Public Health Sector Groans Under Burden of Multiple Epidemics
March 27th 2020This has been a difficult time for public health policy and regulatory organizations struggling to deal with rapidly changing and unquestionably serious societal health-related issues and concerns. The list of problems these agencies must tackle is growing, and so are the questions about the strategies that should be used to address these threats.
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Vaccines Show Promise and Pitfalls of Public Health Strategies
March 13th 2020Segments of the population have apparently rejected the well-documented clinical utility of vaccination for protecting individual and public health. An immediate specific concern is the contentious matter of measles vaccination, which has been well-reported in the lay press.
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If Only That Phase III Oncology Trial Had Been Designed Differently
February 19th 2020The cancer treatment community's ultimate perception of a successfully completed phase III randomized trial depends in large part on how well the trial was conceived and structured. To permit adequate accrual in a timely manner and optimize the chances for a study to achieve success, the question it poses must be relevant to ensure interest by clinical investigators, referring clinicians, and potential research subjects. Further, the initiative must have adequate funding for data collection and analysis, translational laboratory investigations, and other trial components.
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Patient Input Should Inform Oncology Trial Design and Interpretation
January 13th 2020Even the most basic investigation into fundamental mechanisms of the development and progression of cancer in an in vitro system may generate data that, ultimately, prove vital to developing new approaches to prevent, diagnose, and treat malignant disease.
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Success Breeds a Need for Oncology Trials That Tackle Real-World Questions
December 30th 2019Placing the results of a single trial in the context of real-world, everyday practice is increasingly difficult because of the number of available options and the absence of studies that directly compare individual strategies.
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The Dividing Line for Germline Mutation Testing Is Often Arbitrary
December 18th 2019Although hereditary cancer risk was defined solely by family history in the not-so-distant past, today increasingly robust data may help define an individual’s heightened lifetime risk based on the presence of specific molecular findings within the germline
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A Society That Worries About Risks Should Consider Cancer Prevention
November 23rd 2019When discussing the topic of vaccination to prevent serious childhood illness, an increasing number of individuals refuse to accept the unequivocally demonstrated value of this public health strategy despite the very low risk of harm.
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End-of-Life Treatment Has Important Nuances
October 13th 2019Even if a disease is diagnosed as “incurable,” or progression to a state of incurability subsequently develops, the time between diagnosis and death is being prolonged and the quality of life improved with novel oncologic interventions, such that continued therapeutic efforts are justified.
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Small Subgroups May Hold Big Clinical Clues in Oncology
September 23rd 2019With the revolution in our understanding of cancer’s basic molecular biology, it is increasingly evident that subgroups of cancer originating from specific regions of the body have unique natural histories and respond to very different therapeutics. For example, the importance of BRCA mutations, which define a subset of ovarian cancers impressively sensitive to PARP inhibitors, has striking altered the management of this group of gynecologic malignancies.
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Control Arms Must Be Selected for Meaningful Comparison
July 24th 2019Although concerns have been raised in recent years regarding the need for randomized trials to augment the body of clinical understanding, one critical issue that has failed to generate sufficient discussion is how the choice of the control arm affects the interpretation of an individual study’s outcome and potentially undermines the ethical basis for that particular study.
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Evolutionary Medicine May Provide Clues for Cancer Genetics
June 28th 2019Today, with the routine performance of single gene or germline panel testing, as well as a critical focus on prospective follow-up of individuals with incompletely understood germline variants, clinicians are developing an increasingly robust appreciation for the influence of an individual’s genetic background on the likelihood of developing specific malignancies or a group of malignant conditions.
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Sometimes the Weight of Tradition Is Heavier Than Gold-Standard Evidence in Oncology
May 18th 2019Evidence generated from the randomized study design may be largely ignored by an individual or a community of physicians if the results or strategies being examined do not align with existing beliefs or bias, local practice and referral patterns, and other potentially highly relevant factors unrelated to the trial outcome.
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When the Quality of Evidence Just Doesn't Make the Grade in Cancer Care
May 10th 2019The oncology clinical and research communities should demand that essential clinical trials and objectively valid evidence for efficacy and toxicity be obtained and reported before any regulatory agencies or national/international cancer societies support this strategy as a “standard of care” for cancer pain management.
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Old-Fashioned Biology Trumps Technological Potential
April 10th 2019The recent technological advances in medicine and related fields have encouraged a belief among many that there is little technology will not be able to accomplish in improving cancer-related clinical outcomes, but it must be acknowledged that clinical medicine and cancer biology are extremely complex arenas.
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Dose Modulation Should Not Be Undervalued in Oncology
March 28th 2019Considering the decades of clinical investigation involving cytotoxic therapy of malignant disease, it is remarkable— even disconcerting—just how little is understood about the optimal delivery of this critical cancer treatment strategy.
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When a Measure of Significance Is Not All That Significant
March 20th 2019The term statistically significant is almost certainly beautiful music to the ears of clinical investigators and pharma/biotech companies. However, concern develops when one inquires how the most common test of significance, the P value, is used in clinical investigative efforts and whether at times this is more harmful than helpful within the domain of cancer medicine.
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New Strategies and Novel Agents Transform Ovarian Cancer Into a Chronic Condition
March 7th 2019The immediate future of clinical investigation in ovarian cancer is remarkably exciting, with a number of novel agents and combination strategies currently being examined in multiple clinical trials.
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Intellectual Conflicts of Interest Pose Hidden Dangers to Scientific Accuracy
February 1st 2019The model of an independent and self-regulating academic medical community continues to be challenged through widely reported accusations of serious scientific misconduct, failure of investigators to report potential financial conflicts of interest, and suggestions of inadequate transparency related to the questionable role of academic researchers in the analysis and reporting of industry-sponsored clinical trial results.
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