The oncologist
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An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability--group A, >70%; group B, 30%-70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score. ⋯ The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained.
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Oxaliplatin-induced neuropathy is a significant and dose-limiting toxicity that adversely affects quality of life. However, the long-term neurological sequelae have not been adequately described. The present study aimed to describe the natural history of oxaliplatin-induced neuropathy, using subjective and objective assessments. ⋯ These findings establish the persistence of subjective and objective deficits in oxaliplatin-treated patients post-oxaliplatin, suggesting that sensory neuropathy is a long-term outcome, thereby challenging the literature on the reversibility of oxaliplatin-induced neuropathy.
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Although calls for improvements in cancer survivorship planning and programming exist, implementation has lagged. As with most guidelines, moving from recommendations to implementation requires active planning and systems changes to insure sustained use. Here, we draw on the latest in implementation science to outline a process that cancer organizations can use in designing, implementing, prioritizing, and evaluating cancer survivor programs to improve patient outcomes, using smoking cessation as a primary example. We consider the scientific evidence for benefit from interventions and the strategy for implementation and evaluation to sustain programs.
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In developed countries, there has been a remarkable improvement in mortality from breast cancer, but almost all of that benefit has occurred in the estrogen receptor (ER)(+) and human epidermal growth factor receptor (HER)-2(+) subsets. Triple-negative breast cancer, defined as tumors that are negative for ER, progesterone receptor, and HER-2, represent a minority of breast cancers. However, because of the poor prognosis in this particular subtype, triple-negative disease accounts for a disproportionate number of metastatic cases and breast cancer deaths. ⋯ More recently, poly(ADP-ribose) polymerase inhibitors appear to take advantage of the concept of synthetic lethality, or dual pathway inhibition, in attacking triple-negative and BRCA-associated tumors. These and other studies in triple-negative disease will help us to better identify effective treatment options and improve outcomes in these patients. This article addresses the nature of, and therapeutic strategies for, triple-negative breast cancer.
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To describe the clinical studies that led to the FDA approval of rituximab in combination with fludarabine and cyclophosphamide (FC) for the treatment of patients with chronic lymphocytic leukemia (CLL). ⋯ On the basis of the demonstration of clinically meaningful prolongation of PFS, the FDA granted regular approval to rituximab in combination with FC for the treatment of patients with CLL. The magnitude of the treatment effect in patients 70 years and older is uncertain.