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Imagine being newly diagnosed with chronic myelogenous leukemia (CML), a neoplasm of hematopoietic stem cells caused by the Philadelphi chromosome t(9;22). In decades past, individuals diagnosed with CML were offered allogeneic hematopoietic stem cell transplant (allo-HSCT). Survival rates with allo- HSCT are lower compared with newer therapies mainly due to the risk of graft-versus-host disease and infectious complications.

Throughout this series, we have evaluated various challenges and barriers to optimizing care for patients with cancer. While it is evident that we have a long way to go with regard to making cancer therapy logistically easy, better tolerated, and less emotionally exhausting, the past decade has arguably brought us closer to achieving these goals. New oral chemotherapy drugs have freed some patients from the restraints of treatment within a cancer center’s infusion suite. New targeted therapies have increased survival and treatment-related efficacy while reducing adverse events.

An increasing number of cancers are treated with self-administered oral medications either as the sole treatment or as a component of the patient’s cancer therapy. Most supportive and palliative medications (including antiemetics, pain relievers, and antidiarrheals) are oral, and proper adherence to these agents may be important in maximizing the patient’s quality of life. As healthcare providers, we may believe that given the gravity of the disease, patients will be especially compliant with their oral anticancer medications.

Researchers have documented diverse genetic changes in different parts of the same primary tumor, suggesting that individual tumors harbor a complexity of genetic changes that has not been well appreciated (Gerlinger M, Rowan AJ, Horswell S, et al. N Engl J Med. 2012;366:883-892). This discovery has implications for personalized medicine directed at genetic changes identified in 1 biopsy of a primary tumor.

According to 2 large breast cancer trials, CYP2D6 genotyping was not predictive of the effectiveness of tamoxifen in postmenopausal women. Thus, the results of these studies are not generalizable to premenopausal women.

The term “chemo brain” was coined to describe mild cognitive problems in cancer patients attributed to chemotherapy. Although minor chemotherapy-induced memory and cognitive impairments have been described previously, a case-cohort study suggests that these effects can persist more than 20 years posttherapy.

The authors state that chemo brain effects are subtle compared with women who never had chemotherapy, but it’s possible that these effects place people at greater risk for cognitive decline associated with aging.

Primary gastrointestinal stromal tumor (GIST) sited outside the gastrointestinal (GI) tract carries a poorer prognosis than primary GIST within the GI tract, according to a study presented at the recent ASCO GI Symposium in January 2012.

The previous installment in this cancer care series examined the growing importance of oral therapies for the treatment of cancer and the implications of patient adherence on its success. At the present time, more than 20 oral medications are approved by the Food and Drug Administration (FDA) for first-line treatment of cancer.

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