Seminars in oncology
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The ideal goal of cancer pain management is the combination of comfort and function. For the vast majority of cancer pain patients, this balance can be achieved with individually titrated opioid analgesics and specifically prescribed coanalgesics. ⋯ Unlike the control of cancer, the tools to effectively control cancer pain are readily available. Their use takes time, skill, and commitment and should be the very least that is provided to all cancer patients and their families.
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Seminars in oncology · Dec 1994
ReviewChemotherapy and bone marrow transplantation in the treatment of chronic myelogenous leukemia.
Many therapeutic modalities have been or are being investigated for the management of chronic myelogenous leukemia (CML). Conventional chemotherapy with hydroxyurea or busulfan continues to be the most widely prescribed modality. Recent data suggest that hydroxyurea is preferred over busulfan on the basis of survival rates, particularly among patients who undergo bone marrow transplantation. ⋯ Interferon-alfa has been used in the immediate posttransplant period to reverse early cytogenetic relapse in a limited number of patients, which suggests that IFN-alpha also may be useful in preventing relapse in high-risk patients. In autologous bone marrow transplantation, there is interest among investigators in reducing the leukemic burden and altering the marrow microenvironment to favor normal hematopoiesis, but the effect of this alternative on survival is not yet known. Results suggest that young patients are candidates for allogeneic bone marrow transplantation, whereas older patients should be offered IFN-based therapy initially.
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Cancer is unique because its management depends on novel therapies to a greater extent than most other diseases. State-of-the-art care requires access to physicians and facilities that specialize in cancer treatment; however, such access may be blocked by the gatekeeper in the managed care setting. One possible solution to this problem lies in the use of specialists to determine access to tertiary care facilities. ⋯ Finally, managed care organizations may deny coverage of state-of-the-art care associated with clinical trials, which may limit the patient's ability to participate in clinical trials. Managed care organizations should cover such costs if they meet certain criteria, such as absence of clearly superior treatment. To provide comprehensive, state-of-the-art care for cancer patients, managed care organizations and oncologists must collaborate and find solutions to their mutual problems.