© Oxford University Press 2007.
IN THIS ISSUE
Cost of Patient Time for Cancer Treatment in the United StatesAlthough a number of studies have addressed the costs of medical treatments for cancer care, few studies have estimated the patient time costs associated with cancer care. To estimate the time cost of U.S. patients' cancer care, Yabroff et al. (p. 14) used Surveillance Epidemiology, and End Results (SEER)–Medicare data for more than 760,000 patients aged 65 and older with 11 types of cancer and more than 1 million matched non-cancer control subjects for 1995 to 2001. Service frequencies were combined with time and time value estimates. The net cost during the first year of treatment was estimated at $2.3 billion for all cancers combined. Costs varied widely by cancer type and phase of care. The authors conclude that these cost differences are likely due to variability in the stage at diagnosis and in treatment intensity.
In an editorial, Kessler and Ramsey (p. 2) urge U.S. policymakers to consider cancer-related nonmedical costs when evaluating the economic burden of cancer. The burden of direct nonmedical costs, they note, bolsters the argument for investment in technologies for early detection.
Risk of Soft Tissue Sarcomas After Hereditary Retinoblastoma
Hereditary retinoblastoma, which is caused by germline mutations in the RB-1 gene and occurs in childhood, is rarely fatal, but survivors have an increased risk of developing subsequent cancers, including soft tissue sarcomas. To quantify the risks for individual subtypes of soft tissue sarcomas, Kleinerman et al. (p. 24) studied more than 900 long-term survivors. The risks of all subtypes were elevated, with the risk of leiomyosarcomas the highest, at almost 400 times the risk in the general population. For some subtypes, the risks remained elevated for several decades. Most of the soft tissue sarcomas followed radiotherapy for retinoblastoma, but leiomyosarcomas were more often increased outside the radiation field. The authors suggest that hereditary retinoblastoma patients have a genetic predisposition to soft tissue sarcomas that is independent of radiation treatment and note the importance of regular medical surveillance of survivors for sarcomas in their adult years.
In an editorial, Meadows (p. 3) highlights the increased leiomyosarcoma risk as particularly noteworthy and agrees that long-term follow-up is important.
Statin Type, Dose, and Duration of Use and Risk of Colorectal Cancer
Statins have shown anticancer activity in colon cancer cell lines, but epidemiologic studies of the relationship between statin use and risk of colorectal cancer are limited. Coogan et al. (p. 32) conducted a population-based case–control study to evaluate the association for statin type, dose, and duration of use. Regular statin use for at least 3 months was not associated with a lower risk of colorectal cancer, and there was no consistent trend across dose or duration. However, the risk of stage IV cancer was lower among users than nonusers. The authors conclude that statin use was not associated with a reduced risk of colorectal cancer overall and that the reduced risk of stage IV cancer requires confirmation.
Lysosomes and Arsenite Treatment in APL
Cells from patients with acute promyelocytic leukemia (APL) produce a fusion protein between the promyelocytic leukemia protein and the retinoic acid receptor 
(PML/RAR). Treatment of APL patients with all-trans-retinoic acid induces degradation of PML/RAR. When APL patients stop responding to all-trans-retinoic acid therapy, arsenic trioxide (arsenite) is an effective treatment. Kitareewan et al. (p. 41) investigated the mechanism of arsenite action in APL cells. Arsenite destabilized lysosomes, which then released lysosomal proteases into the cytoplasm within 5 minutes of treatment. These proteases could degrade PML/RAR. The authors conclude that, in APL cells, arsenite appears to act through the rapid destabilization of lysosomes.
Imaging of Drug Release from Temperature-Sensitive Liposomes
Liposomal drug delivery systems for systemic chemotherapy can increase tumor drug levels while limiting systemic drug exposure. Ponce et al. (p. 53) used a rat fibrosarcoma model and a novel magnetic resonance imaging method to evaluate the temporal and spatial patterns of doxorubicin delivery via lysolipid-based temperature-sensitive liposomes (Dox-LTSLs) administered at different times with respect to local hyperthermia. Dox-LTSLs injected intravenously during hyperthermia rapidly released doxorubicin into the tumor periphery, resulting in faster tumor drug accumulation and a greater final tumor drug concentration than Dox-LTSLs administered before hyperthermia. Administration during hyperthermia also resulted in slower tumor growth compared with administration either before, or both before and during, hyperthermia. The authors conclude that during Dox-LTSL therapy liposomes should be administered during steady-state local hyperthermia.
Meta-analysis of Folate Intake and Levels and Risk of Breast Cancer
Studies of the association between breast cancer risk and folate intake or blood levels have been mixed. To investigate this association, Larsson et al. (p. 64) performed a meta-analysis of prospective and case–control studies. High blood folate levels were not associated with breast cancer risk in prospective or case–control studies. The authors also found inconsistencies in the association between breast cancer and dietary folate levels in case–control studies and prospective studies. The authors conclude that there is no clear support for an overall relationship between folate intake or blood levels and risk of breast cancer.
Sex Ratio of Offspring and Risk of Prostate Cancer
Defects in sex chromosomes can alter the sex ratio of offspring. To investigate the possible involvement of genes on the Y chromosome in prostate cancer risk, Harlap et al. (p. 77) analyzed the relative risk of prostate cancer among men participating in a family-based research cohort in Israel by the sex of their offspring. Men who had had only daughters—indicating a possible defect on their Y chromosome—had a higher risk of prostate cancer than men who had had at least one son, and the relative risk of prostate cancer decreased as the number of sons increased. The authors conclude that genes on the Y chromosome may be involved in prostate cancer risk in this population.
Hypothyroidism in Patients Treated with Sunitinib
Sunitinib is a small molecule tyrosine kinase inhibitor with activity against metastatic renal cell carcinoma. Fatigue is a common side effect in patients treated with sunitinib. Rini et al. (p. 81) investigated whether thyroid dysfunction could be the cause of this fatigue. Among 66 patients treated with sunitinib, 56 had at least one abnormal thyroid function test, and 47 had symptoms related to hypothyroidism. Seventeen of the 47 patients received thyroid hormone replacement therapy, and the symptoms improved in nine patients. The authors conclude that abnormal thyroid function appears to be common in patients with metastatic renal cell carcinoma treated with sunitinib and so routine thyroid function testing of such patients is warranted.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||