Journal of the National Comprehensive Cancer Network : JNCCN
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J Natl Compr Canc Netw · Mar 2011
Development and validation of 11 symptom indexes to evaluate response to chemotherapy for advanced cancer.
Recent guidance from the FDA discusses patient-reported outcomes as end points in clinical trials. Using methods consistent with this guidance, the authors developed symptom indexes for patients with advanced cancer. Input on the most important symptoms was obtained from 533 patients recruited from NCCN Member Institutions and 4 nonprofit social service organizations. ⋯ Results are evaluated alongside previously published indexes for 9 of these 11 advanced cancers that were created based on expert provider surveys, also implemented at NCCN Member Institutions. Final results are 11 symptom indexes that reflect the highest priorities of people affected by these 11 advanced cancers and the experienced perspective of the people who provide their medical treatment. Beyond the clinical value of such indexes, they may also contribute significantly to satisfying regulatory requirements for a standardized tool to evaluate drug efficacy with respect to symptomatology.
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The involvement of axillary nodes remains a significant prognostic factor in breast cancer. However, management has changed from complete surgical staging to sentinel lymph node biopsies. ⋯ This article focuses on the examination of recent evidence in management of the axilla. It focuses on both the prognostic and therapeutic information gleaned from isolated tumor cells and micrometastatic disease and on the use of completion axillary lymph node dissections or axillary radiation in preventing regional recurrence.
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Collecting data is time-consuming and expensive. Electronic transactions, including electronic medical records and the unification of many billing procedures, have transformed the rate at which data are able to be extracted. Although obstacles remain, the rate at which data are de-identified, collected, and aggregated will help improve safety and standards of care for oncology patients. Everyone participating in the care of oncology patients must understand how important data are as the quality initiatives and performance metrics are numerous and growing; these initiatives cannot be successful without timely, accurate, and quantifiable data that address the continuum of oncology care.