Current oncology reports
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Screening for cancer has become extremely common. The evidence supporting screening for breast, colon, and cervix cancer is strong, but it is unclear for skin cancer, problematic for prostate cancer, and ineffective for lung cancer. Despite the problems associated with many screening approaches for cancer, enthusiasm by the medical profession and the public remains high. The objective analysis for the major tumor types is presented in this review, but the ultimate decision on whether to be screened lies in the personal and societal arena of values.
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Even when managed according to guidelines, approximately 14% of cancer patients have unrelieved pain or unacceptable side effects, and there is good evidence that patients still are not receiving optimal therapy. Implantable drug delivery systems (IDDS) administer small amounts of drugs directly to the spinal cord and reduce systemic narcotic exposure by a factor of 300 to one. ⋯ Even the most refractory pain patients--those failed by a month of comprehensive medical management by experts--when subsequently provided with IDDS, had a 27% reduction in pain scores and a 50% reduction in drug side effects. Given multiple positive small cohort studies and a positive high-power randomized trial, IDDS should be considered as the best treatment for this population.
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Current oncology reports · Jul 2004
ReviewManagement of hot flashes in breast cancer survivors and men with prostate cancer.
Hot flashes are a significant complaint among many breast cancer survivors and many men undergoing androgen deprivation therapy for prostate cancer. Several therapeutic approaches are available to the suffering man or woman. Many of these individuals have tried nonpharmacologic and nonconventional approaches. ⋯ Gabapentin appears to provide similar benefits, but direct comparisons have not been reported. Because of the strong association between gonadal hormones and breast and prostate cancer, the use of hormonal agents to treat hot flashes in these patients has been limited. However, such hormonal therapies as depomedroxyprogesterone acetate can be prescribed for an informed individual who experiences bothersome symptoms despite nonhormonal treatments.
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Statistical developments over the past several years are described in this review. Efforts in phase I studies have focused on efficient estimation of maximum tolerated dose. ⋯ However, design innovations come with costs, including possible increased risk of incorrect conclusions. Other recent challenging statistical developments in clinical trials relate to use of complementary outcomes such as quality of life and to associated biologic questions, including the emergence of the field of genomics.
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Neurologic complications of cancer therapy are an increasingly important concern in patient management. Improvements in systemic therapies and increasing use of local treatments to target such specific tumor sites as brain or leptomeningeal metastases have resulted in increased incidence of treatment toxicity in the central nervous system (CNS). ⋯ The three most common of these, alterations in cognition and consciousness, seizures, and cerebellar dysfunction, are discussed. Prompt recognition of these problems and their causes will have an impact on patient care in all areas of oncology.