Showing papers in "Cancer Control in 2009"
TL;DR: The molecular basis for genesis of endometrioid endometrial cancer with regard to pathogenesis, classification, and implications for targeted therapies is reviewed.
Abstract: Background: Understanding and identifying molecular biology and genetics of endometrial cancer are central to the development of novel therapies. This article reviews the molecular basis for genesis of endometrial cancer with regard to pathogenesis, classification, and implications for targeted therapies. Methods: Genes and cellular pathways that may have an important role in endometrial cancers, both endometrioid and nonendometrioid cancers, are identified. Recently studied drugs and potential future drugs that target some of these genes and pathways are reviewed. Results: The most frequent genetic alteration of endometrioid endometrial cancer is PTEN. PI3CA and K-ras mutations are less common but are often associated with PTEN. Alterations in MLH1 and MSH6 are documented with microsatellite instability. β-catenin has a minor but significant association. Conversely, p53 mutation is more often associated with nonendometrioid cancer; others being inactivation of p16 and/or overexpression of HER-2/neu. Absence of E-cadherin is more often than not present in nonendometrioid cancers and is associated with poor prognosis. Novel agents that target the AKT-PI3K-mTOR pathway and those that inhibit epidermal growth factor receptor (EGFR), vascular endothelial growth factors (VEGF), fibroblast growth factor receptor 2 (FGFR2), and folate receptors are currently being investigated. Conclusions: Novel targeted agents, either alone or in combination with cytotoxic agents, may result in superior treatment for patients. Marguerite Bride. Old Round Barn. Watercolor, 11′′ × 15′′.
305 citations
TL;DR: Although not all resistance mechanisms have been identified and understood, several agents based on the known mechanisms have already been designed and developed and are beginning clinical trials.
Abstract: Background: Although the vast majority of patients with chronic myeloid leukemia (CML) respond to the tyrosine kinase inhibitor (TKI) imatinib mesylate, resistance might occur de novo or during treatment. Methods: The authors reviewed the known mechanisms of primary and secondary resistance to imatinib and other TKIs used in the management of CML. Results: Mutations within the kinase domain of BCR-ABLI account for 30% to 40% of cases of imatinib resistance. Other mechanisms include BCR-ABLI amplification, overexpression of the SRC family of kinases, and pharmacokinetic and pharmacodynamic factors. Conclusions: Although not all resistance mechanisms have been identified and understood, several agents based on the known mechanisms have alrea dy been designed and developed and are beginning clinical trials. Several factors are associated with imatinib resistance, and some interventions have already been designed to reverse this clinical problem.
228 citations
TL;DR: No current evidence suggests either a survival advantage or disadvantage to endometrial cancer that is associated with Lynch syndrome when these cases are compared with sporadic cases and Screening and prevention practices can decrease the likelihood of developing additional cancers.
Abstract: BackgroundApproximately 2% to 5% of endometrial cancers may be due to an inherited susceptibility. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC) syndrome, an autos...
206 citations
TL;DR: It is shown that EBM refers to making medical decisions that are consistent with evidence, as a reliable sign, symptom, or mark to enhance reasonableness or truthfulness of some particular claim ("evidence as a guide to truth"), and to serve as a neutral arbiter among competing views.
Abstract: Background: Since the term “evidence-based medicine” (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public, and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes a specific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. Methods: In this paper, we challenge this critical view of EBM by examining how EBM fits into broad epistemological debates within the philosophy of science. We consider how EBM relates to some classical debates regarding the nature of science and knowledge. We investigate EBM from the perspective of major epistemological theories (logical-positivism/inductivism, deductivism/falsificationism/theory-ladeness of observations, explanationism/holism, instrumentalism, underdetermination theory by evidence). Results: We first explore the relationship between evidence and knowledge and discuss philosophical support for the main way that evidence is used in medicine: (1) in the philosophical tradition that “rational thinkers respect their evidence,” we show that EBM refers to making medical decisions that are consistent with evidence, (2) as a reliable sign, symptom, or mark to enhance reasonableness or truthfulness of some particular claim (“evidence as a guide to truth”), and (3) to serve as a neutral arbiter among competing views. Our analysis indicates that EBM does not have a rigorous epistemological stance. In fact, EBM enthusiastically draws on all major traditions of philosophical theories of scientific evidence. Conclusions: Our findings indicate that EBM should not be construed as a new scientific or philosophical theory that changes the nature of medicine or our understanding thereof. Rather, we should consider EBM as a continuously evolving heuristic structure for optimizing clinical practice.
184 citations
TL;DR: Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with melanoma brain metastasis and promising new agents and approaches are needed.
Abstract: Background: Brain metastasis is common in patients with malignant melanoma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant melanoma eventually develop brain metastasis, and autopsy reports show that 75% of those who died of this disease developed brain metastasis. Methods: We review the level I and level II evidence that guides indications for treatment with surgery, stereotactic radiosurgery, chemotherapy, and immunotherapy for patients with melanoma brain metastasis. Results: Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with melanoma brain metastasis. Chemotherapy has been ineffective. Ongoing studies continue to assess the effects of immunotherapy and agents in development. Conclusions: Brain metastasis is a common and formidable challenge in patients with malignant melanoma. Although there have been no randomized controlled trials exclusively in patients with melanoma brain metastasis, care can be guided by the application of level I evidence for the treatment of brain metastasis in general and phase II studies focusing specifically on melanoma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future. Brain metastasis remains a formidable challenge in patients with melanoma.
137 citations
TL;DR: Comprehensive surgical staging is helpful for women with non-endometrioid endometrial cancer histology and adjuvant therapy is recommended even in women with early-stage disease.
Abstract: Background: Understanding the etiology, presentation, evaluation, and management of selected non-endometrioid endometrial adenocarcinomas of the uterine corpus is needed to define optimal treatment regimens. Methods: The pathology and treatment of selected non-endometrioid endometrial adenocarcinomas of the uterus are reviewed and summarized. Results: The most common non-endometrioid histology is papillary serous (10%), followed by clear cell (2% to 4%), mucinous (0.6% to 5%), and squamous cell (0.1% to 0.5%). Some non-endometrioid endometrial carcinomas behave more aggressively than the endometrioid cancers such that even women with clinical stage I disease often have extrauterine metastasis at the time of surgical evaluation. Therefore, when technically and medically feasible, comprehensive surgical staging is helpful for women with non-endometrioid endometrial cancer histology. Comprehensive surgical staging includes hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and cytological evaluation of the abdominal cavity. While whole abdominal radiotherapy has a limited role in early-stage uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC), there may be a role for postoperative chemotherapy and volume-directed radiotherapy in both early-stage UPSC and CC. In the setting of optimally debulked advanced-stage disease, a combination of radiation and chemotherapy may be indicated. In the setting of recurrent disease or in women with residual disease after surgery, a platinum-based regimen or enrollment in a clinical trial is recommended. Conclusions: UPSC and CC are managed similarly since sufficient data to separate treatment recommendations are lacking. Because both histologies are associated with a high rate of recurrence, adjuvant therapy is recommended even in women with early-stage disease. The remaining cell types should be treated similar to endometrioid or other low-grade histologies.
129 citations
TL;DR: An improved understanding of the causative factors associated with racial disparities in endometrial cancer outcome is needed to facilitate efforts aimed at correcting this important health care problem and providing individualized care to those at highest risk for poor outcome.
Abstract: BackgroundUterine cancer is the most common gynecologic malignancy in the United States, with an estimated 40,100 new cases and 7,470 deaths occurring in 2008. Although the incidence of endometrial...
111 citations
TL;DR: Most written materials have a readability level that is too high and require improvement in ease of use and comprehensibility for the majority of readers.
Abstract: BackgroundHealth literacy requires reading and writing skills as well as knowledge of health topics and health systems. Materials written at high reading levels with ambiguous, technical, or dense text, often place great comprehension demands on consumers with lower literacy skills. This study developed and used an instrument to analyze cervical cancer prevention materials for readability, comprehensibility, suitability, and message design.MethodsThe Suitability Assessment of Materials (SAM) was amended for ease of use, inclusivity, and objectivity with the encouragement of the original developers. Other novel contributions were specifically related to “comprehensibility” (CAM). The resulting SAM + CAM was used to score 69 materials for content, literacy demand, numeric literacy, graphics, layout/typography, and learning stimulation variables. Expert reviewers provided content validation. Inter-rater reliability was “substantial” (κ = .77).ResultsThe mean reading level of materials was 11th grade. Most ma...
106 citations
TL;DR: Epigenetic mechanisms have emerged as having a central role in gene regulation of human melanoma, including the identification of several putative tumor suppressor genes and oncogenes.
Abstract: Background: Recent technological advances have allowed us to examine the human genome in greater detail than ever before. This has opened the door to an improved understanding of the gene expression patterns involved with cancer. Methods: A review of the literature was performed to determine the role of epigenetic modifications in human melanoma. We focused the search on histone deacetylation, methylation of gene promoter regions, demethylation of CpG islands, and the role of microRNA. We examined the relationship between human melanoma epigenetics and their importance in tumorigenesis, tumor progression, and inhibition of metastasis. The development and clinical application of select pharmacologic agents are also discussed. Results: We identified several articles that have extensively studied the role of epigenetics in melanoma, further elucidating the complex processes involved in gene regulation and expression. Several new agents directly affect epigenetic mechanisms in melanoma, with divergent affects on the metastatic potential of melanoma. Conclusions: Epigenetic mechanisms have emerged as having a central role in gene regulation of human melanoma, including the identification of several putative tumor suppressor genes and oncogenes. Further research will focus on the development of novel therapeutics that will likely target and alter such epigenetic changes. Epigenetic mechanisms of gene regulation have become increasingly recognized for their central role in cancer progression and metastasis.
97 citations
TL;DR: Storytelling may be an effective approach for changing CRC risk-related behavioral intentions among Latinas and Mediating factors often used to predict behavior change may not adequately explain the potential persuasive mechanisms of storytelling.
Abstract: BackgroundIn a low socioeconomic-status population of Latina women, we evaluated the potential of storytelling (ST) as a culturally aligned narrative method to promote colorectal cancer (CRC) prevention and screening, compared to a risk tool (RT)-based interventionMethodsSeventy-eight women were randomized in this pilot study to one of two brief interventions to communicate CRC risk reduction options: ST or an RT Measures of behavioral intentions relative to CRC prevention and screening were obtained following the interventionResultsMean scores for intent to obtain and recommend endoscopy to others were significantly better for participants receiving ST than RT (P = 038 and P = 011, respectively) All participants expressed intent to increase fruit and vegetable consumption and physical activity in response to interventions Post-intervention perceptions of cancer risk and fear of CRC were not significantly different for participants receiving ST compared with RT Pre- to post-intervention perception
85 citations
TL;DR: SLNB provides important prognostic and staging data with minimal morbidity and can be used to identify regional node-negative patients who would not benefit from a complete nodal dissection and should be performed on most patients who have melanomas with a Breslow depth of 0.76 mm.
Abstract: BackgroundThe disease status of regional lymph nodes is the most important prognostic indicator for patients with melanoma. Sentinel lymph node biopsy (SLNB) was developed as a technique to surgica...
TL;DR: While several treatment modalities are now available to treat patients who present with metastatic endometrial cancer, overall prognosis remains poor.
Abstract: Background: Endometrial cancer is the most common gynecologic malignancy. The majority of patients have disease confined to the uterus and have an excellent overall prognosis. However, subgroups of patients have advanced primary disease or recurrences following primary treatment. Methods: The management of metastatic disease is variable, depending on factors such as comorbidities, tumor grade, performance status, and prior treatments. Management options include hormonal therapy and cytotoxic chemotherapy, as well as targeted therapies that inhibit angiogenesis and the cellular signaling pathways involved in cell growth and proliferation. A comprehensive review of these treatments for metastatic endometrial cancer was conducted and is discussed. Results: Hormonal therapy and cytotoxic chemotherapy have traditionally been used in the treatment of metastatic endometrial cancer. Advances in molecular biology have led to multiple potential targeted therapies to be used in the treatment of metastatic endometrial cancer. Conclusions: While several treatment modalities are now available to treat patients who present with metastatic endometrial cancer, overall prognosis remains poor. Systemic treatments for patients with metastatic endometrial cancer are reviewed.
TL;DR: The effectiveness of BCR-ABL-dependent transformation of hematopoietic stem cells is due not to a single pathway but rather to the culmination of a network of signaling pathways.
Abstract: BackgroundThe fusion protein BCRABL results in constitutive tyrosine kinase activity. It also affects downstream targets as well as the subcellular location of the normally tightly regulated Abl ty...
TL;DR: While the morbidity of inguinal lymphadenectomy can be substantial, several straightforward pre- and postoperative measures can be instituted to limit morbidity.
Abstract: Background: Surgery is currently the primary treatment modality for metastatic melanoma involving the inguinal lymph nodes. However, inguinal lymph node dissections are associated with substantial morbidity including infection, wound dehiscence, lymphedema, seroma, and deep venous thromboembolism (DVT). Improved understanding is needed regarding the factors predisposing patients to complications and the operative and perioperative maneuvers that can decrease morbidity. Methods: We reviewed recently published literature regarding the morbidity associated with lymphadenectomy in the treatment of inguinal metastatic melanoma. Where available, emphasis was focused on appropriately designed studies aimed at reducing treatment-related morbidity. When appropriate, the review was supplemented by our personal experience. Results: Strategies to limit treatment-related morbidity involve optimizing the preoperative assessment, operative technique, and postoperative care. Establishing the diagnosis of nodal metastasis early using minimally invasive techniques is critical to reduce subsequent perioperative complications. Morbidity is higher for inguinal compared to cervical or axillary lymphadenectomy, and many variations in extent of inguinal lymphadenectomy and operative technique have been reported. The lack of definitive trials has led to controversy regarding surgical technique such as indications for pelvic lymphadenectomy (“deep” node dissection), saphenous vein preservation, and sartorius transposition. In the postoperative period, the use of DVT and lymphedema prophylaxis should be considered to potentially improve patient outcomes. Conclusions: While the morbidity of inguinal lymphadenectomy can be substantial, several straightforward pre- and postoperative measures can be instituted to limit morbidity. Controversy persists regarding the indications for and benefit of pelvic lymphadenectomy, saphenous vein preservation, and sartorius muscle transposition. A multi-institutional trial is currently in progress to investigate the safety of avoiding lymphadenectomy in patients with microscopic metastases in the sentinel node.
TL;DR: Although a survival benefit from comprehensive surgical staging has not been clearly demonstrated in patients diagnosed with endometrial cancer, surgical staging allows one to determine the need for adjuvant therapy.
Abstract: BackgroundThe cornerstone of the management of patients with endometrial cancer is hysterectomy. Since 1988, the role of lymphadenectomy for patients with endometrial cancer has been debated. Patie...
TL;DR: The principle is derived from the requirement for uncertainty or equipoise as a precondition for RCTs, the precept that paradoxically drives discoveries of new treatments while limiting the proportion and rate of new therapeutic discoveries.
Abstract: Background:Progress in clinical medicine relies on the willingness of patients to take part in experimental clinical trials, particularly randomized controlled trials (RCTs). Before agreeing to enr...
TL;DR: Despite the differences between pediatric and adult melanoma, survival rates are similar and are improving in both populations, and further studies will help delineate the pathogenesis of both adult and pediatric melanoma.
Abstract: Background: Malignant melanoma is a rare neoplasm in the pediatric population, but its incidence has risen in recent years. Methods: The literature was reviewed to define the current clinical and pathologic features of pediatric melanoma, highlighting the similarities and differences between adult and pediatric melanoma. Results: Distinctive features of this disease, including frequency and type of genetic abnormalities, predisposing conditions, clinical presentation, stage at diagnosis, prognostic features, and frequency of sentinel lymph node positivity are emphasized. Treatment strategies, extrapolated from adult melanoma trials, are also discussed. Conclusions: Despite the differences between pediatric and adult melanoma, survival rates are similar and are improving in both populations. Further studies will help delineate the pathogenesis of both adult and pediatric melanoma, with the goal of contributing to early detection and improved survival. Melanoma incidence in children has increased in the United States over the last few decades, and continued study is needed to improve early diagnosis, biopsy protocols, therapies, and outcomes.
TL;DR: The process of biomarker identification and validation is providing a rapidly changing molecular view of melanoma, a strategy that is necessary for developing truly stratified or even personalized prevention or management.
Abstract: BackgroundMorphologic and histopathologic markers have been the backbone for the classification and prognostic assessment of melanoma. Availability of an increasing number of molecular markers, how...
TL;DR: There were marked racial variations in the receipt of ADT, primary therapies (namely surgery and surgery combined with radiation), and comorbidities, however, racial disparities in survival were not affected byracial variations in ADT but were explained by racial variation in primary therapies and by racial differences in comorbridities.
Abstract: Background
Racial disparities persist in prostate cancer (CaP) treatment and survival, but disparities in androgen deprivation therapy (ADT), and to what degree it affects racial differences in survival remains to be fully assessed.
TL;DR: A critical review of studies published between 1990 and 2006 to describe the current use of sociocultural constructs in cancer screening research among African Americans finds a multidisciplinary approach to developing a common language and a standardized set of measures will advance research in this area.
Abstract: Background: Studies are increasingly examining the role of sociocultural values, beliefs, and attitudes in cancer prevention. However, these studies vary widely in how sociocultural constructs are defined and measured, how they are conceived as affecting cancer beliefs, behaviors, and screening, and how they are applied in interventions. Methods: To characterize the current state of this research literature, we conducted a critical review of studies published between 1990 and 2006 to describe the current use of sociocultural constructs in cancer screening research among African Americans. We included quantitative and qualitative studies with cancer as a primary focus that included African American participants, assessed screening behaviors, reported race-specific analyses, and considered one or more sociocultural factors. Studies were evaluated for type of cancer and screening analyzed, study population, methodology, sociocultural constructs considered, definitions of constructs, provision of psychometric data for measures, and journal characteristics. Results: Of 94 studies identified for review, 35 met the inclusion criteria and were evaluated. Most focused on breast cancer screening, and thus African American women. Sociocultural constructs were seldom clearly defined, and the sources and psychometric properties of sociocultural measures were rarely reported. Conclusions: A multidisciplinary approach to developing a common language and a standardized set of measures for sociocultural constructs will advance research in this area. Specific recommendations are made for future research.
TL;DR: The benefits and results reported by Cancer Care Ontario in transforming from a direct provider of cancer services to an organization whose responsibilities include improving the quality of care across the province's cancer system are described.
Abstract: Background:Good governance, clinician engagement, and clear accountabilities for achieving specific outcomes are crucial components for improving the quality of care at both an organizational and h
TL;DR: This case is presented of a 61-year-old woman with metastatic ovarian cancer and no history of skin cancer who developed multiple keratoacanthomas while on a clinical trial using sorafenib, a novel antineoplastic drug that targets multiple intracellular and cell-surface kinases, inhibiting tumor cell proliferation and angiogenesis.
Abstract: Address correspondence to Basil S. Cherpelis, MD, Department of Dermatology, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 79, Tampa, FL 33612. E-mail: bcherpel@hsc.usf.edu as two cycles of paclitaxel and carboplatin chemotherapy and four cycles of docetaxel and carboplatin. Subsequently, her serum CA-125 level returned to normal, indicating remission of the cancer. However, 5 months after completing chemotherapy, her serum CA-125 level again elevated to 95 from a nadir of 5, indicating that cancer had returned. A PET/CT scan confirmed multiple hypermetabolic peritoneal masses as well as right inguinal nodal activity. An excisional biopsy was performed on the right inguinal node, and histology disclosed metastatic adenocarcinoma. The patient was referred to our institute for consideration of a clinical trial. In late 2007, she began a clinical trial using a combination of carboplatin, paclitaxel, and sorafenib. The patient continued her monthly follow-up meetings in the Gynecologic Oncology Program. Three months after beginning treatment with carboplatin, tamoxifen, and sorafenib, she reported a rapidly enlarging, non-healing erythematous papule on her left nares and presented to dermatology for evaluation. By this time, she had developed a similar lesion on the left leg (Fig 1). Histologic examination of these lesions revealed well-demarcated crateriform squamous proliferations with a central keratin plug consistent with kerIntroduction Sorafenib is a novel antineoplastic drug that targets multiple intracellular and cell-surface kinases, inhibiting tumor cell proliferation and angiogenesis. While it is currently approved to treat metastatic or unresectable renal cell or hepatocellular carcinoma, studies are underway to evaluate its utility in other solid organ tumors. We present a case of a 61-year-old woman with metastatic ovarian cancer and no history of skin cancer who developed multiple keratoacanthomas while on a clinical trial using sorafenib. Surgical excision was performed palliatively for large and symptomatic lesions. Because of the patient’s terminal condition and unwillingness to undergo multiple surgical procedures, we instituted chemoprophylaxis with oral bexarotene. After two months of therapy, the patient has reported partial regression of some of the tumors and has not developed any new lesions. This is the second known report of multiple keratoacanthomas arising in the setting of sorafenib therapy.1 In addition, this is the first known report of using bexarotene for chemoprophylaxis or treatment of keratoacanthomas.
TL;DR: The contribution to their quality of life that cancer survivors feel they receive from employment may not be linearly related to the quantity of their role function in the workplace.
Abstract: Background: Many quality of life instruments assess the amount of paid work in combination with role function at home in the same items and do not specifically assess social support in the workplace. The goal of this study was to obtain women’s views on the relationship between employment and health-related quality of life. Methods: A focus group and questionnaire study was conducted among 73 women with gynecologic cancer who were employed at diagnosis and 25 people who provided them with psychosocial support. Results: The women held a variety of blue collar and white collar jobs at diagnosis. Employment provided a strong sense of accomplishment and a welcome distraction during treatment. The employment experience was described as distinct from role function at home. No one equated working more hours with better quality of life. Social support at work could be poor at the same time that support from family and friends grew stronger. Conclusions: The contribution to their quality of life that cancer survivors feel they receive from employment may not be linearly related to the quantity of their role function in the workplace. Employment-related items could be useful as an adjunct to standard quality of life measures.
TL;DR: The use of these indicators to measure practice performance holds the promise of improving outcomes of patients with NSCLC.
Abstract: Background: Quality-of-care indicators are measurable elements of practice performance that can be used to assess the quality or change in quality of the care provided. To date, the literature on quality-of-care indicators for non-small cell lung cancer (NSCLC) has not been reviewed. Methods: A search was performed to identify articles reporting on quality-of-care indicators specific for NSCLC published from January 2003 to May 2009 (using MEDLINE and American Society of Clinical Oncology abstract databases). Web sites of major quality care organizations were also searched. The identified indicators were then classified by their aspect of care provision (structure-of-care, process-of-care, or outcome-of-care indicator). Results: For structure-of-care quality indicators, the most cited indicators were related to the quality of lung surgery. These included being National Cancer Institute-designated cancer centers or high-volume hospitals. For process-of-care quality indicators, the most common indicators were the receipt of surgery for early-stage NSCLC and the administration of chemotherapy for advanced-stage NSCLC For outcome-of-care quality indicators, the most cited indicators were related to postoperative morbidity or mortality after lung surgery. Conclusions: Several quality-of-care indicators for NSCLC are available. Process-of-care indicators are the most studied. The use of these indicators to measure practice performance holds the promise of improving outcomes of patients with NSCLC.
TL;DR: The FIQCC is working toward becoming a statewide program that enables practicing oncologists and investigators to measure and address disparities in the delivery of quality cancer care.
Abstract: Background: The Florida Initiative for Quality Cancer Care (FIQCC) is a physician and practice-based quality improvement project that was conceived to study the barriers to delivering quality cancer care in Florida. The ultimate goal of the FIQCC is to improve cancer care throughout the state. This report provides an overview of the development and implementation of the FIQCC. Methods: Representatives from 11 oncology practices across the state of Florida selected quality measures consistent with evidence-, consensus-, and safety-based guidelines that could be abstracted from medical records. Trained abstractors review records of all eligible patients seen by each practice and enter the data into a Web-based application. Frequencies of responses for each indicator are tabulated for overall and practice-specific level of adherence and compared among practices. Seminars are held to discuss strategies to address opportunities for improvement in the quality of cancer care identified by the survey. Results: Three quality of cancer indicator modules organized by diagnosis (colorectal cancer, breast cancer, and non–small cell lung cancer) as well as a module relating to a domain of care (psychosocial care) have been developed by FIQCC participants. All of the participating practices successfully completed data collection for the colorectal cancer and breast cancer modules as well as the psychosocial care module. To date, 1,622 charts have been successfully entered into the FIQCC database. Results from the colorectal survey confirmed high overall rates of compliance with a series of quality indicators but also identified areas for improvement. Conclusions: The FIQCC is working toward becoming a statewide program that enables practicing oncologists and investigators to measure and address disparities in the delivery of quality cancer care.
TL;DR: The TKIs are a superb example of an effective targeted approach for a malignant disease and specific therapy and dosing strategies for individuals with CML will depend on the status of their disease, the anticipated side effects, and concurrent drug therapy.
Abstract: Background Chronic myeloid leukemia, the most common adult leukemia, is characterized by the Ph+ chromosome produced by the fusion of the BCR gene from chromosome 22 and the ABL gene from chromosome 9. Inhibition of the deleterious effects of this potent oncogene by the tyrosine kinase inhibitor (TKI) imatinib has revolutionized care of this disease, but intolerance and resistance does occur. Methods The authors have reviewed both the preclinical and the clinical data concerning second-generation TKIs intended to circumvent or ameliorate issues with imatinib intolerance or resistance. Results Two second-generation TKIs, dasatinib and nilotinib, are currently approved by the US Food and Drug Administration. Both have shown significant clinical activity in patients with chronic myeloid leukemia (CML) and Ph+ acute lymphoblastic leukemia (ALL) who are resistant or intolerant to imatinib or other therapies. Conclusions The TKIs are a superb example of an effective targeted approach for a malignant disease. As more clinical data become available and additional novel agents are developed, specific therapy and dosing strategies for individuals with CML will depend on the status of their disease, the anticipated side effects, and concurrent drug therapy.
TL;DR: Findings show these indicators can be measured easily and reliably, demonstrate variability across practices that suggests potential for improvement, and yield information that can be used to take actions to improve quality.
Abstract: Background: The American Psychosocial Oncology Society has developed the first indicators of the quality of psychosocial care for cancer patients. This report describes the initial evaluation of these indicators. Methods: Medical records of 388 colorectal cancer patients first seen by a medical oncologist in 2006 at seven practice sites were reviewed by trained abstractors whose accuracy was documented by periodic checks. Results: Rates of assessment of emotional well-being within 1 month of a patient’s first visit with a medical oncologist ranged from 6% to 84% (mean = 60%; P < .001). Among the 45 patients identified as having a problem with emotional well-being, rates of evidence of action taken (or explanation for no action) ranged from 0% to 100% (mean = 51%; P = .85). A direct comparison showed that pain was assessed more often than emotional well-being in these patients (87% vs 60%, P < .001). Conclusions: Findings show these indicators can be measured easily and reliably, demonstrate variability across practices that suggests potential for improvement, and yield information that can be used to take actions to improve quality. Additional findings suggest that, to date, efforts to promote routine symptom assessment have been more successful for pain than for emotional well-being.
TL;DR: This review summarizes the recent advances in the field of immunology in CML, specifically in tumor antigen discovery, that have been incorporated into the design of new clinical trials that point to a unique interaction of TKIs with the immune system.
Abstract: BackgroundChronic mye-logenous leukemia (CML) has long been recognized as an entity responsive to immunotherapeutic interventions. Despite the success of the tyrosine kinase inhibitors (TKIs) in th...
TL;DR: The timely collection of information on a wide range of quality measures regarding cancer patients can be efficiently collected using a Web-based data collection tool allowing for practice self-examination and comparison with other practices.
Abstract: Background: Over the past 5 years, the American Society of Clinical Oncology (ASCO) has supported the development of a Web-based quality-reporting tool in response to a recognized need to provide medical oncologists the opportunity to demonstrate the quality of care that they are providing to patients. Methods: The development of quality measures, their basis in the literature, and the descriptions and organizational structure of the measures are discussed. Results: Specific results are the property ofpractices and are not shared outside of the practices except in aggregate. The system allows collection of information concerning a wide range of quality measures in a short period of time. In the last data collection period in the fall of 2008, information was submitted concerning 81 measures of quality divided into one required and six optional modules from over 250 practices concerning 15,000 patients. Conclusions: The timely collection of information on a wide range of quality measures regarding cancer patients can be efficiently collected using a Web-based data collection tool allowing for practice self-examination and comparison with other practices.
TL;DR: Laroscopy is a safe and effective approach for surgical staging of selected patients with endometrial cancer and the use of robotics can extend the benefits of minimally invasive surgery to a larger proportion of patients with this common gynecologic malignancy.
Abstract: BACKGROUND Endometrial cancer is the most common gynecologic malignancy in the United States. Surgical staging is an integral component in the treatment of this disease. Minimally invasive surgical techniques have been utilized with increasing frequency in its management. METHODS This article reviews the use of minimally invasive surgery for the treatment of endometrial cancer. RESULTS Prospective trials and retrospective analyses have demonstrated the safety and feasibility of laparoscopy in performing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for surgical staging in endometrial cancer. The use of minimally invasive techniques does not appear to have an adverse impact on survival, and it improves quality of life in the postoperative period. Robotic surgery has been used in the management of this disease with promising preliminary results. CONCLUSIONS Laparoscopy is a safe and effective approach for surgical staging of selected patients with endometrial cancer. Further studies and cost-benefit analyses are required to determine if the use of robotics improves outcomes over standard laparoscopy and can extend the benefits of minimally invasive surgery to a larger proportion of patients with this common gynecologic malignancy.