Seminars in oncology
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The US Food and Drug Administration has approved three agents for treatment of patients with metastatic breast cancer refractory to anthracyclines and taxanes: capecitabine, ixabepilone, and eribulin mesylate. There is no fixed algorithm of therapeutic choices. ⋯ Individual patient performance status, toxicity (to past regimens and any residual toxicity), preferences, and quality of life are factors in determining optimal treatment options for metastatic breast cancer. Ongoing research is seeking to improve outcomes in this patient population.
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Seminars in oncology · Jun 2011
ReviewPharmacologic management of cancer-related pain, dyspnea, and nausea.
Patients with cancer often face significant distress from their symptoms, especially near the end of life. However, prompt palliation of these symptoms can be complex since symptoms may occur in clusters, may be cancer- or treatment-related, and frequently require a multidisciplinary approach to management and a combination of therapeutic regimens. While evidence for many conventional symptom treatments is lacking, an increasing number of randomized clinical trials in palliative oncology means that new treatments will become increasingly evidence-based. Herein, we provide a brief overview and update of current and new strategies for the pharmacologic management of cancer-related pain, dyspnea, and nausea, which are three of the most prevalent treatable symptoms in advanced cancer.
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Seminars in oncology · Jun 2011
The interface between medical oncology and supportive and palliative cancer care.
Traditionally, medical oncology has focused on the active period of diagnosis, treatment and follow-up of cancer patients, and palliative medicine, the pre-terminal and end-of-life phases. Palliative medicine physicians have particular expertise in communication and symptom control, especially, for example, with pain management. Medical oncologists also have need of excellent communication skills and knowledge of supportive care issues, such as the management of emesis, bone marrow suppression, mucositis, neuropathy, and symptoms created by treatment. This article examines the interface between medical oncology and supportive and palliative care to emphasize how each can benefit from the others.
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Accompanying the ascendance of cancer as a leading cause of death worldwide is a new set of global health priorities focused on palliative care--the relief of symptoms and suffering, optimization of functional status, and quality of life for those with advanced, potentially life-limiting illnesses. In high-income countries, palliative care improves outcomes for patients, caregivers, provider organizations, and health systems. ⋯ This article describes current global disparities in the availability of palliative care. We make the case for international prioritization of palliative care as a critical strategy for improving outcomes for people with cancer and their caregivers worldwide.
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Seminars in oncology · Jun 2011
Best supportive care: a euphemism for no care or a standard of good care?
This article seeks to address the question: Is best supportive care (BSC) in research a euphemism for no care or a standard of good care? The data regarding the ethical and methodological validity of BSC studies are reviewed. Most of the BSC studies published over the past 25 years are really treatment versus no treatment studies represented as BSC studies. By ignoring the best contemporaneous standards of BSC, standardizing practices in multicenter studies, validating participating centers, or documenting treatment delivery, researchers belie the stated intention of studying BSC. ⋯ To be ethical and methodologically valid, BSC studies must incorporate standards consistent with contemporaneous, proven BSC practice standards. Work is underway to develop widely validated standards of practice for the control arm of best supportive care studies. These can be readily incorporated in to study development and evaluation.