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New Palliative Care Cancer Guidelines

Nearly half of all patients with metastatic cancer have incurable disease, but these individuals can live for years after their initial diagnosis. Palliative care can be used during this period to improve quality of life (QOL) for patients and caregivers. Palliative care emphasizes medically appropriate goal setting, honest communication, and meticulous symptom assessment and control. Despite the documented benefits of using palliative care in standard oncologic care, studies indicate that many patients are not referred to these services until near the end of life. Delaying palliative care reduces opportunities for clinicians to address physical symptoms and the emotional, social, and spiritual needs (see also, The Burden of Pain & Depression in Cancer Patients). Potential Benefits of Early Palliative Care Integration In the March 10, 2012 Journal of Clinical Oncology, the American Society of Clinical Oncology (ASCO) issued a provisional clinical opinion (PCO) on integrating palliative care into standard oncology care. The document was prompted by a growing body of research demonstrating the benefits of this integration early in the care of patients with metastatic cancer. Seven randomized controlled trials have shown that providing early palliative care together with standard oncologic care in patients with advanced cancer can be beneficial. These benefits include: Improved symptoms, QOL, and satisfaction. Reduced caregiver burden. More appropriate referral to and use of hospice. Decreased use of futile intensive care. Furthermore, most of these studies demonstrated improved outcomes at a cost lower than that of standard oncologic care alone. No trials to date have demonstrated harm to patients and caregivers or excessive costs from early involvement of palliative care. Hurdles Ahead for Readily Available Palliative...

New Guidelines for Advanced NSCLC

In the most recent update, investigators conducted a literature search for all relevant randomized trials published since 2002, looking specifically for treatment strategies that improved overall survival. Drugs that were found to only improve progression-free survival were evaluated in light of their toxicity and quality-of-life benefits. Several new drugs have entered the market, so it was important to take a fresh look at our first- and second-line therapies. One of the most important additions to first-line treatment for stage IV NSCLC has been the arrival of bevacizumab, which can be used in conjunction with carboplatin-paclitaxel. There have also been new arrivals on the second-line therapy, including pemetrexed and erlotinib. In addition to existing therapies, these new drugs have been evaluated and ranked according to a number of treatment scenarios and the likely benefits that they can confer to patients. According to the evidence, these newer drugs appear to have made an impact on treatment decisions. Clinicians should recognize that it’s important to tailor treatments based on individual characteristics of patients. For example, physical age should no longer be factored into treatment decisions. Instead, patients’ physiological age and performance status are more appropriate benchmarks for deciding on treatments. Additionally, race and genetic makeup appear to impact treatment strategies.  Genes Matter A new aspect of the 2009 ASCO guideline update is the evaluation of genetic biomarkers, which may affect how patients will respond to a particular agent. While there are several biomarkers with evidence supporting an impact on disease progression, none are currently as well-characterized as mutations in the epidermal growth factor receptor (EGFR). When patients have known EGFR mutations, treatment...

American Society of Clinical Oncology GI Symposium

New research presented at the Gastrointestinal (GI) Cancers Symposium from the American Society of Clinical Oncology, or ASCO, from January 22-24, 2010 in Orlando addressed key issues on the prevention, screening, and treatment of GI cancers. The features below highlight just some of the studies that emerged from the symposium. Comparing Treatments for True Cardia & Sub-Cardia Cancer The Particulars: Different surgical treatments are available for the treatment of true cardia and sub-cardia cancer. In left thoracoabdominal (LT) approaches, surgeons make a large incision from the left side of the chest to the middle of the abdomen. In abdominal and transhiatal (AT) approaches, the incision is smaller in the upper abdomen. The AT approach does not provide as much space to remove lymph nodes for analysis as the LT approach, but it is less invasive. Data Breakdown: Researchers randomly assigned 167 patients to undergo surgery with AT or LT between 1995 and 2003. After a medium follow-up of 7.7 years, 5-year survival rates were higher in the AT group than the LT group (51% vs 37%). AT recipients experienced significantly less deterioration in respiratory function, body weight, and other symptoms. Take Home Pearl: When surgical treatment is indicated in true cardia or sub-cardia cancer, AT approaches appear to be superior to LT approaches. Predicting Survival in Gastric Cancer The Particulars: Peritoneal cytology is often used to determine the presence of cancer spread in gastric cancer patients that is not visible to the naked eye. It is performed by microscopic examination of cell samples collected during surgery. Data Breakdown: A study was conducted to analyze poor disease-specific survival (DSS) among...
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