News for Patients from the Journal of Clinical Oncology

When patients are diagnosed with early stage melanoma, the best indicator of how severe their disease will be is whether or not the cancer is present in the lymph nodes. However, standard tests do not always detect the early signs of the disease in the lymph nodes. Now, a new study has shown that a molecular analysis may be better able to identify which patients will experience the most severe cases of disease and would benefit from a more aggressive treatment.

It is a commonly held belief among both physicians and patients that some of the most effective cancer treatments, many of which come with greater side effects, are not appropriate for elderly cancer patients. Many physicians also presume that older patients would be unwilling to undergo aggressive chemotherapy if offered. Consequently, elderly patients are not always informed of their full range of treatment options, and survival and quality of life may suffer as a result.

Recent studies have shown that combining hormonal therapy and radiation therapy extends time to disease progression in high-risk prostate cancer patients. However, little was known about the benefit of using radiation therapy on both the lymph nodes and the prostate gland, or the sequence of administering hormonal and radiation therapy.

For many years, researchers have known that patients who quit smoking after finishing treatment for lung cancer are less likely to experience a recurrence of the disease. Less clear, however, is the effect that smoking during treatment has on patient survival.

For some people living with cancer, clinical trials can represent the best hope of effective therapy. Clinical trials are also responsible for significant advances in cancer treatment over the last 30 years. However, less than 5% of adult cancer patients in the United States participate in clinical trials.

Cancer doctors have suggested for several years that it might be possible to improve the effectiveness of chemotherapy drugs by reducing the amount of time between doses. However, when chemotherapy is given frequently, patients can suffer from serious side effects such as neutropenia, a drop in the number of white blood cells. These side effects have limited the ability of researchers to determine whether more frequent dosing—also called dose dense—can actually benefit patients.

Women with early stage breast cancer have several treatment options to help prevent their cancer from returning after surgery. For premenopausal women whose cancer has spread to their lymph nodes, one such treatment involves chemotherapy with a combination of the drugs epirubicin, fluorouracil, and cyclophosphamide. This combination is commonly called FEC.

Doctors have known for several years that the hormonal cancer treatment can help reduce the risk that a woman's breast cancer will return after surgery. However, this benefit has only been seen in women who are already past menopause, leaving younger patients with fewer options. Typically, pre-menopausal women receive chemotherapy after surgery to reduce their risk, resulting in serious and sometimes permanent side effects.

Doctors know that breast irradiation can help prevent breast cancer from returning in women who have had their tumors surgically removed by lumpectomy. However, many researchers have questioned whether radiation is necessary for women with the smallest tumors, those that are one centimeter or less in size. Some have also suggested that a drug called tamoxifen, given by itself after lumpectomy, could eliminate the need for radiation therapy in many patients with small tumors. Tamoxifen is commonly used to prevent recurrence in women who have a type of cancer called "estrogen receptor-positive" breast cancer.