Outcomes of 2 clinical trials assessing the utility of decision aids
to improve patients' knowledge about cancer treatment and genetic risk are
reported in this issue of JAMA. In the first article by Whelan and colleagues,Article
women with early stage breast cancer whose surgeons used
a decision board—containing written and visual information about surgical
treatments—were more knowledgeable about their treatment options and
expressed less conflict about and greater satisfaction with their treatment
decision than women whose surgeons did not use the decision board. In the
second article, Green and colleaguesArticle report results
of a randomized trial comparing one-on-one genetic counseling with a computer-based
decision aid plus genetic counseling to educate women about testing for the BRCA1 and
BRCA2 genes. They found
that the computer program was more effective than standard genetic counseling
in increasing knowledge of breast cancer genetic risk, but counseling was
more effective than the computer program in reducing anxiety and facilitating
accurate risk perceptions. In an editorial, Eng and IglehartArticle
discuss the benefits and limits of computer-based decision aids.
Some clinical trials of chemotherapy for advanced non–small-cell
lung cancer (NSCLC) have documented that adding a drug to single-agent or
double-agent chemotherapy regimens improves the response rate, but whether
there is a survival benefit with multiagent therapy is not clear. Delbaldo
and colleaguesArticle performed a meta-analysis of data from
NSCLC chemotherapy trials that compared 2 agents to a single agent, and 3
agents to a doublet. The authors found a significant increase in response
and survival rates for 2-agent regimens compared with single-agent chemotherapy.
When comparing 3-agent with 2-agent regimens, they found an increase in response
rate but no increase in survival. In an editorial, Argiris and SchillerArticle
discuss the limitations of current therapies for NSCLC and promising agents in development.
Patients with intermittent claudication may report improvement or stabilization
of symptoms over time. However, whether this reflects a lack of disease progression
or a compensatory reduction in physical activity is not clear. McDermott and
colleagues conducted a prospective cohort study of persons with and without
peripheral arterial disease (PAD) to determine whether PAD, the ankle brachial
index, and specific leg symptoms predict functional decline. They found that
patients with leg pain and a low ankle brachial index score at baseline had
an increased risk of decline in walking endurance at the 2-year follow-up
In 1994, Texas implemented a correctional health care system based on
a managed care model and involving clinical faculty and staff from academic
medical centers. Raimer and StoboArticle report
significant improvements in access to care and health outcomes since the program
was established. In an editorial, KendigArticle discusses
the many benefits that could accrue from wider collaboration between academic
medicine and correctional facilities.
Some promising anticancer drugs hit multiple targets on tumor cells,
a property scientists say may help forestall the development of resistance
to the treatment.
Novel amniotic fluid proteins identified in a primate model of intra-amniotic
infection (IAI) were found in the amniotic fluid and serum of women with subclinical
IAI and could foster development of rapid and noninvasive diagnostic assays
for occult IAI.
Clinical implications for bone and vascular diseases of the osteoprotegerin/RANKL/RANK
For your patients: Information about breast cancer genetics.
This Week in JAMA. JAMA. 2004;292(4):411. doi:10.1001/jama.292.4.411