Independent News on Advances in Hematology/Oncology CLINICALONCOLOGY.COM •June 2014 • Vol. 9, No. 6
SPECIAL FEATURE The state of palliative care in the U.S. ...........................
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HEMATOLOGIC DISEASE Transplant readmission predicts decreased survival ...........................................
4
CURRENT PRACTICE Maurie Markman, MD: Modifying ‘standard of care’ based on lessthan-definitive evidence ........................................ Clinical Conundrums ...........
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Outcomes more similar than different, study suggests, with a net positive San Antonio—In recent years, mammography has come under fire, with several studies concluding that screening may cause more harm than good. But other studies have demonstrated that screening is more beneficial than harmful and essential in the war on breast cancer. Now, a new analysis demonstrates that when you level the playing field, the study conclusions are not all that different, and show a substantial benefit associated with screening. “Modern measures of effectiveness see MAMMOGRAPHY, Y page 16
by the
numbers
Survivorship 64% | Oncologists who
always or almost always discuss survivorship care recommendations with patients
32% | Oncologists who
tell these patients who they should see for cancer-related follow-up care
<5% | Oncologists who
provide a written survivorship care plan to the survivor
Source: “Provision and Discussion of Survivorship Care Plans Among Cancer Survivors: Results of a Nationally Representative Survey of Oncologists and Primary Care Physicians.” J Clin Oncol. 2014;32:1578-1585, PMID: 24752057.
IMAGES in ONCOLOGY
Mammography Debate Rages On
INSIDE
Image courtesy of Science Photo Library
Knowledge Gaps Common in Blood Cancer Treatment
How I Manage…
Use of TKIs a particularly weak area New Orleans—A study designed to identify practice gaps among oncologists in the treatment of acute lymphoblastic leukemia (ALL), B-cell lymphoma (BCL) and chronic myelogenous leukemia (CML) found plenty, particularly related to the optimal use of tyrosine kinase inhibitors (TKIs). According to the study, only about one-third of clinicians recognized the prognostic significance of a major molecular response (MMR) with a TKI, and less than onethird were familiar with prevailing expert opinion regarding the timing and frequency of cytogenetic analyses. see SUBOPTIMAL CARE, E page 17
Pancreatic cancer cells.
Allogeneic Hematopoietic Cell Transplantation in Myelodysplastic Syndrome M
yelodysplastic syndrome (MDS) is comprised of a heterogeneous group of hematologic diseases characterized by a clonal abnormality of hematopoietic stem cells resulting in cytopenias, abnormal blasts and risk for transformation into acute myelogenous leukemia (AML). The clinical course of the disease varies from indolent over several years to a more rapid progression to AML within months.1,2 The median age at diagnosis is around 75 years.3 Allogeneic hematopoietic cell transplantation (allo-HCT) is considered a curative treatment strategy for patients with MDS, and its Nicolaus Kröger, MD role in the treatment of “younger” adults with MDS is well established, even if the outcomes data come mainly from retrospective studies.4-8 The introduction of reduced-intensity or non-myeloablative conditioning regimens has resulted in a substantial reduction in transplant-related toxicity and mortality, and a rapid increase see HOW I MANAGE, E page 18
RE VIE WS & COMMENTAR IES
Expert Insights From The Ohio State University—The James In selected NSCLC patients with brain metastasis, be aggressive ............... 13 David Carbone, MD, PhD
Genetic screenings for breast cancer personalize therapy ..................... 16 Charles Shapiro, MD