Effect of palliative care services on the aggressiveness of end-of-life care in the Veteran's Affairs cancer population.

Background: Cancer care near the end of life (EOL) has become more aggressive over the years. Palliative care services (PCS) may decrease this aggressive cancer care in terminally ill cancer patients. Our objective was to observe the aggressiveness of cancer care near the EOL among Veterans Affairs cancer patients before and after the institution of a PCS team.

Lung cancer management in 2010.

The introduction of newer therapies and approaches for management has led to a renewed excitement in the field of lung cancer. This trend has continued in 2010 with the adoption of the new staging system recommended by the International Association for the Study of Lung Cancer (IASLC). Novel targets, such as EML4-ALK, have been identified and agents targeting these abnormalities have shown promise in uncontrolled clinical trials, while other strategies, including combining targeted agents with cytotoxic chemotherapy in unselected patients, have not proven to be successful.

Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a Veterans' Affairs Central Cancer Registry (VACCR) database analysis.

Background: A long-term determinant of survival in resectable colon cancer is the involvement of regional lymph nodes. We evaluated the clinicopathologic factors associated with lymph node retrieval.

Methods: We conducted a retrospective analysis of patients with resected stage I-III colon cancer in the Veteran's Affairs Central Cancer Registry between 1995 and 2008.

Predictive ability of Charlson comorbidity index on outcomes from lung cancer.

Background: The effect of age and/or comorbidities on management decisions in lung cancer patients has been debated. The Charlson Comorbidity Index (CCI) was developed to help predict mortality from chronic medical conditions. This study was undertaken to evaluate whether CCI is correlated with survival in lung cancer.

Systemic therapy for disseminated basal cell carcinoma: an uncommon manifestation of a common cancer.

While basal cell carcinoma (BCC) is the most common human malignancy, distant metastases from this are rare. Current therapy for disseminated BCC is based on anecdotal reports in the absence of clinical trials to guide management. For many years, platinum based cytotoxic chemotherapy was the mainstay of treatment.

Current concepts in the diagnosis and management of small-cell lung cancer.

Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease.

Statins use and risk for brain metastasis from lung cancer.

Laboratory data suggest an association between statins and risk of brain metastasis (BM) in patients diagnosed with lung cancer. Our retrospective cohort included 252 patients diagnosed with lung cancer and 55 (22%) patients subsequently developed BM. The risk of BM was significantly higher in younger patients (p < .

Lung cancer in women: role of estrogens.

The incidence of lung cancer in females is increasing, in contrast to that seen in males. In addition, the proportion of lung cancer cases in women attributable to smoking is approximately half of that seen in males. Female sex hormones, especially estrogen, may play a key role in this.

Targeted anti-cancer therapy in the elderly.

Cancer is a disease of the elderly with the majority of new diagnoses and deaths from cancer occurring in persons greater than 65 years of age. A major goal of cancer therapy, in the elderly is the preservation of functional independence and quality of life. The advent of targeted therapies has raised the hope that older patients with cancer could be treated as effectively as younger patients and without added toxicities.

Factors affecting bone marrow toxicity following administration of carboplatin and paclitaxel in patients with non-small cell lung cancer.

Background: Despite accounting for more than half of the patients diagnosed with non-small cell lung cancer (NSCLC), only 20% of elderly patients receive chemotherapy. One reason for withholding systemic therapy is the concern for an increased incidence of side-effects, especially cytopenia from bone marrow toxicity. Limited data exist regarding specific factors that affect blood count nadirs following chemotherapy.

Epidermal growth factor receptor signaling in nonsmall cell lung cancer.

Epidermal growth factor is a 170-kd protein that binds to a specific tyrosine kinase receptor, epidermal growth factor receptor (EGFR), on the cell surface. EGFR function is dysregulated in various malignancies including nonsmall cell lung cancer (NSCLC) leading to activation of several signal transduction pathways including K-RAS, PIK3, and STAT3 and STAT5, that promote cell cycle progression, proliferation, invasion, angiogenesis, and inhibit apoptosis. EGFR overexpression is seen in a majority of cases of NSCLC, but its prognostic role is controversial.

Seliciclib in malignancies.

Cyclins and cyclin-dependent kinases (CDK) form a key part of the regulatory proteins that govern the cell cycle. Aberrancy in their function can lead to uncontrolled growth and proliferation of the cells which forms the basis of many human diseases, especially cancers. Seliciclib (CYC202, R-roscovitine) is a second-generation CDK inhibitor that competes for ATP binding sites on these kinases, reducing tumor growth and inducing cell death.

EGFR targeted therapy in non-small cell lung cancer: potential role of cetuximab.

Chemotherapy alone has limited ability to significantly improve survival in non-small lung cancer (NSCLC) beyond what has already been achieved. The epidermal growth factor (EGF) pathway plays a vital role in the pathogenesis and progression of NSCLC. Two classes of drugs inhibit the EGF receptor (EGFR) pathway: small molecules that inhibit the intracellular tyrosine kinase activity of the receptor, and monoclonal antibodies that target the extracellular domain in the ligand-binding region.

Targeted therapy for squamous cell carcinoma of the head and neck.

Targeted agents have emerged as novel drugs in the oncology field based on our understanding of the biology of individual malignancies, and have had a promising impact in several tumors. Squamous cell carcinoma of the head and neck (SCCHN) is a common disease with little progress made in survival over the past few decades. SCCHN is characterized by overexpression of the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF), both of which appear to have a prognostic value.

Cetuximab in hemodialysis: a case report.

Background: Concurrent chemoradiotherapy with cisplatin is the standard therapy for patients with unresectable locally advanced head and neck squamous cell carcinoma. However, cisplatin administration in patients on hemodialysis is complicated by the need to perform hemodialysis immediately after the infusion. Concurrent chemoradiation with cetuximab has been approved in definitive treatment of locally advanced head and neck cancer.

Therapeutic options for elderly patients with advanced non-small cell lung cancer.

Elderly patients with advanced non-small cell lung cancer (NSCLC) are at higher risk for adverse events related to treatment of their disease. Chemotherapeutic agents used alone or together may increase survival, while leading to increased treatment related morbidity. New targeted agents used to treat NSCLC have yet to show sufficient improvement in disease outcomes.

Third generation triplet cytotoxic chemotherapy in advanced non-small cell lung cancer: a systematic overview.

Background: Previous meta-analysis on three drugs combination for treatment of advanced non-small cell lung cancer (NSCLC) did not demonstrate an improvement in survival, however many of the trials included in this meta-analysis used older and less effective cytotoxic drugs. We conducted this analysis to compare the relative efficacy of third generation triplet therapy with that of standard double therapy in the treatment of advanced NSCLC.

Methods: A MEDLINE search was performed using the search terms "lung cancer" and "randomized trials".

Association of positive family history with survival of patients with lung cancer.

Background: Risk factors for development of lung cancer include a family history of the disease. The effect of family history on lung cancer outcomes is unknown. A study was conducted to investigate this.

Iodine-refractory thyroid carcinoma.

The management of thyroid carcinomas commonly involves thyroidectomy, radioactive iodine to ablate any thyroid remnant in patients at high risk of recurrence, and suppressive thyroid hormone replacement. However many tumors will de-differentiate and become refractory to radioactive iodine. After progressive dedifferentiation the prognosis for these patients is poor, with no curative options available as these tumors respond poorly to currently available agents.

Pancytopenia due to iron deficiency worsened by iron infusion: a case report.

Introduction: Iron deficiency anemia is commonly associated with thrombocytosis, although thrombocytopenia has been reported in occasional patients with iron-deficiency anemia. Much less common is the development of thrombocytopenia following replenishment of iron stores.

Case Presentation: We present the unusual case of a 39 year old African American female Jehovah's Witness who presented with a 10 month history of menorrhagia and pancytopenia.

Outcomes after hematopoietic stem-cell transplantation for hematologic malignancies in patients with or without advance care planning.

Purpose: Engagement in advance care planning (ACP) is viewed as a way to prepare for possible death. In patients undergoing hematopoietic stem-cell transplantation (HSCT), an aggressive but possibly curative procedure for cancer, encouraging engagement in ACP is difficult. We conducted this analysis to determine if engagement in ACP among patients who undergo HSCT is associated with adverse outcomes.

Comparison of resource utilization and clinical outcomes between teaching and nonteaching medical services.

Purpose: To compare the resource utilization and clinical outcomes of medical care delivered on general internal medicine inpatient services at teaching and nonteaching services at an academic hospital.

Methods: From February to October 2002, 2189 patients admitted to a 450-bed university-affiliated community hospital were assigned either to a resident-staffed teaching service (n = 1637) or to a hospitalist- or clinic-based internist nonteaching service (n = 552). We compared total hospital costs per patient, length of hospital stay (LOS), hospital readmission within 30 days, in-hospital mortality, and costs for pharmacy, laboratory, radiology, and others between teaching and nonteaching services.

Limited-stage small-cell lung cancer: therapeutic options.

Almost 40% of patients with newly diagnosed small-cell lung cancer (SCLC) have disease confined to the ipsilateral hemithorax and within a single radiation port, i.e., limited-stage disease.