Cancer
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Racial disparities in survival from breast and prostate cancer are well established; however, the roles of societal/socioeconomic factors and innate/genetic factors in explaining the disparities remain unclear. One approach for evaluating the relative importance of societal and innate factors is to quantify how the magnitude of racial disparities changes according to the geographic scales at which data are aggregated. Disappearance of racial disparities for some levels of aggregation would suggest that modifiable factors not inherent at the individual level are responsible for the disparities. ⋯ The current results suggest that modifiable societal factors are responsible for apparent racial disparities in breast and prostate cancer survival observed at larger geographic scales. This research presents a novel strategy for taking advantage of inconsistencies across geographic scales to evaluate the relative importance of innate and societal-level factors in explaining racial disparities in cancer survival.
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Inactivation of the von Hippel-Lindau tumor suppressor gene in most sporadic renal cell carcinoma (RCC) tumors leads to a fundamental reliance on elements of this pathway, namely, the potent proangiogenic factor, vascular endothelial growth factor (VEGF). Thus, VEGF-targeted therapeutics have undergone extensive clinical testing in RCC. ⋯ Robust clinical effects have been observed, including high objective response rates, prolonged progression-free survival, and evidence of long overall survival for patients with metastatic RCC patients who are treated with these agents. Future directions include investigation of combination and sequenced therapy, elucidation of mechanisms of response and resistance, and exploration of the effect of these agents in other disease settings.
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This study investigated whether there was a significant gap in receipt of treatment for nonsmall cell lung cancer (NSCLC) between blacks and whites, and whether the gap or disparity changed during the past 12 years from 1991 to 2002. ⋯ There have been substantial disparities in receiving recommended treatments between blacks and whites, and these disparities have been relatively stable without a significant trend of narrowing during the past 12 years. Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment for NSCLC.
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: Delirium has been the most frequent neuropsychiatric complication in patients with advanced cancer. This exploratory study aimed to determine the proportion of patients who were able to recall their experience of delirium and the level of distress experienced by patients, family caregivers, and healthcare professionals. ⋯ : The majority of patients with advanced cancer recalled their experience of delirium, causing moderate to severe distress in both patients and family caregivers. Appropriate interventions to reduce this distress are needed. Cancer 2009. (c) 2009 American Cancer Society.
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: Palliative care has been progressively adopted by American cancer centers; however, referrals to palliative care continue to occur late in the trajectory of illness. It was hypothesized that the perceived association between the name palliative care and hospice was a barrier to early patients' referral. The objectives of this study were to determine the perception of the impact of the name palliative care compared with supportive care on patient referral and to determine whether there was an association between demographic factors and the perceptions of the 2 names by medical oncologists and their midlevel providers (advance practice nurses and physician assistants) at a comprehensive cancer center. ⋯ : The name palliative care was perceived by medical oncologists and midlevel providers as more distressing and reducing hope to patients and families. Medical oncologists and midlevel providers significantly prefer the name supportive care and stated more likelihood to refer patients on active primary and advanced cancer treatments to a service named supportive care. Cancer 2009. (c) 2009 American Cancer Society.