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This Week in JAMA
March 17, 2010

This Week in JAMA

JAMA. 2010;303(11):1011. doi:10.1001/jama.2010.280


Edited by Boris Pasche, MD, PhD, Robert A. McNutt, MD, and Phil B. Fontanarosa, MD, MBA

Elderly patients with stage III colon cancer are much less likely than younger patients to receive adjuvant chemotherapy, perhaps due to concerns about adverse effects. Kahn and colleagues analyzed the use of adjuvant chemotherapy and clinical adverse events by age in a large cohort of patients with stage III colon cancer and found that older patients received less toxic and shorter chemotherapy regimens and experienced fewer adverse events than younger patients.

To assess long-term treatment-related morbidity associated with radiation for early stage prostate cancer, Talcott and colleagues performed a post hoc cross-sectional survey of surviving participants from a randomized trial that compared conventional dose with high-dose combination proton and photon radiation therapy. The survey was conducted a median 9.4 years after treatment, and the authors found that patient-reported symptoms of urinary, bowel, or sexual dysfunction or related quality-of-life outcomes were similar in the conventional-dose and high-dose radiation groups.

In a survey of executives and palliative care leaders at US cancer centers, Hui and colleagues found that palliative care services—defined as the presence of at least 1 palliative care physician—are available at most cancer centers. However, the scope of services offered and the degree of integration between palliative care and oncology care varied widely among the centers surveyed.

No universally accepted methodology exists to assess response to transarterial locoregional therapy in patients with hepatocellular carcinoma. In an analysis of computed tomography or magnetic resonance imaging scans of 245 consecutive patients treated with transarterial locoregional therapy, Riaz et al classified treatment response with 3 currently accepted guidelines and assessed whether the imaging response of a “primary index lesion”—the largest lesion targeted during the first treatment—could be a biomarker for tumor progression and survival. The authors report that agreement for classification of therapeutic response was high for 2 of the 3 guidelines and that measuring response in a primary index lesion correlated with disease progression and survival.

Current management of early stage, medically inoperable lung cancer is associated with poor tumor control and high rates of mortality. Timmerman and colleagues assessed the efficacy and toxicity of stereotactic body radiation therapy in 59 patients with biopsy-proven early stage non–small cell lung tumors less than 5 cm in diameter and medical conditions precluding surgical treatment. After a median follow-up of 3 years, the authors report overall survival was 55.8%, with high rates of local tumor control and moderate treatment-related morbidity.

There is some evidence that vitamin B6 deficiency may be associated with an increased risk of colorectal cancer. Larsson and colleagues examined this relationship in a systematic review and meta-analysis and found that vitamin B6 intake and blood levels of pyridoxal 5´-phosphate—the active form of vitamin B6—are inversely associated with the risk of colorectal cancer.

“My patient was dying. And, short of divine intervention, there was nothing I could do about it.” From “Do Something.”

Scientists studying how many cancer therapies cause collateral damage to the heart hope to find ways to help patients with cancer avoid treatment-related heart problems.

Progress in the war on cancer

Financial burden of cancer care

Cancer research: translating discovery to patient care

Reducing health disparities in cancer

Circulating tumor cells revisited

Caring for patients with cancer

Join Mary E. Tinetti, MD, Wednesday, April 21, from 2 to 3 PM eastern time to discuss the evaluation of and treatment for patients who fall. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about cancer.