Showing papers in "CA: A Cancer Journal for Clinicians in 2008"

Cancer statistics, 2008.

Abstract: Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,437,180 new cancer cases and 565,650 deaths from cancer are projected to occur in the United States in 2008. Notable trends in cancer incidence and mortality include stabilization of incidence rates for all cancer sites combined in men from 1995 through 2004 and in women from 1999 through 2004 and a continued decrease in the cancer death rate since 1990 in men and since 1991 in women. Overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% and 10.5%, respectively, resulting in the avoidance of over a half million deaths from cancer during this time interval. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year, as well as the proportionate contribution of selected sites to the overall trends. Although much progress has been made in reducing mortality rates, stabilizing incidence rates, and improving survival, cancer still accounts for more deaths than heart disease in persons under age 85 years. Further progress can be accelerated by supporting new discoveries and by applying existing cancer control knowledge across all segments of the population.

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi‐Society Task Force on Colorectal Cancer, and the American College of Radiology*†

Abstract: In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening

Association of insurance with cancer care utilization and outcomes.

Abstract: Advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14% decrease in the death rates from all cancers combined from 1991 to 2004 in the overall US population, with remarkable declines in mortality for the top 3 causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in women (breast and colorectal cancer). However, not all segments of the population have benefited equally from this progress, and evidence suggests that some of these differences are related to lack of access to health care. Lack of adequate health insurance appears to be a critical barrier to receipt of appropriate health care services. This article provides an overview of systems of health insurance in the United States, demographic and socioeconomic characteristics associated with health insurance coverage, and economic burdens related to health care among individuals and families. This article also presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey and the National Cancer Data Base. Although this article focuses on associations between health insurance and cancer care utilization and outcomes, it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient-level, provider, and health system factors. Evidence presented in this paper suggests that addressing insurance and cost-related barriers to care is a critical component of efforts to ensure that all Americans are able to share in the progress that can be achieved by access to high-quality cancer prevention, early detection, and treatment services.

Application of Nanotechnology in Cancer Therapy and Imaging

Abstract: Recent developments in nanotechnology have provided researchers with new tools for cancer imaging and treatment. This technology has enabled the development of nanoscale devices that can be conjugated with several functional molecules simultaneously, including tumor-specific ligands, antibodies, anticancer drugs, and imaging probes. Since these nanodevices are 100 to 1,000-fold smaller than cancer cells, they can be easily transferred through leaky blood vessels and interact with targeted tumor-specific proteins both on the surface of and inside cancer cells. Therefore, their application as cancer cell-specific delivery vehicles will be a significant addition to the currently available armory for cancer therapeutics and imaging.

Psychosocial Interventions for Anxiety and Depression in Adult Cancer Patients: Achievements and Challenges†

Abstract: Psychosocial care is increasingly recognized as an essential component of the comprehensive care of the individual with cancer. Improving patients' access to psychosocial care is important; however, ensuring that the care made available has been shown to be effective is just as important. Accordingly, the goal of this review is to describe an evidence-based approach to the psychosocial care of adults with cancer. The focus is on anxiety and depression because a considerable body of research has examined the impact of psychosocial interventions on these outcomes. After describing the sources, assessment, and prevalence of anxiety and depression in adults with cancer and presenting existing clinical practice guidelines for their management, previous publications that systematically reviewed evidence of the efficacy of psychosocial interventions are summarized. The use of these publications to derive specific recommendations for the use of psychosocial interventions in the management of anxiety and depression is then illustrated. In addition, examples are provided of interventions that are effective against anxiety and depression and have good potential for dissemination in routine clinical practice. The review concludes with a discussion of future directions for the continued development of an evidence-based approach to the psychosocial care of people with cancer.

Vascular access in oncology patients.

Abstract: Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date.

Decision making in oncology: a review of patient decision aids to support patient participation.

Abstract: Although cancer management is becoming more structured with disease-specific guidelines and clinical pathways, many decisions remain complex. Contributing to this complexity is the need to make value tradeoffs between benefits and harms across cancer treatment and/or screening options. Since there is no "best" option for everyone, decisions are defined as being of higher quality when informed with the latest scientific evidence and based on patients' informed values associated with outcomes of options. However, clinicians are not good judges of patients' values, and patients often have inadequate knowledge, unrealistic expectations, and decisional conflict that interfere with their involvement in decision making. Effective approaches to support patient involvement into clinical decisions include clinicians trained in shared decision making, question prompt sheets, patient decision aids, and decision coaching by nurses and other allied health professionals. Based on systematic review of 23 randomized trials of cancer patient decision aids, patients exposed to decision aids are more likely to participate in decision making and achieve higher-quality decisions. This review highlights key historical changes leading to patient involvement in decision making, summarizes evidence on effective interventions to support shared decision making, explores strategies to implement these interventions in oncology practices, and identifies future directions.

Spinal extradural metastasis: review of current treatment options.

Abstract: Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new developments in the surgical and radiotherapeutic fields, as well as in medical oncology, external beam radiotherapy is the cornerstone of the treatment of spinal metastases. In selected cases, surgical treatment is a proven option. Vertebroplasty or kyphoplasty can also be considered. Supportive medical care does not differ from that given for symptomatic lesions to the skeletal system elsewhere in the body. After discussing the treatment options, an algorithm is given.

Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues.

Abstract: Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer screening rates and trends in US adults. In 2007, the ACS updated its colorectal cancer screening guidelines in a collaborative effort with the US Multi-Society Task Force and the American College of Radiology. In this issue of the journal, we summarize the current ACS guidelines, provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and address some issues related to access to care.

The staging of cancer: a retrospective and prospective appraisal.

Abstract: The tumor-node-metastasis (TNM) classification describes the anatomic extent of cancer. The ability to separately classify the individual T, N, and M elements and then group them into stages differs from other cancer staging classifications, which are primarily concerned with summarized groups. The objectives of the TNM system are to aid clinicians and investigators in planning treatment, assessing prognosis, stratifying patients for therapeutic studies, evaluating the results of treatment, and facilitating communication. The most important challenge facing TNM is how to interface the current taxonomy with the numerous nonanatomic prognostic factors currently in use or under study. As nonanatomic prognostic factors become widely used, TNM will remain a solid foundation on which to build prognostic classifications. There is, however, a risk that this system will be corrupted by a variety of irrelevant prognostic data. An anatomic extent of disease classification is needed to provide a standard against which to measure the importance of nonanatomic factors. Methods are needed to express overall prognosis without losing the vital anatomic content of TNM. These methods should be able to integrate multiple prognostic factors, including TNM, yet permit TNM to remain intact and distinct.

Management of Complications of Prostate Cancer Treatment

Abstract: Prostate cancer is the most commonly diagnosed noncutaneous cancer in men in the United States. Treatment of men with prostate cancer commonly involves surgical, radiation, or hormone therapy. Most men with prostate cancer live for many years after diagnosis and may never suffer morbidity or mortality attributable to prostate cancer. The short-term and long-term adverse consequences of therapy are, therefore, of great importance. Adverse effects of radical prostatectomy include immediate postoperative complications and long-term urinary and sexual complications. External beam or interstitial radiation therapy in men with localized prostate cancer may lead to urinary, gastrointestinal, and sexual complications. Improvements in surgical and radiation techniques have reduced the incidence of many of these complications. Hormone treatment typically consists of androgen deprivation therapy, and consequences of such therapy may include vasomotor flushing, anemia, and bone density loss. Numerous clinical trials have studied the role of bone antiresorptive therapy for prevention of bone density loss and fractures. Other long-term consequences of androgen deprivation therapy may include adverse body composition changes and increased risk of insulin resistance, diabetes, and cardiovascular disease. Ongoing and planned clinical trials will continue to address strategies to prevent treatment-related side effects and improve quality of life for men with prostate cancer.

Expanding role of the medical oncologist in the management of head and neck cancer.

Abstract: The multidisciplinary approach to treating squamous cell carcinoma of the head and neck is complex and evolving. This article aims to review some recent developments in squamous cell carcinoma of the head and neck, in particular the expanding role of chemotherapy in its management. Surgery and radiotherapy have remained the mainstay of therapy. Chemotherapy is increasingly being incorporated into the treatment of squamous cell carcinoma of the head and neck. Previously, radiotherapy following surgery was the standard approach to the treatment of locoregionally advanced resectable disease. Data from randomized trials have confirmed the benefits of concurrent chemoradiotherapy in the adjuvant setting. Chemoradiotherapy is also the recommended approach for unresectable disease. Induction chemotherapy has been useful in resectable disease where organ preservation is desirable, but this approach was inferior for the goal of larynx preservation, while leading to similar survival when compared with concomitant chemoradiotherapy. There is recent evidence that taxanes added to induction chemotherapy with cisplatin and fluorouracil result in improved survival outcomes. Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both locoregionally advanced and recurrent/metastatic squamous cell carcinoma of the head and neck.

Tumor-node-metastasis staging of pancreatic adenocarcinoma.

Abstract: Accurate disease staging of patients with pancreatic cancer is essential to divide patients into prognostic subgroups, to allow delivery of stage-specific therapies, and to facilitate meaningful discussions between physicians and patients regarding management and expected outcomes. The tumor-node-metastasis staging system of the American Joint Commission on Cancer has undergone significant revisions over the past 2 decades. In its current form, the system places an emphasis on preoperative clinical staging and facilitates division of patients with pancreatic cancer into 4 groups based on a determination of local resectability and the presence or absence of distant disease as determined on high-quality cross-sectional imaging. A modern understanding of local tumor factors that influence technical resectability is incorporated into the algorithm. In this review, we examine the American Joint Commission on Cancer staging system, describe the rationale for its use, and demonstrate how it is a clinically relevant tool for the staging and management of patients with pancreatic cancer.

Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean?

Abstract: While the past decade has seen the development of multiple new interventions to diagnose and treat cancer, as well as to improve the quality of life for cancer patients, many of these interventions have substantial costs. This has resulted in increased scrutiny of the costs of care for cancer, as well as the costs relative to the benefits for cancer treatments. It is important for oncologists and other members of the cancer community to consider and understand how economic evaluations of cancer interventions are performed and to be able to use and critique these evaluations. This review discusses the components, main types, and analytic issues of health economic evaluations using studies of cancer interventions as examples. We also highlight limitations of these economic evaluations and discuss why members of the cancer community should care about economic analyses.

Opportunities and strategies for breast cancer prevention through risk reduction

Abstract: Due to the high incidence of breast cancer among US females, risk-reduction strategies are essential. Before considering approaches to breast cancer risk reduction, it is important for clinicians to complete individualized qualitative and quantitative assessments of risk for their patients in order to inform physicians' clinical decision making and management and to engage patients collaboratively in a thorough discussion of risks and benefits. This review will summarize information on potential pharmacologic, nutritional, surgical, and behavioral approaches to reducing breast cancer risk. While there is no clear evidence that specific dietary components can effectively reduce breast cancer risk, weight gain and obesity in adulthood are risk factors for the development of postmenopausal breast cancer. Alcohol consumption, even at moderate levels, increases breast cancer risk, although some of the detrimental effects may be reduced by sufficient folate intake. Women at increased risk of breast cancer can opt to reduce their breast cancer risk through the use of tamoxifen or raloxifene; other chemopreventive agents remain under investigation. Surgical approaches to risk reductions are restricted to those patients with a substantially increased risk of developing breast cancer. Patients should be encouraged to maintain a healthy lifestyle for their overall well-being and to remain up to date with recommendations for screening and surveillance.

Surviving Cancer or Other Serious Illness: A Review of Individual and Community Resources†

Abstract: In order to provide appropriate individual and community support for cancer survivors, there is a great need to better understand how people who have survived cancer or other serious illness adapt positively to health challenges and to identify effective approaches for helping people cope with health challenges over their lifetime. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to illness. Of particular interest is the ability of individuals to survive or even thrive despite an adverse event, as influenced by both individual factors such as resiliency and external factors like social support. The experience of having a potentially life-threatening illness can lead to positive adaptation and increased ability to thrive despite difficult circumstances. The cancer survivorship movement and the cancer community in general provide important resources for improving quality of life and alleviating human suffering and distress among patients and survivors and for adding personal meaning and hope to people's lives.

Aiming at a curative strategy for follicular lymphoma.

Abstract: Follicular lymphoma is often managed as an incurable disease. However, a substantial and growing fraction of patients are achieving long-term disease-free survival from aggressive treatment approaches. The application of novel therapeutic tools, including monoclonal antibodies, radioimmunotherapy, and vaccines, as well as new and more active chemotherapeutic agents, is producing complete responses in the majority of treated patients, with a 2-fold increase in disease- and progression-free survival in randomized trials. For some of these treatment approaches, follow up has not yet been long enough to determine a median response duration, but it certainly exceeds the "2 to 3 years" that is routinely stated as dogma to patients with this illness. Furthermore, some patients remain in complete remission beyond a decade from their initial treatment, implying that the assumption of inevitable relapse also must be challenged. One clear fact is that no patients will ever be cured by adopting a palliative treatment approach. The assumption that patients with follicular lymphoma are incurable is certain to be a self-fulfilling prophecy. Here the author summarizes the large and growing body of knowledge that suggests an expectant approach to management is not appropriate for all patients.

Cancer Quality Alliance: Blueprint for a better cancer care system.

Abstract: The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a "Blueprint" for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post-treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst- and a best-case scenario, and concludes with a discussion section identifying "what went right" in the best case and "what went wrong" in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst- and best-case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicine's report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Utilizing the Tumor-Node-Metastasis Staging for Prostate Cancer: The Sixth Edition, 2002†

Abstract: The Sixth Edition of the tumor-node-metastasis staging system for prostate cancer attempts to provide a helpful staging paradigm for clinicians. Accurate staging is critical not only for managing individual patients, but also for ascertaining trends in disease pattern in a large population of patients with prostate cancer. Several modifications have been made in an attempt to improve the cohesiveness and uniformity of patient evaluation and to aid in future meaningful clinical research. As data are accumulated and analysis continues, ongoing critical evaluation of this staging system will undoubtedly incorporate new evidence-based factors and bring about future refinements to prostate cancer staging.