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Showing papers in "CA: A Cancer Journal for Clinicians in 2015"


Journal ArticleDOI
TL;DR: A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.
Abstract: Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

23,203 citations


Journal ArticleDOI
TL;DR: The overall cancer death rate decreased from 215.1 (per 100,000 population) in 1991 to 168.7 in 2011, a total relative decline of 22%.
Abstract: Each year the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. A total of 1,658,370 new cancer cases and 589,430 cancer deaths are projected to occur in the United States in 2015. During the most recent 5 years for which there are data (2007-2011), delay-adjusted cancer incidence rates (13 oldest SEER registries) declined by 1.8% per year in men and were stable in women, while cancer death rates nationwide decreased by 1.8% per year in men and by 1.4% per year in women. The overall cancer death rate decreased from 215.1 (per 100,000 population) in 1991 to 168.7 in 2011, a total relative decline of 22%. However, the magnitude of the decline varied by state, and was generally lowest in the South (∼15%) and highest in the Northeast (≥20%). For example, there were declines of 25% to 30% in Maryland, New Jersey, Massachusetts, New York, and Delaware, which collectively averted 29,000 cancer deaths in 2011 as a result of this progress. Further gains can be accelerated by applying existing cancer control knowledge across all segments of the population.

10,989 citations


Journal ArticleDOI
TL;DR: In this article, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis.
Abstract: Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.

724 citations


Journal ArticleDOI
TL;DR: The American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening as mentioned in this paper.
Abstract: Each year, the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines. The latest data on utilization of cancer screening from the National Health Interview Survey (NHIS) also is described, as are several issues related to screening coverage under the Affordable Care Act, including the expansion of the Medicaid program.

375 citations


Journal ArticleDOI
TL;DR: Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer.
Abstract: Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.4% (55.4 million/318 million) of the total US population in 2014. Every 3 years, the American Cancer Society reports on cancer statistics for Hispanics based on incidence data from the National Cancer Institute, the 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. Among Hispanics in 2015, there will be an estimated 125,900 new cancer cases diagnosed and 37,800 cancer deaths. For all cancers combined, Hispanics have 20% lower incidence rates and 30% lower death rates compared with non-Hispanic whites (NHWs); however, death rates are slightly higher among Hispanics during adolescence (aged 15-19 years). Hispanic cancer rates vary by country of origin and are generally lowest in Mexicans, with the exception of infection-associated cancers. Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer. Variations in cancer risk between Hispanics and NHWs, as well as between subpopulations, are driven by differences in exposure to cancer-causing infectious agents, rates of screening, and lifestyle patterns. Strategies for reducing cancer risk in Hispanic populations include increasing the uptake of preventive services (e.g., screening and vaccination) and targeted interventions to reduce obesity, tobacco use, and alcohol consumption.

372 citations


Journal ArticleDOI
TL;DR: A recent review as mentioned in this paper synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer, and a hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice.
Abstract: Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.

356 citations


Journal ArticleDOI
TL;DR: An overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations is provided.
Abstract: This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

326 citations


Journal ArticleDOI
TL;DR: In this paper, the authors present guidelines to assist primary care clinicians in delivering risk-based health care for colorectal cancer survivors who have completed active therapy, including communication and coordination of care between the treating oncologist and the primary care clinician to effectively manage the long-term care of CRC survivors.
Abstract: Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.

325 citations


Journal ArticleDOI
TL;DR: This article evaluates interventions to close the racial survival disparity in breast cancer and argues that prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment.
Abstract: It is well known that there is a significant racial divide in breast cancer incidence and mortality rates. African American women are less likely to be diagnosed with breast cancer than white women but are more likely to die from it. This review explores the factors that may contribute to the racial survival disparity. Consideration is paid to what is known about the role of differences in tumor biology, genomics, cancer screening, and quality of cancer care. It is argued that it is the collision of 2 forces, tumor biology and genomics, with patterns of care that leads to the breast cancer mortality gap. The delays, misuse, and underuse of treatment for African American patients are of increased significance when these patients are presenting with more aggressive forms of breast cancer. In the current climate of health care reform ushered in by the Affordable Care Act, this article also evaluates interventions to close the disparity gap. Prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment. Lastly, areas of future investigation and policy initiatives aimed at reducing the racial survival disparity in breast cancer are discussed.

235 citations


Journal ArticleDOI
TL;DR: An overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema is provided in this article, which includes current trends in therapeutic and surgical treatment options as well as longer-term management.
Abstract: This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.

198 citations


Journal ArticleDOI
TL;DR: The importance of expanding cancer treatment to include the promotion of overall long-term health is emphasized in the Institute of Medicine report on delivering quality oncology care as discussed by the authors, and the role of the oncologist in helping cancer patients and survivors embark upon changes in lifestyle behaviors, and it calls for the development of partnerships between oncologists, primary care providers, and experts in nutrition, exercise science, and behavior change to help positively orient cancer patients toward longer and healthier lives.
Abstract: Answer questions and earn CME/CNE The importance of expanding cancer treatment to include the promotion of overall long-term health is emphasized in the Institute of Medicine report on delivering quality oncology care. Weight management, physical activity, and a healthy diet are key components of tertiary prevention but may be areas in which the oncologist and/or the oncology care team may be less familiar. This article reviews current diet and physical activity guidelines, the evidence supporting those recommendations, and provides an overview of practical interventions that have resulted in favorable improvements in lifestyle behavior change in cancer survivors. It also describes current lifestyle practices among cancer survivors and the role of the oncologist in helping cancer patients and survivors embark upon changes in lifestyle behaviors, and it calls for the development of partnerships between oncology providers, primary care providers, and experts in nutrition, exercise science, and behavior change to help positively orient cancer patients toward longer and healthier lives.

Journal ArticleDOI
TL;DR: Information is provided about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States—ductal carcinoma in situ and lobular carcinomas in situ—using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries.
Abstract: An estimated 60,290 new cases of breast carcinoma in situ are expected to be diagnosed in 2015, and approximately 1 in 33 women is likely to receive an in situ breast cancer diagnosis in her lifetime. Although in situ breast cancers are relatively common, their clinical significance and optimal treatment are topics of uncertainty and concern for both patients and clinicians. In this article, the American Cancer Society provides information about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States-ductal carcinoma in situ and lobular carcinoma in situ-using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries. The authors also present an overview of in situ breast cancer detection, treatment, risk factors, and prevention and discuss research needs and initiatives.

Journal ArticleDOI
TL;DR: The evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice.
Abstract: Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.

Journal ArticleDOI
TL;DR: Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user‐centered design of decision aids that promote shared decisionMaking.
Abstract: Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.

Journal ArticleDOI
TL;DR: A review of the literature regarding the medical use of marijuana and these cannabinoid pharmaceuticals (with emphasis on indications relevant to oncology), as well as available information regarding adverse effects of marijuana use is presented in this article.
Abstract: Answer questions and earn CME/CNE Marijuana has been used for centuries, and interest in its medicinal properties has been increasing in recent years. Investigations into these medicinal properties has led to the development of cannabinoid pharmaceuticals such as dronabinol, nabilone, and nabiximols. Dronabinol is best studied in the treatment of nausea secondary to cancer chemotherapy and anorexia associated with weight loss in patients with acquired immune deficiency syndrome, and is approved by the US Food and Drug Administration for those indications. Nabilone has been best studied for the treatment of nausea secondary to cancer chemotherapy. There are also limited studies of these drugs for other conditions. Nabiximols is only available in the United States through clinical trials, but is used in Canada and the United Kingdom for the treatment of spasticity secondary to multiple sclerosis and pain. Studies of marijuana have concentrated on nausea, appetite, and pain. This article will review the literature regarding the medical use of marijuana and these cannabinoid pharmaceuticals (with emphasis on indications relevant to oncology), as well as available information regarding adverse effects of marijuana use.

Journal ArticleDOI
TL;DR: The authors in this paper reviewed the evolution and current state of treatment options for patients with peritoneal carcinomatosis and highlighted recent advances in understanding the molecular biology of carcinoma and the focus of current and future clinical trials.
Abstract: Until recently, a diagnosis of peritoneal carcinomatosis was uniformly accompanied by a grim prognosis that was typically measured in weeks to months. Consequently, the management of carcinomatosis revolves largely around palliation of symptoms such as bowel obstruction, nausea, pain, fatigue, and cachexia. A prior lack of effective treatment options created the nihilistic view that currently exists and persists despite improvements in the efficacy of systemic therapy and the evolution of multimodality approaches including surgery and intraperitoneal chemotherapy. This article reviews the evolution and current state of treatment options for patients with peritoneal carcinomatosis. In addition, it highlights recent advances in understanding the molecular biology of carcinomatosis and the focus of current and future clinical trials. Finally, this article provides practical management options for the palliation of common complications of carcinomatosis. It is hoped that the reader will recognize that carcinomatosis is no longer an imminent death sentence and that through continued research and therapeutic innovation, clinicians can make an even greater impact on this form of metastatic cancer.

Journal ArticleDOI
TL;DR: The collaborative research infrastructure for children with cancer in the United States is well positioned to advance novel treatments into clinical investigations for a spectrum of rare and ultra‐rare childhood cancers.
Abstract: The outcome for children with cancer has improved significantly over the past 60 years, with greater than 80% of patients today becoming 5-year survivors Despite this progress, cancer remains the leading cause of death from disease in children in the United States, and significant short-term and long-term treatment toxicities continue to impact the majority of children with cancer The development of targeted new agents offers the prospect of potentially more effective and less toxic treatment for children More than a decade since imatinib mesylate was introduced into the treatment of children with Philadelphia chromosome-positive acute lymphoblastic leukemia, transforming its outcome, a range of targeted agents has undergone study in pediatric cancer patients Early lessons learned from these studies include a better understanding of the adverse event profile of these drugs in children, the challenge of developing pediatric-specific formulations, and the continued reliance on successful development for adult cancer indications on pediatric drug development The collaborative research infrastructure for children with cancer in the United States is well positioned to advance novel treatments into clinical investigations for a spectrum of rare and ultra-rare childhood cancers A greater investment of resources in target discovery and validation can help drive much needed development of new, more effective treatments for children with cancer

Journal ArticleDOI
TL;DR: Early integration of pediatric palliative care (PPC) for children with life-threatening conditions and their families enhances the provision of holistic care, addressing psychological, social, spiritual, and physical concerns, without precluding treatment with the goal of cure as mentioned in this paper.
Abstract: Early integration of pediatric palliative care (PPC) for children with life-threatening conditions and their families enhances the provision of holistic care, addressing psychological, social, spiritual, and physical concerns, without precluding treatment with the goal of cure. PPC involvement ideally extends throughout the illness trajectory to improve continuity of care for patients and families. Although current PPC models focus primarily on the hospital setting, community-based PPC (CBPPC) programs are increasingly integral to the coordination, continuity, and provision of quality care. In this review, the authors examine the purpose, design, and infrastructure of CBPPC in the United States, highlighting eligibility criteria, optimal referral models to enhance early involvement, and fundamental tenets of CBPPC. This article also appraises the role of CBPPC in promoting family-centered care. This model strives to enhance shared decision making, facilitate seamless handoffs of care, maintain desired locations of care, and ease the end of life for children who die at home. The effect of legislation on the advent and evolution of CBPPC also is discussed, as is an assessment of the current status of state-specific CBPPC programs and barriers to implementation of CBPPC. Finally, strategies and resources for designing, implementing, and maintaining quality standards in CBPPC programs are reviewed.

Journal ArticleDOI
TL;DR: A review of the multimodal approach to the diagnosis and management of anal cancer based on a review of published data and in light of available guidelines is presented in this article, where the authors focus on the treatment of squamous cell carcinomas of the anal canal, which has evolved from surgery as first-line treatment to curative chemoradiation.
Abstract: Answer questions and earn CME/CNE The management of squamous cell carcinomas of the anal canal has evolved from surgery as first-line treatment to curative chemoradiation, with surgery reserved for salvage. Significant progress has been made in understanding how to most effectively deliver chemotherapy and reduce toxicity through advancements in radiation delivery. The purpose of this article is to review the multimodality approach to the diagnosis and management of anal cancer based on a review of the published data and in light of available guidelines.

Journal ArticleDOI
TL;DR: In this paper, the authors highlight opportunities for nonpsychiatrists to improve identification and treatment of psychosocial distress and psychiatric syndromes and to request formal psychiatric consultation in appropriate situations.
Abstract: An aging population and advances in diagnostics and treatment have resulted in a rapidly growing population of people impacted by cancer People live longer after a cancer diagnosis and tolerate more aggressive treatments than in the past Younger patients struggle with diversions from the normal developmental milestones in career and relationships, while older patients deal with the dual challenges of aging and cancer Cancer's transition from likely death to survival has increased interest in its impact on psychosocial issues and quality of life, rather than just longevity In this article, the authors review the psychiatric diagnosis and management of the mental health issues most often encountered in oncology Oncology treatment teams, including oncologists, nurses, social workers, and other ancillary staff, are often on the front lines of addressing psychiatric distress and clinical syndromes when psychiatrists are not easily available The purpose of this review article is to highlight opportunities for nonpsychiatrists to improve identification and treatment of psychosocial distress and psychiatric syndromes and to request formal psychiatric consultation in appropriate situations Psychotherapeutic, psychopharmacologic, cognitive, and behavioral-oriented interventions, as well as supportive interventions, are discussed for treating patients who are facing challenges during active cancer treatment, survivorship, and at the end of life This review is not exhaustive but highlights the more common psychosomatic medicine and palliative care scenarios that impact cancer patient care The importance of recognizing and addressing burnout and compassion fatigue in multidisciplinary professionals who care for those treated for cancer is also discussed given the secondary impact this can have on patient care

Journal ArticleDOI
TL;DR: A brief overview of the context for and special considerations of molecular prevention along with a discussion of the results from major randomized controlled trials is provided in this paper, where the authors provide a brief overview and discussion of their results.
Abstract: The heterogeneity and complexity of advanced cancers strongly support the rationale for an enhanced focus on molecular prevention as a priority strategy to reduce the burden of cancer. Molecular prevention encompasses traditional chemopreventive agents as well as vaccinations and therapeutic approaches to cancer-predisposing conditions. Despite challenges to the field, we now have refined insights into cancer etiology and early pathogenesis; successful risk assessment and new risk models; agents with broad preventive efficacy (eg, aspirin) in common chronic diseases, including cancer; and a successful track record of more than 10 agents approved by the US Food and Drug Administration for the treatment of precancerous lesions or cancer risk reduction. The development of molecular preventive agents does not differ significantly from the development of therapies for advanced cancers, yet it has unique challenges and special considerations given that it most often involves healthy or asymptomatic individuals. Agents, biomarkers, cohorts, overall design, and endpoints are key determinants of molecular preventive trials, as with therapeutic trials, although distinctions exist for each within the preventive setting. Progress in the development and evolution of molecular preventive agents has been steadier in some organ systems, such as breast and skin, than in others. In order for molecular prevention to be fully realized as an effective strategy, several challenges to the field must be addressed. Here, the authors provide a brief overview of the context for and special considerations of molecular prevention along with a discussion of the results from major randomized controlled trials.

Journal ArticleDOI
TL;DR: In this paper, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies, and contemporary cancer-specific and health care quality of life outcomes are described for each of these approaches.
Abstract: Answer questions and earn CME/CNE Since the dissemination of prostate-specific antigen screening, most men with prostate cancer are now diagnosed with localized, low-risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long-term disease-specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer-specific and health care quality-of-life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed. CA Cancer J Clin 2015;65:264–282. © 2015 American Cancer Society.

Journal ArticleDOI
TL;DR: Average annual cancer death rates during 2002 to 2011 for each of the 435 congressional districts are calculated using mortality data from the National Center for Health Statistics and population estimates from the US Census Bureau to facilitate cancer control and stimulate conversation about the relationship between cancer and policies.
Abstract: Knowledge of the cancer burden is important for informing and advocating cancer prevention and control. Mortality data are readily available for states and counties, but not for congressional districts, from which representatives are elected and which may be more influential in compelling legislation and policy. The authors calculated average annual cancer death rates during 2002 to 2011 for each of the 435 congressional districts using mortality data from the National Center for Health Statistics and population estimates from the US Census Bureau. Age-standardized death rates were mapped for all sites combined and separately for cancers of the lung and bronchus, colorectum, breast, and prostate by race/ethnicity and sex. Overall cancer death rates vary by almost 2-fold and are generally lowest in Mountain states and highest in Appalachia and areas of the South. The distribution is similar for lung and colorectal cancers, with the lowest rates consistently noted in districts in Utah. However, for breast and prostate cancers, while the highest rates are again scattered throughout the South, the geographic pattern is less clear and the lowest rates are in Hawaii and southern Texas and Florida. Within-state heterogeneity is limited, particularly for men, with the exceptions of Texas, Georgia, and Florida. Patterns also vary by race/ethnicity. For example, the highest prostate cancer death rates are in the West and north central United States among non-Hispanic whites, but in the deep South among African Americans. Hispanics have the lowest rates except for colorectal cancer in Wyoming, eastern Colorado, and northern New Mexico. These data can facilitate cancer control and stimulate conversation about the relationship between cancer and policies that influence access to health care and the prevalence of behavioral and environmental risk factors.

Journal ArticleDOI
TL;DR: A review of population-based programs to increase colorectal cancer screening in the United States is presented in this article, where the authors select published reports that meet at least 5 of the 6 International Agency for Research on Cancer (IARC) criteria for cancer prevention.
Abstract: Answer questions and earn CME/CNE Screening to detect polyps or cancer at an early stage has been shown to produce better outcomes in colorectal cancer (CRC). Programs with a population-based approach can reach a large majority of the eligible population and can offer cost-effective interventions with the potential benefit of maximizing early cancer detection and prevention using a complete follow-up plan. The purpose of this review was to summarize the key features of population-based programs to increase CRC screening in the United States. A search was conducted in the SCOPUS, OvidSP, and PubMed databases. The authors selected published reports of population-based programs that met at least 5 of the 6 International Agency for Research on Cancer (IARC) criteria for cancer prevention and were known to the National Colorectal Cancer Roundtable. Interventions at the level of individual practices were not included in this review. IARC cancer prevention criteria served as a framework to assess the effective processes and elements of a population-based program. Eight programs were included in this review. Half of the programs met all IARC criteria, and all programs led to improvements in screening rates. The rate of colonoscopy after a positive stool test was heterogeneous among programs. Different population-based strategies were used to promote these screening programs, including system-based, provider-based, patient-based, and media-based strategies. Treatment of identified cancer cases was not included explicitly in 4 programs but was offered through routine medical care. Evidence-based methods for promoting CRC screening at a population level can guide the development of future approaches in health care prevention. The key elements of a successful population-based approach include adherence to the 6 IARC criteria and 4 additional elements (an identified external funding source, a structured policy for positive fecal occult blood test results and confirmed cancer cases, outreach activities for recruitment and patient education, and an established rescreening process).

Journal ArticleDOI
TL;DR: This charge from the Institute of Medicine calls for adherence to existing quality indicators (QIs) or measures (QMs), practice guidelines, and the creation of new QIs or QMs when none exist.
Abstract: In this era of multidisciplinary management of the patient with cancer, there is a critical need for accurate information related to the patient, tumor characteristics, and treatment received or planned to facilitate the quality of care delivered. Staging has been a core component of cancer care for decades, and the rapidly evolving pace of oncology calls for measures to improve the quality of cancer staging. The Institute of Medicine report on improving the quality of cancer care noted that “in order to continue to advance the high-quality cancer care delivery system, measurement and assessment of progress in improving the delivery of cancer care, public reporting of information gathered, and development of innovative strategies to facilitate performance improvement will be needed.” This charge from the Institute of Medicine calls for adherence to existing quality indicators (QIs) or measures (QMs), practice guidelines, and the creation of new QIs or QMs when none exist. The American Joint Committee on Cancer (AJCC) is engaged in several efforts to improve the quality of cancer staging. QIs are well-defined, quantifiable targets that allow for the assessment of structure, process, and outcome with regard to care. QIs must be measurable, actionable, and based on evidence. In addition, QIs should serve as benchmarks for the comparison of different metrics associated with care across many institutions. Among several important QIs and QMs for the care of the patient with cancer, accurate and complete documentation of cancer stage has critical implications for the patient, clinician, and public health scientists. Clinicians involved in the care of the patient with cancer, cancer registries, and other users of staging data look to the AJCC to formulate and revise the rules for cancer staging in the United States. Established in 1959, the AJCC has been collaborating with the Union for International Cancer Control since 1982 to provide a unified anatomic staging system for cancer worldwide. Updates to the staging system are performed periodically by convening the best expertise in the field and using the highest available level of evidence. Previous editions of the AJCC staging system have included nonanatomic prognostic factors within the TNM framework for some disease sites. Expansion of staging to include widely accepted pertinent prognostic factors for many other disease sites is also currently under consideration in the ongoing efforts to develop the 8th edition of the AJCC staging system. Accurate staging allows the clinician to offer patients treatment recommendations based on practice guidelines and to discuss prognosis. Cancer stage also serves as an important inclusion, exclusion, and/or stratification criterion for clinical trials. In addition to other variables, data elements with which to derive disease stage are abstracted into the National Cancer Data Base (NCDB), the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, and the Center for Disease Control’s (CDC’s) National Program of Cancer Registries (NPCR). These data elements allow for research into disease outcomes and trends over time based on stage of disease when necessary and are informative in the formulation of guidelines, targeted population cancer control efforts, and allocation of resources. Importantly, staging facilitates national and international collaborative cancer research efforts, and allows clinicians from different cultural and language backgrounds to communicate and share data regarding cancer. This is especially important as the global burden of cancer cases continues to rise, especially in lowincome and middle-income countries. Despite the fundamental role of cancer staging, timely and accurate stage assignment with appropriate documentation can be difficult to achieve in practice. First, ambiguities in portions of the AJCC staging manual leave interpretation of staging rules to the clinician or registrar, either of whom may be incorrect. Critical to improving quality staging data are cancer registrars, who are personnel with specialized training to abstract pertinent information with regard to the history, diagnosis, treatment, and

Journal ArticleDOI
TL;DR: It is implied that prostate cancer decision-makers may not be as autonomous as the authors would assume given the concerns about patient well-being given the risk of harm associated with surgery and radiation.
Abstract: Medicine operates under an assumption that “patients will naturally gather evidence about the risks and benefits of each medical choice, apply their values to that evidence, and reach a considered decision.” In other words, that patients will generally make “autonomous” decisions, meaning decisions that are 1) intentional rather than habitual, impulsive, accidental, or forced; 2) involve substantial understanding of the nature of the decision, the foreseeable consequences, and possible outcomes; and 3) are not subject to controlling influences. Although this assumption has been challenged in other areas of medical decision-making, herein we want to challenge it within the context of treatment decision-making regarding localized, low-risk prostate cancer. Many men will face this decision given that there are 220,800 new cases of prostate cancer diagnosed each year in the United States. Yet there is alarming evidence to indicate that patients may not be properly informed about their options, particularly expectant management options such as watchful waiting or active surveillance. In addition, there is further evidence that men may be especially prone to using intuition, impulse, and “heuristics” or mental shortcuts in their decision-making, all of which threaten autonomous decision-making. Two recent articles in this journal have highlighted the complexities of treatment decision-making in patients with low-risk prostate cancer. As Filson et al note in their article, men with a new diagnosis of localized prostate cancer face an array of treatment options, each associated with high disease-specific survival given the slow-growing nature of many prostate cancers. Radical prostatectomy and radiation therapy are the most commonly used treatments for localized prostate cancer, and each has associated treatment-related complications that impact men’s quality of life. Increasingly, active surveillance is being recommended by clinical guidelines as a treatment option for men with low-risk disease. Unlike watchful waiting, active surveillance involves careful monitoring of the disease with an expectation of curative treatment if there is progression. Although active surveillance has disadvantages of periodic testing and associated anxiety, its major advantage is the preservation of current health and the avoidance of treatment-related complications, including impotence and urinary and rectal incontinence. Despite the appropriateness of expectant management strategies such as active surveillance for patients with early-stage prostate cancer, as highlighted by Filson et al in their article, men who might benefit from expectant management are not routinely offered the option. Other studies have reported similar findings. One report found that only 10 of 25 patients with early-stage prostate cancer were offered a treatment choice, whereas another found that of 21 men (19 of whom chose surgery or radiation), few remembered active surveillance being presented as a viable option and another study found that health professionals were less likely to discuss active surveillance for localized prostate cancer with Hispanic patients compared with white patients. Furthermore, studies have found biases and heuristics at work in patients’ decision-making (all favoring surgery or radiation) such as the “commission bias” (doing something is better than “doing nothing” even if the “something” causes more harm) and the “availability bias” (reliance on anecdotal stories), in addition to fear, heavy reliance on physician recommendation, reported pressure from family, and lack of awareness that treatment does not guarantee improved survival. These findings regarding prostate cancer decisionmaking are ethically significant given that they imply that prostate cancer decision-makers may not be as autonomous as we would assume. They also raise concerns about patient well-being given the risk of harm associated with surgery and radiation. An 8-year follow-up study of 272 men showed that men who underwent surgery consistently reported more urinary leakage and impaired erection and libido. Findings from the Prostate Cancer Intervention Versus Observation Trial (PIVOT) showed higher rates of urinary leakage and erectile dysfunction among men

Journal ArticleDOI
TL;DR: The authors analyzed the American Cancer Society’s Cancer Prevention Study II Nutrition Cohort, a prospective study of cancer incidence initiated in 1992, and found that aspirin use was reported at the time of enrollment, in 1997, and every 2 years thereafter through June 2009.
Abstract: Study Findings The authors analyzed the American Cancer Society’s Cancer Prevention Study II Nutrition Cohort, a prospective study of cancer incidence initiated in 1992. At the time of enrollment, participants (including 86,402 men) filled out questionnaires regarding their demographic, lifestylerelated, and medical risk factors. Aspirin use was reported at the time of enrollment, in 1997, and every 2 years thereafter through June 2009.

Journal ArticleDOI
TL;DR: Investigation set out to investigate whether the lung cancer screening guidelines were integrated into practice and what the barriers might be to implementation.
Abstract: T he results of a recent study have demonstrated that the implementation of lung cancer screening guidelines is lacking among primary care physicians (Cancer Epidemiol Biomarkers Prev. 2015;24:664-670). The National Lung Screening Trial (NLST), which included more than 53,000 individuals at high risk of lung cancer, demonstrated a 20% reduction in lung cancer-specific mortality and an overall mortality reduction of 6.7% with annual low-dose computed tomography (LDCT) (N Engl J Med. 2011;365:395-407). Cancer screening guidelines from multiple organizations now include LDCT of the chest for the early detection of lung cancer in patients aged older than 55 years with a significant smoking history. Furthermore, Medicare now will provide coverage for the test. Researchers set out to investigate whether the lung cancer screening guidelines were integrated into practice and what the barriers might be to implementation.

Journal ArticleDOI
TL;DR: Together with colleagues from the Eastern Cooperative Oncology Group, RESORT study lead author Brad Kahl, MD, director of lymphoma service at the University ofWisconsin in Madison and clinical research director for hematologic malignancies at University of Wisconsin Carbone Cancer Center, recruited 408 previously untreated patients with low tumor burden follicular lymphoma.
Abstract: Together with colleagues from the Eastern Cooperative Oncology Group, RESORT study lead author Brad Kahl, MD, director of lymphoma service at the University of Wisconsin in Madison and clinical research director for hematologic malignancies at University of Wisconsin Carbone Cancer Center, recruited 408 previously untreated patients with low tumor burden follicular lymphoma. Patients with other low grade lymphomas were eligible, but were not reported in the current article. Low tumor burden was defined as no mass measuring greater than 7 cm, fewer than 3 masses measuring more than 3 cm, no systemic or B symptoms, no splenomegaly measuring greater than 16 cm, no organ compromise, no leukemic phase greater than 5000/mL circulating lymphocytes, and no cytopenias. All patients were treated with rituximab at a dose of 375 mg/m once a week for 4 weeks. Restaging was performed at 13 weeks and patients with stable or progressive disease were taken off the study. Patients with responding disease (289 patients) were randomized to observation with rituximab retreatment at the time of disease progression until treatment failure (143 patients) or scheduled maintenance rituximab of 1 dose every 13 weeks until treatment failure (146 patients). Retreatment consisted of weekly rituximab for another 4 weeks, which was repeated at each occurrence of progressive disease until treatment failure. Treatment failure was defined as no response to retreatment, time to disease progression of less than 26 weeks, initiation of alternate therapy, or inability to complete planned treatment. Treatment failure for patients on the maintenance arm was defined as any disease progression occurring between scheduled rituximab doses.

Journal ArticleDOI
TL;DR: A largescale, retrospective, population-based study of patients diagnosed with stage IV NSCLC, examining practice patterns in relation to systemic treatment and changes in chemotherapy administration over time, as well as associations with survival.
Abstract: R ecent studies have revealed that few elderly patients receive chemotherapy for advanced non-small cell lung cancer (NSCLC), even though it has been shown that the majority of patients will benefit from systemic treatment. The authors of the current study hypothesized that this may be occurring in the general population of patients with NSCLC, not just the elderly. To investigate, researchers conducted a largescale, retrospective, population-based study of patients diagnosed with stage IV NSCLC, examining practice patterns in relation to systemic treatment and changes in chemotherapy administration over time, as well as associations with survival (Cancer [published online ahead of print April 17, 2015]. doi: 10.1002/cncr.29386).