Cancer Control

Elderly patients – those aged 65 years and over – use more medications than their younger counterparts and experience higher risks for polypharmacy, drug interactions, adverse drug reactions, and noncompliance for this age-group.

The data on polypharmacy in the aged is reviewed, supplemented with preliminary information from studies performed on elderly patients with cancer at our institution.

Polypharmacy occurs in ambulatory, extended care, and institutional settings. Over-the-counter medications are underreported. The number of potential drug-related problems is related to the total number of prescriptions. Methods for evaluating the extent of polypharmacy include the “brown-bag” technique and careful medication histories.

The risks of polypharmacy may be reduced with patient and physician education, intervention, and drug monitoring. Further pharmacokinetic investigations of anticancer medications are needed to recognize the potential for harmful drug interactions, to understand their toxicity profiles, and to avoid the clinical implications of drug interactions.

The majority of the presently known nonrandom chromosome changes in hematologic malignancy were described during the 1970s and 1980s. The last 10 years have been devoted to the location of oncogenes and tumor suppressor genes altered as a consequence of those changes. New molecular methodology has helped speed this process, which has resulted in DNA sequencing of many of the genes involved, permitting molecular detection of abnormal clones.

This review examines the most common alteration-based subgroups of cytogenetics and molecular genetics in hematologic disorders with the exclusion of lymphoma. Prognosis has been updated to reflect improving treatment protocols.

The versatility of cytogenetics for delineating genetic changes is difficult to match by molecular testing. Once a clonal anomaly is identified, molecular methodology can detect residual disease with far greater sensitivity than cytogenetics, but relies on translocation junction targets that exclude clones characterized by deletion or trisomy.

Cytogenetic and molecular testing offers independent diagnostic and prognostic evaluation for most patients with hematologic malignancy.

The treatment of acute myelogenous leukemia has evolved in recent years due to advances in supportive care, the identification of prognostic factors, and the careful evaluation of chemotherapeutic modalities in randomized clinical trials.

The classification and prognostic features are reviewed, and the results from clinical trials have been evaluated with an emphasis on randomized trials and on both remission induction and postremission phases of management.

The combination of an anthracycline and standard-dose Ara-C form the basis of remission induction. High-dose Ara-C has greater toxicity. For postremission therapy, high-dose Ara-C improves results in those with good risk features or normal cytogenetics. Acute promyelocytic leukemia management includes all-trans-retinoic acid.

Once a patient relapses from a nontransplant approach, high-dose therapy and allogeneic marrow transplantation are considered. Autologous stem cell transplantation cures some patients who do not have a donor.

Support groups help their participants to cope with the emotional and practical impact of their illnesses.

The effectiveness of the Leukemia Society of America support groups in enhancing the quality of life for their participants is reviewed. The groundwork, purpose, and structure of such groups, as well as alternate sources of support, are presented. Evaluation and future directions for oncology groupwork are discussed.

Support groups complement the therapies provided by clinical practitioners and scientists by addressing the additional needs of cancer patients over the course of illness and survival.

New concepts and methods that address the needs of specific age-groups and incorporate the newly generated data on cancer treatments will further enhance the benefits provided by support groups.

Evidence-based medicine demands the use of information from clinical trials to direct medical care. Knowledge of the principles of trial design and conduct is important to assess the validity of results.

The authors review the key principles behind clinical study design and conduct, and they summarize important biases and confounding issues.

Clear hypotheses, a well-described study population, precise measurements, freedom from bias, and consideration of any interactions are attributes of good clinical trials.

The greatest level of evidence in support of a difference in outcome is associated with randomized, controlled clinical trials, particularly when combined with other randomized trials in a systematic fashion (meta-analysis).