Journal of the National Comprehensive Cancer Network : JNCCN
-
J Natl Compr Canc Netw · Sep 2007
ReviewInterventional therapies for cancer pain management: important adjuvants to systemic analgesics.
Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. ⋯ Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.
-
J Natl Compr Canc Netw · Aug 2007
ReviewPoint: the value of predicting life expectancy in men with clinically localized prostate cancer.
The prediction of life expectancy in prostate cancer screening and treatment is a controversial topic that evokes various opinions regarding its validity. The authors believe incorporating life expectancy prediction into the treatment algorithms for prostate cancer is important. ⋯ These estimates can then be used to help guide treatment discussion. Estimating life expectancy benefits older men in whom decisions regarding the best form of treatment may be difficult.
-
J Natl Compr Canc Netw · Mar 2007
ReviewGuidelines for improving breast health care in limited resource countries: the Breast Health Global Initiative.
Breast cancer is an increasingly urgent problem in low- and mid-level resource regions of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care when diagnostic or treatment resources are lacking. For this reason, it is important to identify which resources most effectively fill health care needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made to maximize improvement in outcome. ⋯ The BHGI collaborated with 12 national and international health organizations, cancer societies, and nongovernmental organizations to host 2 BHGI international summits. The evidence-based BHGI guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast health care. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in health care delivery, based on outcomes, cost, cost-effectiveness, and use of health care services.
-
J Natl Compr Canc Netw · Sep 2006
ReviewLiver transplantation for hepatocellular carcinoma: an update.
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and the most common primary hepatic malignancy. It arises on a background of hepatic cirrhosis in approximately 95% of the cases in the United States. ⋯ Transplantation for patients whose tumors do not exceed the Milan criteria yields results equivalent to those of transplantation for non-HCC indications. Controversy now exists regarding the use of living donors, expansion of selection criteria, and role of adjuvant therapy.
-
J Natl Compr Canc Netw · Jul 2006
ReviewComputed tomography screening for the early detection of lung cancer.
Although lung cancer is the leading cause of cancer-related death in the world and has an increased chance of cure if detected at an earlier stage, routine lung cancer screening is currently not recommended in the United States. Unfortunately, most patients with lung cancer present only after the onset of symptoms and have advanced disease that cannot be surgically resected. ⋯ Although past randomized screening trials evaluating the use of standard chest radiography or sputum cytology have not resulted in lower mortality, recent studies suggest that computed tomography (CT) may have promise as a screening tool. This article summarizes experience over the past decade of using low-dose spiral CT imaging as a screening tool to detect early lung cancers in asymptomatic, high-risk individuals.