American Society of Clinical Oncology educational book
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Am Soc Clin Oncol Educ Book · Jan 2013
ReviewTobacco and lung cancer: risks, trends, and outcomes in patients with cancer.
Tobacco use, primarily associated with cigarette smoking, is the largest preventable cause of cancer mortality, responsible for approximately one-third of all cancer deaths. Approximately 85% of lung cancers result from smoking, with an additional fraction caused by secondhand smoke exposure in nonsmokers. The risk of lung cancer is dose dependent, but can be dramatically reduced with tobacco cessation, especially if the person discontinues smoking early in life. ⋯ Tobacco cessation in patients with cancer may improve cancer treatment outcomes, but cessation support is often not provided by oncologists. Reducing the health related effects of tobacco requires coordinated efforts to reduce exposure to tobacco, accurately assess tobacco use in clinical settings, and increase access to tobacco cessation support. Lung cancer screening and coordinated international tobacco control efforts offer the promise to dramatically reduce lung cancer mortality in the coming decades.
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Am Soc Clin Oncol Educ Book · Jan 2013
ReviewUnderstanding variation in the quality of the surgical treatment of prostate cancer.
More than 80% of men with prostate cancer undergo active treatment, which can be associated with significant morbidity. Outcomes of surgical treatment vary widely depending on who treated the patient and where the patient was treated, implying that there is room for improvement. Factors influencing outcomes include patient characteristics as well as some measure of procedure volume. ⋯ However, much of the variation in functional outcomes after prostate cancer surgery arises from differences in technical skill. Evaluating and improving intraoperative surgeon performance will inevitably be challenging, as they require acquisition and interpretation of data collected in the operating room. To this end, several methods have been described to objectively assess what happens in the operating room.
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Despite efforts to reduce disparities in cancer outcomes among vulnerable populations, certain subgroups do not experience the gains made in the reduction of cancer incidence and mortality. In this article, we review recent trial data reporting on patient-, physician-, and system-centered interventions to improve quality and reduce disparities in cancer care spanning patient navigation to health reform. We conclude with data from a state that implemented a multitiered approach, targeting patient and systems barriers, that serves as a guide for future endeavors.
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Am Soc Clin Oncol Educ Book · Jan 2013
Review Historical ArticleNational plan for prevention, early detection, and cancer control in Peru.
Peru currently is executing an ambitious plan for cancer control: its first nationwide program of cancer prevention and cancer control, and the first such program launched in Latin America. The adequate strategies were identified from previous experience developing smaller initiatives and from knowledge of our epidemiology and priorities. ⋯ With a growing Peruvian economy in a globalized market context, emerging sectors are being exposed to new risk factors for cancer and educational strategies were implemented. The development of the National Plan for Cancer Control was launched involving not only technical efforts by a multidisciplinary team, but also political concertation.
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Am Soc Clin Oncol Educ Book · Jan 2013
ReviewBiomarkers and correlative endpoints for immunotherapy trials.
Immunotherapies for lung cancer are reaching phase III clinical trial, but the ultimate success likely will depend on developing biomarkers to guide development and choosing patient populations most likely to benefit. Because the immune response to cancer involves multiple cell types and cytokines, some spatially and temporally separated, it is likely that multiple biomarkers will be required to fully characterize efficacy of the vaccine and predict eventual benefit. ⋯ Earlier clinical endpoints such as response rate and progression-free survival do not correlate with overall survival demonstrated for some immunotherapies, suggesting the need to develop other intermediary clinical endpoints. Insofar as all these biomarkers and surrogate endpoints are relevant in multiple malignancies, it may be possible to extrapolate findings to immunotherapy of lung cancer.