End-of-life discussions are often neglected until a crisis necessitates a decision about initiation of life-sustaining therapies. Grudzen and colleagues conducted a single-blind, randomized clinical trial of emergency department–initiated palliative care consultation for patients with advanced cancer vs usual care. Quality-of-life scores were higher in the 69 patients randomized to palliative care consultation than in the 67 receiving usual care. They found no significant differences between the 2 groups in depression, intensive care unit admission, discharge to hospice, or survival—indicating that the palliative care intervention did not shorten survival. Thomas provides an Editor’s Note; and Bruera, an Editorial.
Editor’s Note, Editorial
Human papilloma virus (HPV) has been implicated as an etiologic agent in head and neck cancers. The oral cavity harbors a broad spectrum of HPV types, but little is known about the potential of less common forms in mediating head and neck cancer risk. Agalliu and colleagues studied selected mouthwash samples, derived from 2 large cohorts, for HPV types. The authors found that additional HPV types, including γ11- and γ12-HPV species and β1-HPV-5 type, were associated with head and neck cancer risk. Rollison and Gillison provide an Invited Commentary.
Precision oncology has been useful for evaluating actionable mutations in adult cancers, but little is known about the use of whole-exome sequencing for pediatric cancers. Harris and colleagues report results of whole-exome sequencing of tumor and peripheral blood samples from 121 patients 30 years or younger, a median of 7 years old. Diagnostic germline findings were identified in 10% of cases. Mutations of potential clinical utility were found in the tumors of 24% of patients. Data demonstrate the feasibility and utility of the approach in pediatric populations. Khan and Helman provide an Editorial.
A meta-analysis including 3043 patients derived from 10 randomized clinical trials evaluated the risk of cardiovascular events associated with the use of tyrosine kinase inhibitors (TKIs) for the treatment of chronic myelogenous leukemia. Douxfils and colleagues found that use of most TKIs was associated with an increased risk of vascular occlusive events. Although newer-generation TKI therapy increased the rate of molecular remission at 1 year, there was no statistical difference between the agents in 1-year overall survival.
Marijuana use is rapidly becoming accepted in our society. More information is needed about the use of marijuana in patients with cancer. Wilkie and colleagues review the history of medical marijuana use and its role in alleviating cancer symptoms, particularly pain, nausea and vomiting, and anxiety. In addition, evidence does exist that cannabis may have direct antitumor activity.
Continuing Medical Education
Highlights. JAMA Oncol. 2016;2(5):559. doi:10.1001/jamaoncol.2015.3505