Caring for Patients With Cancer

Abstract

DESPITE THE DECLARATION OF THE “WAR ON CANcer” nearly 40 years ago, efforts of dedicated physicians and other clinicians who provide care for patients with cancer, billions of dollars in funding for cancer research, and increased public attention and interest in early cancer detection, cancer remains a leading cause of death worldwide, accounting for nearly 7 million deaths annually. In the United States, cancer is the second leading cause of death, and in 2009, accounted for an estimated 270 000 deaths among US women and 293 000 deaths among US men. For many patients and their families, cancer is perhaps the most feared diagnosis they can receive, not only because of concerns about cancer-related mortality, but because cancer and its treatment are associated with significant morbidity, often taking a devastating toll on physical functioning, quality of life, and emotional well-being. This theme issue of JAMA includes reports of novel research studies and scholarly commentaries that provide physicians with new information on cancer care. Four studies in this issue of JAMA report research findings on treatment outcomes for colon, prostate, liver, and lung cancer. In an analysis of 675 patients with stage III colon cancer who underwent surgical resection and received adjuvant chemotherapy, Kahn and colleagues found that compared with younger patients, older patients (age 75 years) received shorter and less toxic chemotherapy regimens and experienced fewer adverse events, an important finding considering the steadily increasing proportion of older patients receiving treatment. Talcott and colleagues reported that among 280 men who had been enrolled in a clinical trial and received radiation therapy for clinically localized prostate cancer, higher-dose radiation therapy, compared with standard dose, was not associated with an increase in patient-reported prostate cancer symptoms, such as urinary obstruction, urinary incontinence, sexual dysfunction, or bowel problems at a median of 9.4 years after treatment. These findings provide reassuring news with respect to the long-term functional consequences of this treatment because many patients now receive higher-dose radiation. In an evaluation of imaging methods used to assess response of “primary index lesions” to treatment with chemoembolization or radioembolization among 245 patients with hepatocellular carcinoma, Riaz and colleagues reported that agreement for classification of therapeutic response (disease progression and survival) was high between the Response Evaluation Criteria in Solid Tumors (RECIST [unidimensional]) guidelines and World Health Organization (WHO [bidimensional]) guidelines, but low between each of these and the European Association for Study of the Liver (EASL [necrosis]) guidelines. These findings provide useful information as it relates to the assessment of response to treatment for one of the leading causes of cancer deaths worldwide. In a preliminary report involving 55 patients with inoperable non–small cell lung cancer, Timmerman and colleagues reported that stereotactic body radiation therapy was associated with a 55.8% survival rate at 3 years along with high rates of local tumor control and moderate treatment-related morbidity. These promising findings support further studies of this treatment approach for older patients with inoperable non–small cell lung cancer. Two other studies provide new information on palliative cancer care services and risk of colon cancer. In a recent survey of palliative care services conducted among 142 executives and 120 program leaders from 71 National Cancer Institute (NCI)–designated cancer centers and a random sample of 71 non-NCI centers, Hui and colleagues found that most cancer centers reported having a palliative care program, although the scope of services and the degree of integration with other services varied widely. In a meta-analysis of studies assessing the relationship between colorectal cancer and vitamin B6 intake in 9 studies with 6064 cases, and blood levels of pyridoxal 5 -phosphate (PLP; the active form of vitamin B6) in 4 studies with 883 cases, Larsson and colleagues found that vitamin B6 intake and blood PLP levels were inversely associated with the risk of colorectal cancer. Five insightful commentaries in this theme issue address critically important current topics related to cancer. Gapstur and Thun highlight some progress and successes