Triple-negative Breast Cancer
3
| Liposomal Vincristine in ALL
42
| Ziv-aflibercept Controversy
VOLUME 3, ISSUE 18
110
DECEMBER 15, 2012
Editor-in-Chief, James O. Armitage, MD
Hematology
Bone Marrow Transplants Reduce Risk of Graftvs-Host Disease Compared to Peripheral Blood By Caroline McNeil
P
atients who receive bone marrow transplants are significantly less likely to develop chronic graft-vs-host disease than those who receive peripheral blood stem cell transplants, according to a new, large randomized trial, the first of its kind with unreFrederick R. Appelbaum, MD lated donors. Published recently in The New England Journal of Medicine,1 the study found higher rates of engraftment among the peripheral blood transplant recipients but no statistically significant difference in relapse or survival between the two groups. The results should change current practice for some patients, said Frederick R. Appelbaum, MD, of the Fred Hutchinson Cancer Research Center, in
an accompanying editorial (see sidebar on page 16). Currently, 76% of transplants in the United States use stem cells harvested from peripheral blood via apheresis. Bone marrow, which was the initial source of blood stem cells, is obtained while the donor is under anesthesia.
Evolving Practice The use of peripheral blood stem cells began to overtake bone See Page 119 marrow transplants after trials with matched sibling donors showed better rates of engraftment. Some studies with sibling donors have also shown better survival and lower relapse rates. However, the higher T-cell content of peripheral blood cells increases the risk of chronic graft-vs-host disease, a serious and sometimes fatal complication.
Recognizing and Managing Physician Burnout in Oncology
continued on page 16
Issues in Oncology
A new ASCO survey attempts to understand why physicians experience burnout more often than other professionals. By Jo Cavallo
A
lthough job burnout occurs in all professions, it is more common among physicians, according to a study published recently in Archives of Internal Medicine.1 Physicians on the front line of care, such as those working in emergency rooms or in family medicine, experience the highest rates of burnout. The research, led by Tait D. Shanafelt, MD, Di-
rector of the Mayo Clinic Department of Medicine Program on Physician Well-being, compared 6,179 practicing physicians ages 29 to 65 with a probabilitybased sample of 3,422 U.S. workers of the same age group in other fields. Of the nearly 7,300 physicians who answered questions about their work/life balance, 45.8% reported at least one symptom of serious burnout, such as emotional exhaustion (loss of enthusiasm for work) or depersonalization (high Caring for patients with cancer can degree of cynicism).
be extremely rewarding, but also one of the most demanding and stressful areas of medicine.
— Tait D. Shanafelt, MD, and Lotte Dyrbye, MD Tait D. Shanafelt, MD
Findings in Oncologists
ASCOPost.com
Screening for Ovarian Cancer: A Gynecologic Oncologist’s Perspective By M. Steven Piver, MD
T
he recent U.S. Preventive Services Task Force (USPSTF) Reaffirmation Recommendation Statement concluded that in the population of asymptomatic women without known genetic mutations that increase risk for ovarian cancer, clinicians should not screen for ovarian cancer using transvaginal ultrasound and serum CA125 testing. The USPSTF points out, correctly, that the recommendations only apply to asymptomatic women without known risk factors, including CA1 or BRCA2 deleterious mutations, Lynch syndrome, or family history of ovarian continued on page 122
Dr. Piver is Senior Gynecologic Oncologist, Sisters of Charity Hospital, and Founder of the Gilda Radner Familial Ovarian Cancer Registry, Roswell Park Cancer Institute, Buffalo, New York.
MORE IN THIS ISSUE Oncology Meetings Coverage 5th AACR Conference on Cancer Health Disparities �����������������7, 49 54th ASTRO Annual Meeting �����11, 12, 27, 48, 66, 68-70 11th International Kidney Cancer Symposium �������������������������������� 22 35th ESMO Congress ����������� 78, 82, 86 Statins and Cancer ������������������������������������� 17 Surgical Resection for Liver Metastases ���������������������������������������� 24 Sequestration and Cancer Research �������35 FDA Update ������������������������������������ 2, 37-41 Direct from ASCO ������������������������������������� 55 Letters to the Editor �������������������������� 94–97
An earlier article coauthored by Dr. Shanafelt and Lotte Dyrbye, MD, continued on page 19
A Harborside Press® Publication