Cancer

In women aged younger than 35 years, a pregnancy occurring before or after the diagnosis of breast cancer was not an independent prognostic factor of death. In the subset of patients having a high risk of relapse, it may be preferable to postpone a pregnancy beyond 5 years after the breast cancer therapy.

The authors found little evidence about the clinical use and cost effectiveness of human epidermal growth receptor 2 testing for breast cancer patients in the adjuvant setting. Given the increasing use of targeted therapies, it is critical to build an evidence base that supports making informed decisions on emerging testing technologies in clinical practice.

Evaluation of survival outcomes for extrahepatic cholangiocarcinoma using parametric survival analysis for cases extracted from the Surveillance, Epidemiology, and End Results data set suggested that multimodality therapy including surgery and adjuvant radiotherapy is associated with early survival improvement.

The authors assessed 151 consecutive patients with gastroesophageal adenocarcinoma who had chemoradiation and surgery. Baseline and postchemoradiation positron emission tomography changes were correlated with overall survival and the degree of pathologic response in the resected specimen. Their results showed that the degree of changes used as continuous variable produce the best estimate for survival compared to traditional dichotomized percent decrease.

Adjuvant treatment with a 4-drug, sequential chemotherapy regimen failed to improve disease-specific survival in patients who had high-risk, extravesical urothelial cancer compared with the survival observed for contemporary controls who underwent surgery alone. The therapy was poorly tolerated, illustrating the difficulty in delivering intensive, postoperative chemotherapy to an older patient population in a timely manner.

The investigators reviewed 2743 patients with myelodysplastic syndrome (MDS). Two hundred eighty-seven (10%) patients had deletion 5q and 216 (8%) had monosomy 5 abnormalities. The median survival was 33 months with deletion 5q alone, 17 months with deletion 5q and 1 other abnormality, and only 6 months to 12 months with deletion 5q and 2 or more abnormalities or chromosome 7 abnormality. Only 93 patients (3.4% of total) had lower risk MDS and deletion 5q; their median survival was 29 months (2-year survival 60%). This study provided expectations of outcome in MDS subsets with deletion 5q and highlighted that most patients with deletion 5q have additional abnormalities and a worse prognosis than what was previously reported in the literature.

First-line systemic therapy with rituximab and fludarabine produced a high complete remission rate in both gastric and extragastric mucosa-associated lymphoma tissue (MALT) lymphoma, but patients with gastric MALT responded faster. This regimen had very good tolerability, but establishing the long-term benefit of this therapy will require continued follow-up.

Greater than half of recurrences after surgery for early stage nonsmall cell lung cancer involved local sites. Pathologic factors such as lymphovascular space invasion, stage, and histology may help distinguish patients those at highest risk.

This phase 2/3 study tested the safety and efficacy of lenalidomide for stage IV metastatic melanoma patients with refractory disease. A dose of 25 mg versus 5 mg oral lenalidomide was well tolerated, but it did not confer significant clinical benefits in tumor response, time to progression, or overall survival of these patients.

Life-threatening illness creates severe stress that may result in marital discord, separation, or divorce and may adversely impact treatment, quality of life, and survival. The results of the current study demonstrated that partner abandonment in patients with serious medical illness was most pronounced in men and affected both quality of care and life.

The current study suggested that the vascular endothelial growth factor pathway is a critical signaling pathway in osteogenic sarcoma. The data identified specific proteins within these pathways toward which future investigations should be directed to further clarify their prognostic potential.

Angiocidin is a tumor-associated molecule that is emerging as a key mediator of tumor progression in epithelial malignancies. The authors demonstrated the role of angiocidin in promoting gelatinase up-regulation and tumor cell invasion in sarcomas and evaluated the potential use of angiocidin-inhibitory peptides in decreasing tumor cell invasion in these aggressive neoplasms.

Although obesity is associated with increased risk of higher grade disease and prostate-specific antigen recurrence after radical prostatectomy, whether these associations vary by race is unknown. In this study, the authors observed that obesity did not appear to be more or less influential in 1 race than another but, rather, was identified as a risk factor for aggressive cancer regardless of race.

The authors evaluated the performance of relative survival and cause-specific survival based on death certificate with respect to accuracy in estimating breast cancer-specific survival. Relative survival accurately estimated breast cancer-specific survival in higher risk patients, while for low risk patients, death certificate-based estimates were more accurate.

Surveillance, Epidemiology, and End Results and Medicare data were used to characterize the specialties of physicians who provided care for Medicare recipients diagnosed with cancer >5 years earlier. The results showed that less than half of long-term survivors continued to see oncology specialists annually, and that the percentage who did so declined with each year from diagnosis, whereas most survivors saw primary care providers, and the percentage who did so did not decline substantially.

Anthracycline-containing chemotherapy regimens were associated with an increased risk of congestive heart failure, cardiomyopathy, and cardiac dysrhythmias, but not significantly associated with ischemic heart disease or conduction disorders.

A pilot study was conducted, using a phase 1 trial design, of huachansu (a Chinese medicine that comes from dried toad venom from the skin glands of Bufo gargarizans or B. melanostictus) in patients with advanced cancer. There were no dose-limiting toxicities even at doses up to 8× higher than typically used in China; 6 patients had prolonged stable disease or minor tumor shrinkage.

In this large prospective observational study that evaluated patient and treatment characteristics contributing to hematologic toxicity in breast cancer patients, there were no significant differences noted with regard to chemotherapy-related hematologic toxicities between older and younger patients treated with curative intent. Relative dose intensity of chemotherapy was significantly reduced for the older patients compared with their younger counterparts.

The aim of this analysis was to identify factors associated with the increased prevalence of lower-body functional limitations by comparing long-term cancer survivors with persons without a cancer history (controls). Of long-term survivors of cancers, 57.0% reported being limited in ≥1 lower-body functional limitations, compared with 26.6% of controls. Arthritis, lower-back pain, and access to medical care can be targeted to reduce the prevalence of lower-body functional limitations and improve quality of life of long-term survivors of breast, cervical, ovarian, and uterine cancers, possibly with the aid of a survivorship care plan.

For patients with metastatic osteosarcoma, the addition of liposomal muramyl tripeptide phosphatidylethanolamine (MTP-PE) to chemotherapy did not lead to a statistically significant improvement in outcome. However, the pattern of event-free survival and overall survival benefit was similar to that seen in nonmetastatic osteosarcoma patients treated with liposomal MTP-PE, where overall survival was improved.

This meta-analysis revealed overall increased mortality of up to 25% in patients experiencing depressive symptoms after cancer diagnosis (risk ratio [RR] unadjusted = 1.25; 95% confidence interval [CI], 1.12 to 1.40; P < .001), and a 39% higher risk in patients diagnosed with major or minor depression after cancer diagnosis (RR unadjusted = 1.39; 95% CI, 1.03-1.89; P = .033), based on 25 independent studies. Given the scarce number of relevant studies available to date, the effect of depressive symptoms on cancer recurrence did not reach significance (RR unadjusted = 1.23; 95% CI, 0.85-1.77; P = .275, k = 3).