The document discusses enhancing quality of life as an important goal for cancer treatment. It notes that while treatments have increased survival rates, they can also cause chronic health issues for survivors that reduce quality of life. More research is needed to better understand and prevent these toxic side effects, through identifying biomarkers and mitigation strategies. The authors call for increased priority and resources for quality of life research to both improve existing treatments and enable more patients to benefit from new therapies.
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer
Presentation date : 03-03-2012
CME - Head and Neck Oncology
Critical evaluation of an article titled " Systematic review of basket trials, umbrella trials, and platform trials: A landscape analysis of master protocols"
Global Medical Cures™ | NEULASTA- Pediatric PostMarketing Adverse Event ReviewGlobal Medical Cures™
Global Medical Cures™ | NEULASTA- Pediatric PostMarketing Adverse Event Review
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Awareness about Liver Cancer in Biotechnology Students_Crimson PublishersCrimsonpublishersCancer
Liver cancer is a major disease caused by sudden mutation occurred in the genes. To cure this disease gemcitabine seems to be affective. Gemcitabine is anticancer agent that has profile containing mild toxicity. It seems to be affective in solid tumors. To check its effectiveness, a questionnaire was developed and the awareness about liver cancer is checked in the post graduate students. All the students were fully aware of this disease.
The effect of long-term traditional Chinese medicine treatment on disease-fre...LucyPi1
Abstract Objective: Traditional Chinese medicine (TCM) has been extensively used as one of popular alternative therapies for several cancers. However, it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients. In this study, we explored the effect of long-term TCM treatment on patients with different stages of lung cancer. Methods: All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study. Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group (control group). All patients were regularly followed up by clinic appointment or phone, and all survival data were collected from databases after the last follow-up in October 2017. Results: A total of 575 patients were included in this study, with 299 patients in the TCM group and 276 in the control group. For all patients, 5-year disease-free survival (DFS) was 62.2% in TCM group and 42.1% in the control group, and 6-year DFSs were 51.8% and 35.4%, respectively (HR = 0.51, 95% CI: 0.40 to 0.66, log-rank P ≤ 0.001). For patients with stage I, 5-year DFSs were 83.7% (TCM group) and 57.5% (control group) and 6-year DFSs were 73.7% and 51.9%, respectively (HR = 0.30, 95% CI: 0.18 to 0.50, log-rank P ≤ 0.001). For patients with stage II in the TCM group and the control group, 5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%, respectively (HR = 0.31, 95% CI: 0.19 to 0.52, log-rank P ≤ 0.001), and for patients with stage III, 5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group (HR = 1.06, 95% CI: 0.72 to 1.56, log-rank P = 0.76). Conclusions: This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients, especially in patients with stage I and II disease. However, these observational findings need being validated by large sample randomized controlled trials.
Introduction: Adjuvant chemotherapy such as S-I is thought to prolong the life expectancy of patients with gastric cancer. The
number of older patients with gastric cancer has recently been increasing. Here we examined the prognosis of older patients with stage II or III gastric cancer.
Methods: The study cohort comprises 658 patients with stage II or III gastric cancer who underwent curative surgery from 1994 to 2014 in our institution. From 1994 to 2003 was considered the early phase, whereas from 2004 to 2014 was considered the late phase. The patients were classifi ed by age into under 65 years (Non-Elderly [NE]); 65-74 years (Early Elderly [EE]); and over 74 years (Late Elderly [LE] groups.
Use of complementary and alternative medicine by cancer patients at the Unive...home
CAM use is common among cancer patients in Nigeria. Most users do not obtain the
expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology
should ask his/her patients about the use of CAM; this knowledge will enable them to better
counsel the patients
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer
Presentation date : 03-03-2012
CME - Head and Neck Oncology
Critical evaluation of an article titled " Systematic review of basket trials, umbrella trials, and platform trials: A landscape analysis of master protocols"
Global Medical Cures™ | NEULASTA- Pediatric PostMarketing Adverse Event ReviewGlobal Medical Cures™
Global Medical Cures™ | NEULASTA- Pediatric PostMarketing Adverse Event Review
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Awareness about Liver Cancer in Biotechnology Students_Crimson PublishersCrimsonpublishersCancer
Liver cancer is a major disease caused by sudden mutation occurred in the genes. To cure this disease gemcitabine seems to be affective. Gemcitabine is anticancer agent that has profile containing mild toxicity. It seems to be affective in solid tumors. To check its effectiveness, a questionnaire was developed and the awareness about liver cancer is checked in the post graduate students. All the students were fully aware of this disease.
The effect of long-term traditional Chinese medicine treatment on disease-fre...LucyPi1
Abstract Objective: Traditional Chinese medicine (TCM) has been extensively used as one of popular alternative therapies for several cancers. However, it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients. In this study, we explored the effect of long-term TCM treatment on patients with different stages of lung cancer. Methods: All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study. Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group (control group). All patients were regularly followed up by clinic appointment or phone, and all survival data were collected from databases after the last follow-up in October 2017. Results: A total of 575 patients were included in this study, with 299 patients in the TCM group and 276 in the control group. For all patients, 5-year disease-free survival (DFS) was 62.2% in TCM group and 42.1% in the control group, and 6-year DFSs were 51.8% and 35.4%, respectively (HR = 0.51, 95% CI: 0.40 to 0.66, log-rank P ≤ 0.001). For patients with stage I, 5-year DFSs were 83.7% (TCM group) and 57.5% (control group) and 6-year DFSs were 73.7% and 51.9%, respectively (HR = 0.30, 95% CI: 0.18 to 0.50, log-rank P ≤ 0.001). For patients with stage II in the TCM group and the control group, 5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%, respectively (HR = 0.31, 95% CI: 0.19 to 0.52, log-rank P ≤ 0.001), and for patients with stage III, 5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group (HR = 1.06, 95% CI: 0.72 to 1.56, log-rank P = 0.76). Conclusions: This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients, especially in patients with stage I and II disease. However, these observational findings need being validated by large sample randomized controlled trials.
Introduction: Adjuvant chemotherapy such as S-I is thought to prolong the life expectancy of patients with gastric cancer. The
number of older patients with gastric cancer has recently been increasing. Here we examined the prognosis of older patients with stage II or III gastric cancer.
Methods: The study cohort comprises 658 patients with stage II or III gastric cancer who underwent curative surgery from 1994 to 2014 in our institution. From 1994 to 2003 was considered the early phase, whereas from 2004 to 2014 was considered the late phase. The patients were classifi ed by age into under 65 years (Non-Elderly [NE]); 65-74 years (Early Elderly [EE]); and over 74 years (Late Elderly [LE] groups.
Use of complementary and alternative medicine by cancer patients at the Unive...home
CAM use is common among cancer patients in Nigeria. Most users do not obtain the
expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology
should ask his/her patients about the use of CAM; this knowledge will enable them to better
counsel the patients
Become A Partner Now! Then follow us into 2017 as a Sponsor!
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Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
Cardiometabolic diseases (CMDs), such as hypertension, excess weight, obesity, diabetes (type-2), and vascular diseases are considered lifestyle diseases. In the last three decades, these diseases have reached epidemic proportions worldwide [1]. According to the results of a recent study published in the journal Circulation, adopting five low-risk lifestyle factors may be linked to longer life spans in Americans [2]. Metabolic diseases, which are lifestyle diseases are preventable.
Ultrasound Technology as a Novel Treatment Strategy in Pancreatic Cancer_Crim...CrimsonpublishersCancer
Adenocarcinoma of the pancreas (PDAC) accounts for 2.4% of all cancers diagnosed and is the fourth leading cause of cancer death, with almost equal rates of incidence and mortality [1]. By 2030, pancreatic cancer is projected to be the second leading cause of cancer-related death [2], surpassing breast, prostate and colorectal cancer. The overall survival at 5 years of around 7.2% as the majority of patients present with advanced disease at diagnosis. Patients with localized disease are treated with surgery, with or without neoadjuvant chemotherapy/ radiotherapy, followed by adjuvant chemotherapy. The majority (around 80%) of patients are treated only with chemotherapy as they have an advanced disease. Patients are treated in the first line with gemcitabine-abraxane or Folfirinox and with Naliri plus 5FU in the second line. There have been few clinical advances in PDAC treatment over the last 20 years and chemotherapy is the only treatment option available for the majority of patients. These tumours are also resistant to many targeted therapies such as anti-EGFR therapy like cetuximab [3] due to the presence of a KRAS mutation in the majority of primary tumors. Personalized medicine strategies have not yet been established in pancreatic cancer as in other more common tumour types. Thus, novel anti-tumour strategies are an important clinical need in order to improve survival rates.
Herbal Medicine for Cancer Treatment: Main Force or Supplement_Crimson Publis...CrimsonpublishersCancer
The Estimated numbers of new cancer cases and deaths in 2020 will be an estimated. 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States and there were 17 million new cases of cancer worldwide in 2018 [1]. The four most common cancers occurring worldwide are lung, female breast, bowel and prostate. A person’s risk of developing cancer depends on different factors, including age, genetics, and exposure to some potentially known carcinogens and those which are believed to be carcinogenic. Some avoidable lifestyle factors including smoking can increase cancer risk. However, cancer risk factors are similar worldwide. Insufficient exercise, alcohol, imbalanced diet, and obesity, and various infections account for a considerable proportion of cancers worldwide. Prevalence of any one of the risk factors varies in different ethnic groups and can vary by region and country, which contributes to variation of cancer incidence rates of the common types of cancer worldwide.
Herbal and Synthetic Drug Combinations in Cancer Therapy A Reviewijtsrd
Cancer is one of the leading and most serious diseases in the current decade, every year millions of people die because of various kinds of cancers. Many aspects relate to the cause of disease besides heredity, food habits, smoking, nutritional behaviors, radiation etc. Cancer is a high mortality disease and the therapeutics for cancer, especially for cancer metastasis is still imperfect. The successful cancer treatment till now has been under study, only chemotherapy and radiation treatments are at times successful. Alternative and less toxic medication is very much in need towards the disease, the use of concepts of herbal medicine with synthetic drug could present better drug leads towards the inhibitory treatment of Cancer. Nature shows plethora of medicinal plants with anticancer and antioxidant activities which may suppress the disease completely. By applying combination therapy instead of monotherapy can lead to improved efficacy and reduced toxicity of the conventional method of treatments of cancer. Anusree S | Dr. Silvia Navis A | Dr. Prashob G R "Herbal and Synthetic Drug Combinations in Cancer Therapy- A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-5 , August 2019, URL: https://www.ijtsrd.com/papers/ijtsrd25222.pdfPaper URL: https://www.ijtsrd.com/pharmacy/pharmacology-/25222/herbal-and-synthetic-drug-combinations-in-cancer-therapy--a-review/anusree-s
CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Cardiovascular Disease
Introduction
Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.
Definition
According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.
Epidemiology
Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.
Clinical Presentations
Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...
Evidence TableEvidence TablePICOT Question
[Insert here]APA Source Reference
(Include the DOI or URL. Use the source URL, not the library link.) Indicate: Peer Reviewed,
Clinical Guideline, or
Best Practice GuidelineAim, Hypothesis,
or Research QuestionConceptual or
Theoretical FrameworkResearch Design/MethodologyMeasurement
MethodSample Population
or SettingResearch Variables Data AnalysisFindingsGaps in ResearchSignificant Findings from a Critical Appraisal of the Evidence
(level, quality of the evidence)Good QuotesAdditional NotesEnd of Worksheet
Role of Clinical Trial Participation in Cancer Research: Barriers,
Evidence, and Strategies
Joseph M. Unger, Ph.D.1, Elise Cook, M.D.2, Eric Tai, M.D.3, and Archie Bleyer, M.D.4
1Fred Hutchinson Cancer Research Center, Seattle, Washington
2The University of Texas MD Anderson Cancer Center, Houston, Texas
3Centers for Disease Control and Prevention, Atlanta, Georgia
4St Charles Health System, Quality Department, Bend, Oregon
OVERVIEW
Fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. But although barriers to
trial participation have been the subject of frequent study, the rate of trial participation has not
changed substantially over time. Barriers to trial participation are structural, clinical, and
attitudinal, and differ according to demographic and socioeconomic factors. In this paper, we
characterize the nature of cancer clinical trial barriers, and we consider global and local strategies
for reducing barriers. We also consider the specific case of adolescents with cancer, and show that
the low rate of trial enrollment in this age group strongly correlates with limited improvements in
cancer population outcomes compared to other age groups. Our analysis suggests that a clinical
trial system that enrolls patients at higher rates produces treatment advances at a faster rate and
corresponding improvements in cancer population outcomes. Viewed in this light, the issue of
clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor.
Fewer barriers to trial participation would allow trials to be completed more quickly and would
improve the generalizability of trial results. Moreover, increased accrual to trials is important to
patients, since trials provide patients the opportunity to receive the newest treatments. In an era of
increasing emphasis on a treatment decision-making process that incorporates the patient
perspective, the opportunity for patients to choose trial participation for their care is vital.
INTRODUCTION
The path from initial development of a new cancer drug to diffusion of the new therapy into
the cancer treatment community relies, crucially, on clinical trials, which represent the final
step in evaluating the efficacy of new therapeutic approaches for malignancy. It has been
repeatedly estimated that <5% of adult cancer patients enroll in cancer clinical trials.1,2
...
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
10 STRATEGIC POINTS 2
Ten Strategic Points
Grand Canyon University
DNP-815- O502: Scientific Underpinnings
10 Strategic Points Table
(Use this table to complete the 10 Strategic Points document for your project.)
10 Strategic Points
Comments/Feedback
Broad Topic Area
Impact of Medication Administration Errors on 3-4-Year-old Leukemia Patients
Literature Review
A. Verghese, A., Charlton, B., Kassirer, J. P., Ramsey, M., & Ioannidis, J. P. (2015). Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. The American journal of medicine, 128(12), 1322-1324.
The article looks at the “Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes” from the American journal of medicine. It takes into consideration the fact that, the oversights in the corporeal assessment are a medical fault which aren’t studied via chart evaluation. Furthermore, the article states that these oversights in the corporeal assessments may be the primary contributors to the neglected or late diagnosis besides unnecessary exposure to contrast as well as radiation on the Leukemia patients. Either the authors indicate that the incorrect treatments resulting from these delays leads to unfavorable results like fainting on the Leukemia patient, lack of appetite on the side of the patient, worsening the Leukemia conditions which eventually can lead to early death of the patient.
B. Hockings, J. K., Owolabi, D. K., Broyles, J. E., & Wheelis, S. C. (2017). Impact of medication administration error on over 3 years Leukemia patients and the stimulating factors in acute leukemia and stem cell transplant patients. Supportive Care in Cancer, 25(6), 1853-1858.
The authors of this article explored the “Impact of medication administration error on over 3 years Leukemia patients and the stimulating factors in acute leukemia and stem cell transplant patients.” This article is from supportive care in cancer and it was retrieved from Google Scholar. The article authors acknowledge the fact that, the medication administration errors lead to severe impacts on the health conditions of the patient more especially the ones who are 3 – 4 years of Leukemia. According to the authors, the impacts associated with the medication administration errors may lead to worsening of the health condition of the patient, the rate of Leukemia advancement into higher stages may also increase with treatment or managing of this deadly disease being more complicated. The authors argue that using erroneous medicines, the Leukemia advancement increases without the knowledge of the patient which makes even the survival chances of the patient to reduce due to stress upon realizing that there was an error in his or her medication.
C. Douer, D. (2016). Efficacy and safety of vincristine sulfate liposome injection in the treatment of adult acute lymphocytic leukemia. The oncologist, 21(7), 840-847.
...
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
Imperatives for psychiatric education and leadership
THRIVE-stm2016-2
1. P A T I EN T A D V O C A C Y
Enhancing quality of life as a goal
for anticancer therapeutics
THE GLOBAL BIOMEDICAL COMMUNITY’S SUCCESSES IN CANCER THERAPY OVER THE
past 30 years and particularly in the last 5 years have made many cancers survivable diseases
(1). The U.S. National Academy of Medicine’s 2013 Quality Cancer Care report estimates
18 million survivors in the United States by 2018 and 1.5 million new cancer diagnoses per
year. The increase in treatment options and survival progress for many cancer types brings
into sharper focus the responsibility to also prioritize continued improvements in the quality of
life throughout disease-directed treatment and the full continuum of care for both cancer
patients and survivors.
In the weeks, years, and decades after treatment, many survivors experience a significantly
higher incidence of serious and even life-threatening chronic conditions—often unintended
consequences of toxicities from the drugs and therapies that saved their lives (2). These
consequences can include cardiac dysfunction or failure, pulmonary disease, neurological def-
icits, liver injury, and endocrine disorders. In addition to their physical and emotional toll, these
effects interfere with daily functioning and quality of life, including overall well-being, ability to
maintain employment, financial stability, and relationships with friends and family.
The most commonly cited example in this realm is the latent cardiotoxicity that can follow
high-dose anthracycline therapy used to treat childhood leukemias and osteosarcomas. In-
deed, survivors of childhood cancer have a sevenfold higher risk of cardiac mortality than
the general population (3). However, such off-target toxicities are not limited to traditional
cytotoxic or radiotherapies. As the use of targeted therapies (including immunotherapy) to
treat previously refractory cancers expands, so does the evidence of adverse off-target effects
from these drugs. A recent review highlights the diversity of immune-mediated toxicities re-
sulting from anti–CTLA-4 and anti–PD-1 antibody therapies (4). Many of these effects are
reversible with a halt in treatment, whereas other treatment-related effects require complete
cessation of therapy because of their severity. In some instances, immune-mediated, potential-
ly fatal hepatotoxicity and cytokine-release syndrome were observed with these treatments,
and dose stoppage was the only option. Other treatment-related effects may be subtler but
can nonetheless significantly compromise a patient’s quality of life. For example, lingering
cognitive- and executive-function deficits have been associated with vascular endothelial growth
factor receptor tyrosine kinase inhibitors (VEGFR TKIs) used to treat renal cell carcinoma (5).
Whether attempting to protect against slowly evolving cardiac damage or acutely manifest-
ing cytokine storm, the translational science knowledge base required to inform clinician and
patient decisions about dosing, protection, and monitoring is at best incomplete. Because of
our limited mechanistic understanding of the onset and progression of these adverse effects of
therapy, we lack diagnostic or predictive biomarkers of toxicity and have few protective co-
therapies to mitigate adverse effects. These deficits limit the ability to personalize the effective
dose for patients in need and have a negative impact on the quality of life for patients and
survivors who have overcome so much already.
As advisory board members of HESI THRIVE (http://hesithrive.org)— a funding agency for
quality-of-life research—we call on the biomedical and patient advocacy communities to join
us in raising the visibility of this important yet under-resourced and under-recognized oppor-
tunity to improve the lives of cancer patients and survivors. The time is right to broaden our
perspective on what it means to make more therapies available to more patients. Consider the
fact that “toxicity” is one of only three elements of evaluation in the American Society of Clinical
Oncology’s 2015 conceptual framework to assess the value of cancer treatment options (6). And
yet, despite its heavy emphasis on toxicity, the framework’s authors note the limited data avail-
able for assessing the quality of life and chronic impact of these drugs. Thus, they subsequently
rely exclusively on reports of high-grade acute adverse effects (including death) from clinical
trials, neglecting toxicities that might be low-grade but chronic and have a greater impact on
overall quality of life than a more serious but acute and rapidly resolving adverse event. Surely,
a more nuanced data set on which to base important therapy judgements can be developed.
CREDIT:STEVENDIRECTOR/GPSPHOTOS
E D I T O R I A L
www.ScienceTranslationalMedicine.org 22 June 2016 Vol 8 Issue 344 344ed9 1
Syril D. Pettit is the Executive
Director of the ILSI, Health and
Environmental Sciences Insti-
tute (HESI), Washington, DC
20005, USA. Email: spettit@
hesiglobal.org
Steven E. Lipshultz is Pediatrician-
in-Chief of Children’s Hospital
of Michigan; Chair of Pediatrics,
Wayne State University School
of Medicine; President of Uni-
versity Pediatricians; and Inter-
im Director of Children’s
Research Center of Michigan,
Detroit, MI 48201, USA; and
Editor-in-Chief, Cardio-Oncology.
CharlesS.CleelandisMcCullough
Professor of Cancer Research,
Department of Symptom
Research, Division of Internal
Medicine, The University of Texas
MD Anderson Cancer Center,
Houston, TX 77030, USA.
Samantha Roberts is Director
of Scientific Affairs, Friends of
Cancer Research, Washington,
DC 20036, USA.
Myrtle Davis is Chief, Toxicology
and Pharmacology Branch,
Developmental Therapeutics
Program, Division of Cancer
Treatment and Diagnosis, U.S.
National Cancer Institute,
Bethesda, MD 20892, USA.
onJune22,2016http://stm.sciencemag.org/Downloadedfrom
2. The potential for experimental research to identify new safety biomarkers or dosing strat-
egies for minimizing toxicities of oncology therapies as an essential expanded focus for quality-
of-life research remains largely unrealized. We believe that, with resources and prioritization,
researchers can make real progress in this space. The impact of mechanistic and translational
studies on anthracyclines is a case in point. When use of the anthracycline doxorubicin as an
antineoplastic agent was launched more than 40 years ago, it quickly became evident that car-
diotoxicity would be dose limiting. Studies in Syrian golden hamsters and rhesus monkeys
soon replicated the drug’s acute arrhythmogenic effects and became the launching point for
exploration of dexrazoxane as a potential protective inhibitor of these cardiotoxicities. Further
work in a range of preclinical animal models and in vitro assays has identified monitorable
serum biomarkers of doxorubicin-induced toxicities, elucidated the protective pharmacology
of dexrazoxane (iron chelation and topoisomerase II inhibition), provided proof of concept for
different dose-optimization strategies, and characterized the mechanism of latent doxorubicin-
induced cardiotoxicity (accumulated mitochondrial damage). Cumulatively, these findings have
yielded dramatic changes in clinical dosing practices for doxorubicin and spurred the use of
protective therapies such as dexrazoxane to enhance antineoplastic efficacy while reducing both
acute and delayed adverse effects (7).
Currently, the U.S. National Cancer Institute’s Provocative Questions initiative (PQ 9 spe-
cifically) and innovative seed-funding programs such as the HESI-Pardee THRIVE Initiative
are among a very few that provide much needed, albeit modest, research funding in this space.
Efforts led by the International CardiOncology Society, THRIVE, Friends of Cancer Research,
and others add further depth of field by creating new, multidisciplinary communities of prac-
tice to synergize expertise and applications. There is a growing network of expertise behind the
prevention, prediction, and management of treatment-related toxicities that can limit patient
adherence to treatment or a survivor’s ability to thrive after treatment.
The need for, and the achievability of, a quality-of-life–driven research agenda has nev-
er been stronger. By increasing the rigor, visibility, and frequency of this research, we also
increase the potential to both broaden the lifetime benefit of existing cancer treatments
and enhance the reach of future therapies.
–Syril D. Pettit, Steven E. Lipshultz, Charles S. Cleeland, Samantha Roberts, Myrtle Davis,
Brian R. Berridge, Rebecca A. Kirch
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E D I T O R I A L
www.ScienceTranslationalMedicine.org 22 June 2016 Vol 8 Issue 344 344ed9 2
Brian R. Berridge is Senior
GSK Fellow and Head of
Worldwide Animal Research
Strategy, GlaxoSmithKline,
King of Prussia, PA 19406, USA.
Rebecca A. Kirch is Executive
Vice President, Healthcare
Quality and Value, National
Patient Advocate Foundation,
Washington, DC 20005, USA.
All authors are members of the
HESI THRIVE Advisory Board.
Citation:
S. D. Pettit, S. E. Lipshultz,
C. S. Cleeland, S. Roberts,
M. Davis, B. R. Berridge,
R. A. Kirch, Enhancing quality
of life as a goal for anticancer
therapeutics. Sci. Transl. Med. 8,
344ed9 (2016).
10.1126/scitranslmed.aag0382
onJune22,2016http://stm.sciencemag.org/Downloadedfrom
3. 10.1126/scitranslmed.aag0382]
(344), 344ed9. [doi:8Science Translational Medicine
(June 22, 2016)
Roberts, Myrtle Davis, Brian R. Berridge and Rebecca A. Kirch
Syril D. Pettit, Steven E. Lipshultz, Charles S. Cleeland, Samantha
Enhancing quality of life as a goal for anticancer therapeutics
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