Cancer control : journal of the Moffitt Cancer Center
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Chemotherapy-induced nausea and vomiting (CINV) is one of the most debilitating toxicities associated with cancer treatment. Although effective antiemetic agents are available, their use in practice often is suboptimal. ⋯ Interventions for CINV should include standard-of-care antiemetics combined with corticosteroids. The cost of using older, less expensive antiemetics may be outweighed by the expenditures to rescue patients after suboptimal prophylaxis, as well as the indirect costs of missed work and lost productivity.
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Ovarian cancer remains the most deadly of the gynecologic cancers. It is difficult to diagnose until in advanced stages. An effective screening test may help to decrease mortality from ovarian cancer. Due to the low incidence of ovarian cancer in the general population, a good screening test must have high sensitivity and specificity to allow accurate detection without excessive false-positive results. Thus, effective screening for ovarian cancer has remained elusive. ⋯ No effective screening methods for ovarian cancer that have been adequately validated are available. Routine screening for ovarian cancer in the general population is not currently recommended.
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In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. However, the narrow confines of the bony pelvis and angling limits in current stapling technology, along with the standard practice of autonomic nerve-sparing total mesorectal excision, have made laparoscopic surgery in the setting of rectal cancer more challenging. The available literature focusing on laparoscopic resection for rectal cancer has been predominantly retrospective in nature, with a limited number of prospective studies. ⋯ In view of the limited prospective data, laparoscopic resection for mid to low rectal cancer is still investigational in the United States. While feasibility studies are promising, open surgical resection remains the current standard of care. It is hoped that the long-term results of ongoing and newly initiated multi-institutional trials will fully define the role of laparoscopy in the treatment of mid to low rectal cancer.
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Surgery is currently the primary treatment modality for metastatic melanoma involving the inguinal lymph nodes. However, inguinal lymph node dissections are associated with substantial morbidity including infection, wound dehiscence, lymphedema, seroma, and deep venous thromboembolism (DVT). Improved understanding is needed regarding the factors predisposing patients to complications and the operative and perioperative maneuvers that can decrease morbidity. ⋯ While the morbidity of inguinal lymphadenectomy can be substantial, several straightforward pre- and postoperative measures can be instituted to limit morbidity. Controversy persists regarding the indications for and benefit of pelvic lymphadenectomy, saphenous vein preservation, and sartorius muscle transposition. A multi-institutional trial is currently in progress to investigate the safety of avoiding lymphadenectomy in patients with microscopic metastases in the sentinel node.
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Since the term "evidence-based medicine" (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public,and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes aspecific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. ⋯ Our findings indicate that EBM should not be construed as a new scientific or philosophical theory that changes the nature of medicine or our understanding thereof. Rather, we should consider EBM as a continuously evolving heuristic structure for optimizing clinical practice.