Night-Shift Work Ups Breast Cancer Risk: New Data

A unique aspect of this latest study showing the link is that women who had a preference for morning (so-called 'larks') were at greatest risk.
Medscape Medical News

Grief Over Patient Loss Affects Oncologists' Lives

Grief stemming from patient loss can negatively affect not only oncologists personally, but also other patients and their families.
Medscape Medical News

Lung Cancer: New Drugs, Emerging Therapies

Dr. Mark Kris highlights new developments in lung cancer -- including targeted therapies for small cell carcinoma and promising immunotherapies -- to be presented at ASCO® 2012.
Medscape Hematology-Oncology

GI Cancers: Promising Data Across the Board

Dr. David Kerr previews what he expects are practice-changing studies in colorectal, gastric, esophageal, and hepatocellular cancer, to be presented at ASCO® 2012.
Medscape Hematology-Oncology

FDA Advises Checking Prefilled Syringes for Overfilling

The US Food and Drug Administration has advised healthcare providers to visually inspect Hospira Carpuject prefilled cartridges to check for overfill.
News Alerts

[News] Chinese miners at increased risk of cancer

A study led by researchers in China has confirmed the association between inhalation of silica dust and a heightened risk of lung cancer. The study observed 74 040 people working at metal mines and pottery factories in the country. Average follow-up was 33 years. Mortality from all causes was higher in workers exposed to silica dust (993 vs 551 per 100 000 person-years in non-exposed workers). “We saw elevated mortality from lung cancer among exposed workers compared to non-exposed workers”, Weihong Chen (Huazhong University of Science and Technology, Hubei Province, China), co-author of the study, told The Lancet Oncology.

[Corrections] Correction to Lancet Oncol 2012; 13: 569

Toh HC, Ha TC, Wee J. Personalised medicine in nasopharyngeal cancer. Lancet Oncol 2012; 13: 568–69—In this Comment (published online May 3, 2012), Han Chong Toh and Tam Cam Ha's names were spelt incorrectly. This correction has been made to the online version as of May 28, 2012, and the printed Article is correct.

[Comment] Capecitabine in the treatment of rectal cancer

The fluorouracil prodrug capecitabine was developed as an oral substitute for intravenous fluorouracil in the 1990s. Since then, many phase 2 and 3 trials have investigated capecitabine in different tumour types and stages, at various doses, and as a single agent or multiagent therapy. Most phase 3 trials that compared the two drugs reported that capecitabine was at least as effective as fluorouracil, and capecitabine was approved by the US Food and Drug Administration (FDA) for treatment of metastatic breast cancer in 1998, for metastatic colorectal cancer in 2001, and as adjuvant therapy for colon cancer in 2005.

[News] 3D histopathology could help cancer research and treatment

Researchers have developed a new technique for generating high-resolution three-dimensional (3D) representations of tissue samples, with the potential to aid the study of tumour growth and spread.

[Comment] Finally, a substantial role for radiotherapy in melanoma

Does adjuvant radiotherapy have a well-defined role in the definitive management of high-risk malignant melanoma? For decades, the answer to this question has been murky and contentious. Early reports gave conflicting results, but the data were clouded by variability in target field sizes, radiation doses, and fractionation schemes. In The Lancet Oncology, Bryan Burmeister and colleagues present an important intergroup randomised trial showing that adjuvant nodal basin radiotherapy, when used carefully and systematically, significantly improved regional lymphatic control for high-risk patients compared with no further treatment after lymphadenectomy (20 relapses among 109 patients in the adjuvant radiotherapy group vs 34 among 108 patients in the observation group, hazard ratio [HR] 0·56, 95% CI 0·32–0·98; p=0·041).

Synovial sarcoma in children and adolescents: A critical reappraisal of staging investigations in relation to the rate of metastatic involvement at diagnosis

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Andrea Ferrari, Gian Luca De Salvo, Odile Oberlin, Michela Casanova, Angela De Paoli, Annie Rey, Véronique Minard, Daniel Orbach, Modesto Carli, Bernadette Brennan, Max M. Vannoesel, Carlo Morosi, Michael C. Stevens, Gianni Bisogno
Background European protocols for paediatric synovial sarcoma (SS) require that all children routinely undergo chest computed tomography (CT) scanning and bone scanning as initial staging procedures. This study aims to determine the rate of initial metastases in paediatric SS based on specific clinical characteristics, thereby investigating whether these diagnostic procedures are really necessary in all patients. Methods Data on 258 previously-untreated SS patients <21years old were pooled from the databases of different European paediatric groups (study period 1988–2005) for this analysis, and the associations between patients’ characteristics and any presence of metastasis were estimated. Results Fifteen cases (5.8%) had distant metastases at diagnosis (86% pulmonary). The presence of metastases was unassociated with patients’ gender or age, tumour grade or site, but it was influenced by T-status, and especially primary tumour size: the risk of metastases was 32 times higher in cases of tumour >5cm than for tumours ⩽5cm. Conclusions Our findings suggest that tumour diameter can be used as a variable for identifying patients at greater risk of metastases and warranting more accurate radiological investigations. Chest CT scanning may improve the accuracy of pulmonary staging over X-ray, but requires different ionising radiation exposures that might have carcinogenic potential: it can be omitted for patients with tumours ⩽5cm. Given the very low risk of bone metastases, bone scans may be recommended only in cases with evidence of lung metastases.

Population-based evidence of increased survival in human papillomavirus-related head and neck cancer

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Mari Nygård, Bjarte Aagnes, Freddie Bray, Bjørn Møller, Jon Mork
Background Evidence from clinical, population-based and molecular studies has shown that human papillomavirus (HPV) infection can be a causal risk factor for a subset of head and neck squamous cell carcinomas (HNSCC). It is proposed that HPV-associated oropharyngeal cancer is a new disease entity that requires treatment and prevention strategies distinct from present recommendations. Methods In our population-based study we estimated incidence and survival trends in 8270 patients with HPV-related HNSCC (HPV⁺HNSCC) and HPV-unrelated HNSCC (HPV^–HNSCC) in Norway over the past three decades. Results In the period 1981–1995, patients with HPV⁺HNSCC had poorer survival than HPV^–HNSCC (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.14–1.44). By 1996–2007, survival had increased in both groups, but the increase was significantly greater among HPV⁺HNSCC patients (HR 0.57, 95% CI: 0.48–0.67). During the same period, incidence also increased, but only for HPV⁺HNSCCs. From 1981–1995 to 1996–2007, median age at diagnosis for HPV⁺HNSCC decreased from 63.2 to 59.8years, while for HPV^–HNSCC median age at diagnosis of 66.6years remained unchanged. Conclusions We demonstrate a population level improvement in survival among patients with oropharyngeal squamous cell cancers commonly related to infection with HPV. In contrast, patients with HNSCC not related to HPV only showed a modest improvement in survival in the period 1981–2007. A concomitant increase in incidence and survival was observed for HPV-related cancers only. This trend cannot be explained by changes in treatment, cancer registration nor screening, but is most likely due to an increased prevalence of HPV-positive tumours.

Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Mariska den Heijer, Caroline Seynaeve, Reinier Timman, Hugo J. Duivenvoorden, Kathleen Vanheusden, Madeleine Tilanus-Linthorst, Marian B.E. Menke-Pluijmers, Aad Tibben
Purpose To explore the course of psychological distress and body image at long-term follow-up (6–9years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. Methods Psychological distress (general and breast cancer specific) and body image (general and breast specific) were assessed in 36 high-risk women before PM (T0), at 6months (T1) and 6–9years (T2) after PM/BR. Investigated predictive variables (assessed at T0) for long-term body image (assessed at T2) included psychological distress, body image and coping styles. Results Breast cancer specific and general distress significantly decreased from T0 to T1 as well as from T1 to T2. Problems regarding breast related and general body image were significantly higher at T1 than at T0. Subsequently, breast related body image scores significantly decreased from T1 to T2, while the decrease in general body image scores were not significant. Active coping and seeking social support were predictive of lower scores (i.e. less problems) on breast related and general body image at long-term follow-up. Furthermore, higher scores on general body image before PM/BR were predictive for increased general body image scores at long-term follow-up. Conclusion Our findings indicate that psychological distress is decreased after PM/BR, at the cost of persistent problems regarding body image. Exploration of coping styles and body image perception before PM/BR may help to identify vulnerable women who may benefit from additional support.

Why is Partial-breast Irradiation Still Investigational

The investigational nature of partial breast irradiation (PBI) remains an area of controversy in the field of breast radiotherapy. While we have a long track record of conducting and strongly supporting the research in this area, we have chosen the more cautious approach of continuing to offer PBI only as part of a trial, open to selected breast cancer patients at low risk of local recurrence. This position reflects the fact that existing whole breast radiotherapy has revealed very successful in controlling local recurrences and it remains the safest choice for the patient. Our thinking has been reinforced by the recent data linking the prevention of recurrence to long term breast cancer survival: until more is known about PBI safety, its indiscriminate use may deprive some women from their best chance of fighting breast cancer. Considerations regarding the correct interpretation of the available evidence in view of the still limited duration of follow up and of the pattern of local recurrence of breast cancer sustain our position that PBI can be offered only in the context of a clinical trial. Unfortunately, more time and data are warranted for PBI to be legitimately recognized a standard radiotherapy approach in breast conservation therapy.

Real-world Impact of Availability of Adjuvant Therapy on Outcomes in Patients With Resected Pancreatic Adenocarcinoma: A Canadian Cancer Agency Experience

Background: Patients with resected pancreatic cancer (PC) have a poor prognosis. In 2004, European Study Group for Pancreatic Cancer 1 (ESPAC1) showed that the use of adjuvant therapy (AT) with 5-fluorouracil (5-FU) improves overall survival (OS). Subsequently, the British Columbia Cancer Agency (BCCA) introduced guidelines to offer AT as the standard of care for patients with resected PC. This study reviews the OS and disease-free survival (DFS) in a pre-AT era (2000 to 2004) to the AT era (2005 to 2008) at the BCCA. Methods: Using pathology records, all PC resections at Vancouver General Hospital from 2000 to 2008 were identified. Patients referred to the BCCA and their treatment records were obtained from the Cancer Agency Information System and BCCA pharmacy database. Charts were reviewed to abstract patient and tumor characteristics, DFS, and OS. Outcomes were compared by log-rank comparison. Results: In the pre-AT era, 53 resections were recorded, with 64% referred to the BCCA. Median age was 65 years; poorly differentiated 59% and margin positive 38%. About 24% of patients received AT: all 5-FU. In the AT era, 64 resections were recorded, with 86% referred. Median age was 65 years, poorly differentiated 34% and margin positive 34%. 69% of patients received AT: 61% 5FU and 39% gemcitabine. Major reasons for no AT: delayed referral or metastases at time of referral 45% and poor performance status 35%. Pre-AT DFS 13 months versus 15 months AT era (P=0.55). Pre-AT OS 19 months versus 18 months AT era (P=0.59). Conclusions: Since the guideline for AT, there was an increase in the proportion of patients referred and treated, however, over 30% still do not receive or complete AT. In this single-institution series, there was no difference in survival outcomes between the pre-AT and AT eras. Strategies to improve rate and timeliness of referral should be explored.

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and Sargramostim as Prophylaxis Against Hospitalization for Neutropenic Complications in Patients With Cancer Receiving Chemotherapy

Background: Comparative effectiveness of filgrastim, pegfilgrastim, and sargramostim in preventing hospitalization for febrile neutropenia (FN) during myelosuppressive chemotherapy has not been well characterized and is an important clinical question in oncology. Methods: This study used a retrospective cohort design and US healthcare claims data. Source population included patients with solid tumors receiving filgrastim, pegfilgrastim, or sargramostim during their first observed course of chemotherapy between July 2001 and June 2007. For each patient, every unique chemotherapy cycle during the course was identified, along with each cycle in which filgrastim, pegfilgrastim, or sargramostim was administered by the fifth day of the cycle (ie, as prophylaxis). Risks of hospitalization for neutropenic complications (broad definition: admission with a diagnosis of neutropenia, fever, or infection; narrow definition: admission with a diagnosis of neutropenia) and for any reason were examined on a cycle-specific basis during all the cycles in which colony-stimulating factor prophylaxis was administered. Unadjusted and adjusted odds ratios (ORs) for hospitalization were estimated. Results: Risk (unadjusted) of hospitalization for neutropenic complications (narrow definition) was 2.1% for filgrastim prophylaxis (n=8286), 1.1% for pegfilgrastim prophylaxis (n=67,247), and 2.5% for sargramostim prophylaxis (n=1736). Corresponding risks of hospitalization based on the broad definition were 4.0%, 2.6%, and 5.1%. Risks of all-cause hospitalization were 7.9%, 5.3%, and 9.6%, respectively. Adjusted odds of hospitalization were significantly higher for filgrastim [OR (range across the 3 alternative measures of hospitalization): 1.58-1.79; P<0.001] and sargramostim (OR: 1.89-2.68; P<0.001) versus pegfilgrastim. Conclusions: Risk of hospitalization for neutropenic complications during cancer chemotherapy is lower with pegfilgrastim prophylaxis than with filgrastim or sargramostim prophylaxis.

Adjuvant Radiation Therapy Increases Overall Survival in Node-Positive Gastric Cancer Patients With Aggressive Surgical Resection and Lymph Node Dissection: A SEER Database Analysis

Objectives: To determine the outcomes of postoperative radiation therapy on survival in gastric cancer. Methods: An analysis of patients with surgically resected and nonmetastatic gastric cancer from the Surveillance, Epidemiology, and End Results database from 1990 to 2003 was carried out. Survival curves were calculated according to the Kaplan-Meier method. Multivariate analysis was carried out by the Cox proportional hazard model. Results: We identified 11,630 patients who met inclusion criteria. Radiation therapy was associated with increased survival in patients with American Joint Committee on Cancer stage IB to IV. The median survival for stage IB and II patients treated with radiation was 96 months and 37 months, respectively, versus 56 months and 23 months for patients who did not receive adjuvant radiation (P=0.0281 for stage IB and <0.0001 for stage II). The 5-year overall survival for node-positive patients treated with radiation was 30.4% versus 21.4% for patients who did not receive adjuvant radiation (P<0.0001). The survival benefit of radiation therapy was maintained even if ≥15 lymph nodes were removed for N1 and N2 disease and if ≥30 lymph nodes were removed for N3 disease. For node-positive patients with ≥15 lymph nodes removed, adjuvant radiation was linked to increase survival in patients who underwent partial gastrectomy, total gastrectomy, and en bloc gastrectomy with other organs removed. Radiation was a strong independent factor for survival on multivariate analysis. Conclusions: There is a correlation between survival and radiation therapy in node-positive gastric cancer patients and is independent of the extent of surgical resection and lymph node dissection.

Screening Colonoscopy Among Colorectal Cancer Survivors Insured by Medicaid

Objectives: The objectives of this research study are to describe the proportion of Medicaid-insured colorectal cancer survivors who had a colonoscopy between 3 and 18 months after surgery of the colon or rectum and to determine if patient, health services, and community characteristics are associated with colonoscopy follow-up after treatment. Methods: A retrospective cohort study among 1044 Medicaid-insured individuals diagnosed with local or regional colorectal cancer was conducted. Multivariable logistic regression analyses assessed patient, hospital, and community characteristics associated with colonoscopy. Results: About 42% of the study population had a colonoscopy 3 to 18 months after surgery. Factors associated with receipt of colonoscopy in the multivariable model include having colon (vs rectal) cancer, having local (vs regional) cancer, and having received chemotherapy as part of first course of therapy. Being 75 or older (vs <65), having first course of therapy at a hospital with the highest surgical volume (vs lowest surgical volume), and living in an urban (vs rural) environment were associated with a decreased likelihood of colonoscopy. Colonoscopy utilization patterns diverge after 65 years of age when persons become dually insured by Medicare. By age 80 years, there seems to be an almost 3-fold difference in receipt of colonoscopy—those with comorbidity are more likely to be screened than those without comorbidity. Conclusions: Less than half of Medicaid-insured colorectal cancer survivors received a colonoscopy in 3 to 18 months after colorectal resection. Improvements in screening in this high-risk population should be the target of future interventions to reduce the probability of recurrence.

Acquired Angioedema and Marginal Zone Lymphoma [DIAGNOSIS IN ONCOLOGY]

Remarkable Tumor Response to Crizotinib in a 14-Year-Old Girl With ALK-Positive Non-Small-Cell Lung Cancer [DIAGNOSIS IN ONCOLOGY]

Bilateral Ear Swelling and Erythema After Chemotherapy: A Case of Ara-C Ears [DIAGNOSIS IN ONCOLOGY]

Prospective, Observational Study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer [Palliative and Supportive Care]

Purpose

Pain is prevalent among patients with cancer, yet pain management patterns in outpatient oncology are poorly understood.

Patients and Methods

A total of 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled onto this prospective study regardless of phase of care or stage of disease. At initial assessment and 4 to 5 weeks later, patients completed a 25-item measure of pain, functional interference, and other symptoms. Providers recorded analgesic prescribing. The pain management index was calculated to assess treatment adequacy.

Results

Of the 3,023 patients we identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing. We found no difference in treatment adequacy between the initial and follow-up visits. Multivariable analysis revealed that the odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (odds ratio, 0.51; 95% CI, 0.37 to 0.70; P = .002). Other significant predictors of inadequate pain treatment were having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment.

Conclusion

Most outpatients with common solid tumors must confront issues related to pain and the use of analgesics. There is significant disparity in pain treatment adequacy, with the odds of undertreatment twice as high for minority patients. These findings persist over 1 month of follow-up, highlighting the complexity of these problems.

Prevention of Pegfilgrastim-Induced Bone Pain: A Phase III Double-Blind Placebo-Controlled Randomized Clinical Trial of the University of Rochester Cancer Center Clinical Community Oncology Program Research Base [Treatment-Related Complications]

Purpose

Pegfilgrastim-induced bone pain is a significant clinical problem that may result in discontinuation of pegfilgrastim and lead to less effective chemotherapy dosing. Interventions for pegfilgrastim-induced bone pain are needed.

Patients and Methods

The University of Rochester Cancer Center Clinical Community Oncology Program Research Base randomly assigned 510 patients at 17 sites to receive either naproxen (500 mg two times per day) or placebo on the day of pegfilgrastim administration, continuing for 5 to 8 days after pegfilgrastim. Patients recorded pain severity (using a scale of 0 to 10) and duration in daily diaries. The primary outcome measure was the area under the curve (AUC) for pain for days 1 through 5. Secondary outcome measures included the identification of risk factors for the development of pain and response to naproxen.

Results

Patients' mean age was 55.6 years and 86% were female. Sixty-eight percent of patients had breast cancer and 10% had lung cancer. Pain reached its peak at 3 days for both groups. The mean AUC for pain was 7.71 for the placebo group and 6.04 for the naproxen group (P = .037). Naproxen reduced maximum pain from 3.40 to 2.59 (P = .005). Naproxen also reduced overall pain incidence from 71.3% to 61.1% (P = .020) and duration from 2.40 to 1.92 days (P = .009). The reduction in severe pain (> 5 on a scale of 1 to 10) from 27.0% to 19.2% was also significant (P = .048). Risk factors could not be identified to predict incidence, severity, or ability to prevent pegfilgrastim-induced bone pain.

Conclusion

Our phase III randomized placebo-controlled clinical trial demonstrated that naproxen at a dose of 500 mg twice per day is effective in reducing the incidence and severity of pegfilgrastim-induced bone pain.

Chemotherapy-Related Thrombocytosis: Does It Increase the Risk of Thromboembolism

Oncology 2012;82:327–332 (DOI:10.1159/000337235)

Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Oncology 2012;82:321–326 (DOI:10.1159/000337573)

Front & Back Matter

Oncology 2012;82:X (DOI:10.1159/000339389)

Palliation of Symptomatic Malignant Ascites: An (Often) Unmet Need

Oncology 2012;82:313–314 (DOI:10.1159/000337690)

A Pilot Study of Long-Acting Octreotide for Symptomatic Malignant Ascites

Oncology 2012;82:315–320 (DOI:10.1159/000337246)

Successful Treatment of Aortic Rupture with Endovascular Stent Grafting in a Patient with Mantle Cell Lymphoma

Case Rep Oncol 2012;5:275–279 (DOI:10.1159/000339227)

Total Vertebrectomy for Non-Small Cell Lung Cancer

Case Rep Oncol 2012;5:267–270 (DOI:10.1159/000339299)

Two Cases of Cerebral Involvement in Malignant Lymphoma (CD20+) That Responded to Combination Therapy with Rituximab and Cladribine

Case Rep Oncol 2012;5:260–266 (DOI:10.1159/000339406)

Kaposi’s Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity

Case Rep Oncol 2012;5:271–274 (DOI:10.1159/000339228)

Acute Generalized Exanthematous Pustulosis Induced by Erlotinib (Tarceva) with Superimposed Staphylococcus aureus Skin Infection in a Pancreatic Cancer Patient: A Case Report

Case Rep Oncol 2012;5:253–259 (DOI:10.1159/000338806)

Table of Contents

Editorial Board

The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium

Abstract: Background: Cigarette smoking is associated with esophageal adenocarcinoma (EAC), esophagogastric junctional adenocarcinoma (EGJA) and esophageal squamous cell carcinoma (ESCC), and alcohol consumption with ESCC. However, no analyses have examined how delivery rate modifies the strength of odds ratio (OR) trends with total exposure, i.e., the impact on the OR for a fixed total exposure of high exposure rate for short duration compared with low exposure rate for long duration. Methods: The authors pooled data from 12 case–control studies from the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium (BEACON), including 1242 (EAC), 1263 (EGJA) and 954 (ESCC) cases and 7053 controls, modeled joint ORs for cumulative exposure and exposure rate for cigarette smoking and alcohol consumption, and evaluated effect modification by sex, body mass index (BMI), age and self-reported acid reflux. Results: For smoking, all sites exhibited inverse delivery rate effects, whereby ORs with pack-years increased, but trends weakened with increasing cigarettes/day. None of the examined factors modified associations, except for ESCC where younger ages at diagnosis enhanced smoking effects (P<0.01). For EAC and EGJA, ORs with drink-years exhibited inverse associations in <5drinks/day consumers and no association in heavier consumers. For ESCC, ORs with drink-years increased, with trends strengthening with greater drinks/day. There was no significant effect modification, except for EAC and EGJA where acid reflux mitigated the inverse associations (P=0.02). For ESCC, younger ages at diagnosis enhanced drinking-related ORs (P<0.01). Conclusions: Patterns of ORs by pack-years and drink-years, delivery rate effects and effect modifiers revealed common as well as distinct etiologic elements for these diseases.

The descriptive epidemiology of female breast cancer: An international comparison of screening, incidence, survival and mortality

Abstract: Background: This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes.Results: Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies.Conclusion: The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly “westernised” lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.

Analyzing the time trends of disease rates can help understand the etiology of the disease since a changing trend implies the changes of environmental risk factors while a constant trend may be explained by some genetic or stable environmental risk factors. Describing the gender difference in disease rates also has important etiological implications on risk factors with different distributions in males and females. As an integration of these two methodologies, Dyego Leandro Bezerra de Souza and colleagues provided a good example of presenting the changing epidemiology of two male predominant cancers, laryngeal and hypopharyngeal cancers, in Spain . In this recently published paper, the authors found the gap between genders in these two cancers has been narrowed in recent years and concluded that the observed trends might be explained by the different changes in tobacco and alcohol consumptions between genders.

Editorial Board

Geriatric thoracic oncology: Gaining momentum

Lung cancer accounts for the highest cancer associated mortality in the US. Of the 160,000 estimated deaths from lung cancer this year, the majority will be secondary to non-small cell lung cancer. Lung cancer is a disease of the older adult with over two-thirds of cases diagnosed in patients over the age of 65years and half of the cases diagnosed in patients over the age of 70years. With the rapid “graying” of the US population, akin to other age associated conditions, the overall incidence of lung cancer is expected to rise over the next 15–20years. With significant research in the field of lung cancer over the last 20years, the incidence and mortality from lung cancer decreased among individuals aged ≤50years, but increased among those aged ≥70years.

Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer

Abstract: The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management.The unique peculiarities of anesthesia in older cancer patients prompted the International Society of Geriatric Oncology (SIOG) to put together a panel of international experts with the aim of reviewing the literature and drafting a consensus document. This article summarizes their views.

Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803)

Abstract: Objective: The purpose of this study was to assess the impact of aging, comorbidities and symptoms on physical function in patients surviving 20years since adjuvant treatment for breast cancer.Patients and methods: Patients were originally treated on CALGB 7581 (from 1975 to 1980), a randomized trial of three adjuvant therapies and reassessed (153 of 193 eligible survivors) 20years from the onset of therapy for physical function and symptoms by the EORTC QLQ-C30 and comorbidities by the OARS questionnaire.Results: The average age at reassessment was 64.5years. 66% of patients had at least two comorbidities and 22% had four or more, but relatively little interference with activities. Older patients had greater multimorbidity. Physical function was generally high and comparable to matched population norms. Older patients had greater difficulty with strenuous activities. For every increase in number of comorbidities, physical function score decreased by 5.1 (p<.001). Symptoms were also frequent (80%) and correlated strongly with decreases in function (0–100u scale) (p<.001), to an even greater degree than comorbidities.Conclusion: Very long-term cancer survivors have changes in physical function and symptoms largely consistent with their aging suggesting that the impact of cancer and its treatment is attenuated over time and largely replaced by the impact of age-related comorbidities and functional decline.

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

Abstract: Objective: The aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.Methods: We analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.Results: The population aged 65years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men +0.3 CI +0.1/+0.5, women +0.2 CI −0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men +1.3 CI +1.0/+1.7, women +0.9 CI +0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC +1.5; CI +0.5/+2.5) and for melanoma among men (APC +2.7; CI +0.5/+4.8).Conclusions: Recent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.

US Oncology Research

US Oncology Research is now one of the largest community-based research programs in the U.S. Over the years more than 50,000 patients have participated in over 1,200 clinical trials in our program.

Author: usoncology
Added: 05/26/2012

Singing the "Haemo Blues"

Derek Caine did not have a musical background when he was diagnosed with CLL/SLL in 2004, but he has since written what has become the blood cancer patient's anthem. Titled "The Haemo Blues,&quot...

Author: patientpower
Added: 05/25/2012

Bendamustine: A Less Toxic Therapy for CLL?

Bendamustine, a drug developed over 50 years ago in the former East Germany, is finding new life for the treatment of CLL. Already used by many physicians in Germany, bendamustine has been used both a...

Author: patientpower
Added: 05/25/2012

IMPACT Trial Analysis - Overall survival advantage for Advanced Prostate Cancer

Analysis of the IMPACT Trial: What is the Overall Survival Advantage for Men With Advanced Prostate Cancer?

Author: patientpower
Added: 05/25/2012

Leading Prostate Cancer Expert Responds to Panels New PSA Guidelines

Dr. Leonard Gomella responds to a recent recommendation by a government panel stating that men should not be routinely screened for prostate cancer using the PSA test. Dr. Gomella shares what he feels...

Author: patientpower
Added: 05/25/2012