Postoperative Pain in Breast Cancer
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| Aging Population and Cancer Care
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| Too Young for Cancer: A Patient’s Story
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VOLUME 6, ISSUE 7
APRIL 25, 2015
Editor-in-Chief, James O. Armitage, MD | ASCOPost.com
Journal Spotlight
Radiotherapy or Not in Older Women Receiving Breast-Conserving Surgery and Endocrine Treatment? Study shows omitting radiotherapy may increase local recurrence risk but has no effect on survival
By Chandrakanth Are, MBBS, MBA, FRCS, FACS
By Matthew Stenger
I
n the phase III PRIME II trial, designed to assess whether whole-breast irradiation could be omitted in women aged ≥ 65 years with early-stage breast cancer undergoing breast-conserving surgery and receiving adjuvant endocrine treatment, Ian H. Kunkler, MB BChir, FRCR, of Western General Hospital, Edinburgh, and colleagues found an increased risk of ipsilateral recurrence in women not receiving radiotherapy.1 No significant differences between radiotherapy and no-radiotherapy groups were observed for regional recurrence, distant metastases, contralateral breast cancers, new breast cancers, or overall survival. The study is reported in Lancet Oncology.
Study Details In the trial, 1,326 women from 76 centers in the Unit-
ed Kingdom, Greece, Australia, and Serbia were randomly assigned between April 2003 and December 2009 to receive radiotherapy at 40 to 50 Gy in 15 to 25 fractions (n = 658) or no radiotherapy (n = 668). Patients were considered to be at low risk Ian H. Kunkler, of recurrence on the basis of MB BChir, FRCR hormone receptor–positive and axillary node–negative disease, T1 to T2 disease ≤ 3 cm at the longest dimension, and clear margins. Patients could have grade 3 tumor histology or lymphovascular invasion, but not both. The primary endpoint was ipsilatcontinued on page 3
Oncology Worldwide
Noncommunicable Diseases Are the Leading Cause of Death in Low- and Middle-Income Countries By Jo Cavallo
T
Heal Thy Patient … Reflections on the Human Side of Medicine Physician Perspective
he greatest health threat to people living in lowand middle-income countries is no longer infectious diseases like HIV/AIDS, which has seen a 33% decline in the global rate of new infections since 2001.1 It is the rise of noncommunicable diseases (including cancer, cardiovascular disease, and diabetes), which are now the leading cause of death and disability in
low- and middle-income countries, killing more than 8 million people before the age of 60 in 2013 alone, according to a new report by the Council on Foreign Relations (CFR), an independent nonprofit think tank headquartered in New York.2 In many of these countries, especially those in Africa, the proportion rises to 80% or higher, the report found. Over the past 15 years, mortality rates from nonWe need more oncologists and communicable diseases physicians from related fields to in these countries have increased 53%—significollaborate on cancer control. We’ve cantly faster than the rate made so much progress in cancer of population growth—fueled by a constellation of and heart disease in high-income factors, including urbancountries, but it is not being extended ization, limited access to preventive care, greater in developing countries. exposure to air pollution, —Thomas J. Bollyky
T
he first time I met Mrs. X and her husband was to discuss the surgical treatment options for pancreatic cancer. She had just been diagnosed with pancreatic cancer at her local hospital and was being referred to a tertiary care center for operative management. Mrs. X and her husband were no different than the approximately 45,000 patients diagnosed with pancreatic cancer on an annual basis in the United States. They were anxious, as is expected, but maintained a calm grace and dignified composure. They were in their 60s and were extremely polite and courteous, despite continued on page 80
Dr. Are is Associate Professor of Surgical Oncology, Vice Chair of Education, and Program Director of the General Surgery Residency Program at the University of Nebraska Medical Center, Omaha. Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
MORE IN THIS ISSUE Oncology Meetings Coverage National Comprehensive Cancer Network ���������������������������������������� 13 Patrick I. Borgen, MD, on Postoperative Pain in Breast Cancer ����� 21 Aspirin and COX-2 Inhibitors in Colon Cancer ���������������������������������������������26 High Cost of Novel Cancer Drugs ����������30 Geriatrics for the Oncologist ����������������� 40 Direct From ASCO �������������������������� 42–45 Coping With Stress, Burnout, Fatigue ���50 Improving Cancer Care Globally �����������54 Hope Rugo, MD, on Avoiding Hair Loss During Chemotherapy �������������� 74
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ASCO Annual Meeting, May 29 - June 2, 2015, Chicago
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