuscitation (CPR). The clinical benefit of CPR in the event of cardiac arrest in those with cancer is discussed, as are do not resuscitate (DNR) orders, living wills, and health care proxies. In addition, the issues that surround DNR status, including who should discuss DNR status with a patient, and how and when it should be discussed, are reviewed. Staff raised concerns about the effect of discussing DNR status on the doctor-patient relationship, and wondered whether writing DNR orders adversely affects the care of patients.
A Staff Dialogue on a Socially Distanced Patient: Psychosocial Issues Faced by Patients, Their Families, and Caregivers
Authors: Goodman Annekathryn , Penson Richard T. , Blatman Robert , McIntyre James , Gioiella Marie Elena , Chabner Bruce A. , Lynch Thomas J. 
Published: August 2004

Abstract
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 non-profit organization dedicated to supporting and advancing compassionate health care delivery, which 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.
The following case of an HIV-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependant on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.
Reality Testing in Cancer Treatment: The Phase I Trial of Endostatin
Authors: Ryan David P. , Penson Richard T. , Ahmed Sabrina , Chabner Bruce A. , Lynch Thomas J. 
Published: August 2004

Abstract
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 non-profit organization dedicated to supporting and advancing compassionate health care delivery which 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.
The September 1999 Schwartz Center Rounds addressed the growing attention around the phase I trial of Endostatin™. Endostatin represents a new treatment paradigm. It is an antiangiogenic protein, an endogenous fragment of collagen XVIII. In an attempt to ensure a fair allocation of a very limited number of treatment slots in this classical phase I trial, a lottery was established. More than 1,400 patients enrolled within 2 days of the lottery, all vying for three places in the first cohort. Two contrasting cases are presented, each a potentially eligible patient. The discussion focuses on the dilemma presented by patients desperate for an unproven treatment and the responsibility of staff to explain and support without compounding the hype or suffocating the hope.
A Staff Dialogue on Phase I Trials: Psychosocial Issues Faced by Patients, Their Families, and Caregivers
Authors: Lintz Kathleen C. , Penson Richard T. , Chabner Bruce A. , Mack Sally , Lynch Thomas J. 
Published: August 2004

Abstract
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded The Kenneth B. Schwartz Center to be housed at Massachusetts General Hospital (MGH). He created this center to advance the hopes, goals, and ideas expressed in his article, “A Patient's Story,” published in the July 16, 1995 issue of the Boston Globe Magazine. The Schwartz Center is a non-profit organization dedicated to strengthening the relationship between patients and caregivers and to supporting and advancing “compassionate health care delivery in which caregivers, patients, and their families relate meaningfully to one another in a way that provides hope to the patient, support to caregivers, and sustenance to the healing process.” One of the Center's major projects is the sponsoring of the Schwartz Center Rounds, a monthly, multidisciplinary forum in which caregivers discuss a specific cancer patient and the important psychosocial issues faced by the patient, family, and caregivers. The forum allows caregivers to reflect on their experiences with patients and to gain support and insight from fellow staff members.
The following case discussion was addressed at the January 1998 Schwartz Center Rounds. In this article, the case will be presented, followed by verbatim dialogue from the Rounds and a subsequent discussion of the relevant issues with emphasis on staff psychosocial issues.
J.T. was a 43-year-old man who developed adenocarcinoma of the lung and was treated at MGH. He died while participating in a phase I trial, resulting in marked frustration and distress among his caregivers. Staff questioned whether cancer patients entering phase I trials and their families receive unbiased information about the possible risks and benefits of the trial. They were also concerned about whether or not patients and their families really understand the physical and emotional risks of a trial. Moreover, they addressed whether patients are presented with alternatives to enrolling in a phase I trial, such as palliative care. Despite all these concerns, caregivers are reconciled to the belief that patients do value the opportunity to participate in phase I trials, in that they can contribute hope and meaning to other patients' struggles with cancer.
Cytotoxic Agents in the Era of Molecular Targets and Genomics
Authors: Chabner Bruce A. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to: Identify single nucleotide polymorphisms.Explain how they could influence drug response and toxicity in cancer patients.Explain how the DNA repair capability of tumor cells affects their response to ET-743 and other cancer drugs.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.comCancer treatment is evolving due to the development of molecularly targeted agents and the utilization of pharmacogenomics and pharmacogenetics to identify patients who are at an increased risk for toxicity or may be uniquely responsive to cytotoxic therapies. By identifying polymorphisms in the human genome that confer changes in the ability to metabolize or activate cancer agents, a more patient-specific treatment approach can be initiated. Molecularly targeted therapies such as PS-341, flavopiridol, Iressa, and anti-vascular endothelial growth factor antibodies may help to overcome resistance to cytotoxic therapies by lowering the apoptotic threshold and increasing cytotoxicity. Using molecularly targeted agents in combination with traditional cytotoxic agents may increase the percentage of patients who achieve disease stabilization and prolonged survival. With the development of genetic tools and genotyping of tumor and patient prior to initiating treatment, antitumor efficacy may be increased with a substantial reduction in toxicity.
Vascular Endothelial Growth Factor: Regulation in the Mouse Skin Carcinogenesis Model and Use in Antiangiogenesis Cancer Therapy
Authors: Conti Claudio J. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to: Describe mechanisms of tumor neovascularization.Identify possible targets for cancer therapy in the biologic pathways that control angiogenesis.Identify some of the drugs that are presently used in preclinical or clinical trials, as well as their targets.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Of the various mechanisms responsible for tumor neovascularization, the angiogenesis process, in particular vascular endothelial growth factor (VEGF), is described here as a target for cancer therapy. While hypoxia is a trigger of tumor angiogenesis, various alterations in oncogenes and tumor suppressor genes also have been reported to induce VEGF expression in tumors. The regulation of VEGF has been investigated in chemically induced mouse squamous cell carcinoma of the skin. In this cancer model, VEGF expression appears to be dependent on ras oncogene activation as well as the epidermal growth factor receptor. Thus, in addition to VEGF, oncogene signaling pathways may be relevant targets in antiangiogenesis cancer therapies.
The central role of VEGF in angiogenesis has led to the development of several drugs targeting the pathway of this growth factor. The present paper provides an overview of these drugs and their stage of development. In the near future, clinical trials using anti-VEGF drugs and other antiangiogenic agents, such as endostatin and angiostatin, will yield valuable information about their potential for cancer therapy.
ZD1839 (Iressa™): For More Than Just Non-Small Cell Lung Cancer
Authors: Ranson Malcolm 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Recognize the basic biology and importance of the erbB family of growth factor receptors.Explain the current status of clinical development of ZD1839 in solid tumors other than non-small cell lung cancer (NSCLC).Appreciate some of the future directions for clinical research for this class of anti-tumor agent.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
ZD1839 (Iressa™) is an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor that blocks signal transduction pathways involved in cell proliferation. Preclinical studies demonstrated that ZD1839 is a promising agent for the treatment of a wide range of tumors and has additive-to-synergistic effects when combined with radiation or chemotherapy in various cell lines and xenografts. Phase I clinical trials have reported that ZD1839 has acceptable tolerability and antitumor activity. In addition to non-small cell lung cancer, phase II/III studies are currently investigating ZD1839 as monotherapy or in combination therapy against prostate, breast, head and neck, gastric, and colorectal tumors.
ZD1839 (Iressa™): What's in It for the Patient?
Authors: Natale Ronald B. , Zaretsky Susan L. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Identify the available survey instruments for measuring the quality of life (QOL) of patients with lung cancer.Appreciate the importance of symptom management to cancer patients.Learn how QOL measurements are being assessed in clinical trials in lung cancer.Recognize the global burden of lung cancer.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Although cytotoxic chemotherapy has had a significant impact on the treatment of some malignancies, its impact against most solid tumors is limited. This is especially true in the case of non-small cell lung cancer (NSCLC) in which about 90% of patients ultimately die from metastatic disease. Although chemotherapy has produced modest improvements in response rates and survival in a subset of patients with advanced NSCLC, its primary objective remains to provide palliation of disabling disease-related symptoms. It is hoped that the introduction of new, rationally designed anticancer agents, with greater specificity and less toxicity, will improve the outcome for patients with a range of tumor types, including NSCLC.
ZD1839 (Iressa™) is the first of a new class of epidermal growth factor receptor tyrosine kinase inhibitors. The results of two large phase II trials have shown that ZD1839 provides clinically significant symptom relief for many patients with extensively pretreated advanced NSCLC. Moreover, this improvement in disease-related symptoms correlated with improved survival and tumor response. ZD1839 also had an acceptable tolerability profile: most drug-related adverse events were mild and reversible and quite different from those typically associated with cytotoxic agents. Some patients also experienced improved quality of life, particularly those with a partial response or stable disease. Thus, ZD1839 offers a new treatment option providing meaningful symptom relief for many patients with advanced NSCLC.
Epidermal Growth Factor Receptor Dependence in Human Tumors: More Than Just Expression?
Authors: Arteaga Carlos L. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Describe the current limitations in measuring levels of EGR receptor (EGFR) expression in tissues.Identify the molecular pathways for signal transduction induced by EGFR activation.Identify the level of expression of EGF in different tumor types.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
The epidermal growth factor receptor (EGFR) is a rational target for antitumor strategies. EGFR signaling causes increased proliferation, decreased apoptosis, and enhanced tumor cell motility and neo-angiogenesis. The EGFR is expressed or highly expressed in a variety of human tumors of epithelial origin. ZD1839 (Iressa™) is an orally active, selective EGFR tyrosine kinase inhibitor, which blocks signal transduction pathways implicated in proliferation and survival of cancer cells.
The lack of a consistent method of evaluating levels of EGFR has caused a disparity in reports of the EGFR as a prognostic factor; however, for some tumors, EGFR is a strong prognostic indicator associated with more aggressive disease and reduced survival. So far, no clear association between EGFR levels and response to EGFR-targeted agents has been found. Preclinical studies with ZD1839 have noted a relationship between the two in some cases, but not others.
EGFR signaling may be increased by a number of mechanisms in addition to high expression levels of EGFR, including receptor mutations, heterodimerization with other members of this receptor family such as HER2 (erbB2), increased expression of (autocrine/ paracrine) ligands, and alterations in molecules that control receptor signaling output. Each of these components could be assessed to give an indication of the magnitude of EGFR signal amplification. Evaluation of signaling components downstream from EGFR should provide information on the activation of the EGFR pathway.
Until EGFR-based assays predictive of a response to receptor-targeted therapies are available, there is no clear justification for stratifying patients by EGFR status or excluding patients with low EGFR levels from trials with ZD1839 or other EGFR inhibitors.
ZD1839 (Iressa™) in Non-Small Cell Lung Cancer
Authors: Herbst Roy S. , Kies Merrill S. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Identify the current status of Phase I, II, and III trials of ZD1839 in non-small cell lung cancer (NSCLC).Describe the clinical development plan for ZD1839 in second line, adjuvant (maintenance), and prevention in patients with NSCLC.Identify treatment options for patients with NSCLC.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Despite the advent of cisplatin-based combination chemotherapy for advanced non-small cell lung cancer (NSCLC), the prognosis for this patient population remains poor. Novel biologically targeted agents currently in development have the potential for greater efficacy against NSCLC, and possibly less toxicity than is associated with conventional cytotoxic chemotherapy. The epidermal growth factor receptor (EGFR) is recognized as a potentially useful target, and the small molecule, orally active EGFR-tyrosine kinase inhibitor ZD1839 (Iressa™) is currently the furthest along in clinical development of the anti-EGFR agents. This review summarizes the currently available clinical data on the use of ZD1839 in the treatment of NSCLC.
Relapsed Ovarian Cancer: Challenges and Management Strategies for a Chronic Disease
Authors: Armstrong Deborah K. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:Better appreciate the challenges faced in managing treatment of patients with ovarian cancer.Describe the factors that impact on the design of long-term treatment strategies for patients with relapsed ovarian cancer.Describe important disease management issues, including when to initiate treatment, which treatments to consider and why, and patient education.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com
Advances in the treatment and early detection of ovarian cancer have led to gains in 5-year survival rates, with 52% of women diagnosed between 1992 and 1997 surviving 5 years or longer, compared with 41% of women diagnosed between 1983 and 1985. Although approximately 10%-15% of patients achieve and maintain complete responses to therapy, the remaining patients have persistent disease or eventually relapse. These patients will generally undergo a series of treatments, each associated with progressively shorter treatment-free intervals. Nevertheless, median survival of patients with recurrent ovarian cancer ranges from 12-24 months, demonstrating the chronic natural history of the disease. Advances in the treatment of ovarian cancer over the past decade have led to these improvements and have prompted oncologists to now view the management of patients with ovarian cancer as an ongoing, long-term challenge. This shift in approach has raised important new questions regarding patient management, including the need to define trigger points for initiating or changing treatment (e.g., sequential increases in serum cancer antigen 125 levels, appearance of symptoms, or cumulative toxicities), anticipation of impending treatment decision points, recognition that the overtreatment of patients early in the disease process may adversely affect future treatment opportunities, and a renewed emphasis on patient education and participation in decision-making. This review will discuss these important patient management issues and will conclude with case studies illustrating two distinct treatment strategies (planning and sequencing) for the long-term management of patients with ovarian cancer.