Volume 13 Issue 3, March 2016

A survey on the official prices of 31 cancer drugs across 18 countries, published by Vogler and colleagues, has revealed substantial differences in price for the same drug in different countries. Herein, we discuss inequalities in the access to cancer care and raise some challenging questions.

The recently updated breast cancer screening guidelines from the American Cancer Society are less aggressive than previous versions and clearer about overdiagnosis. However, a lack of attention was placed on the differences in effect estimates between trials at high and low risk of bias, and the authors failed to quantify the most serious harm.

Prostate-specific antigen (PSA)-based screening approaches are associated with reduced prostate-cancer mortality, but can lead to overdiagnosis, unnecessary biopsies and overtreatment. Two solutions for this problem exist: to abandon PSA-based screening completely, or to improve the accuracy of PSA-based screening methods to solve the benefit-to-harm equation. Herein we explore these solutions by examining three recent publications.

Tumour cells can evade the immune response through different strategies, with the tumour microenvironment being a key determinant of which pathways become activated to restrain antitumour immunity. The authors of this Review describe the four major types of therapeutic interventions required in combinations to generate a strong antitumour response. Importantly, they also discuss which combination therapies might effectively engage immunity to suppress tumour progression in four different scenarios defined by the composition of the immune tumour microenvironment.

The practice of palliative care for patients with cancer is continually improving, and an increasing evidence base indicates that early integration of oncological and palliative care can result in wide-ranging benefits for the patients, their loved ones, clinicians, and health-care payers. Herein, David Hui and Eduardo Bruera discuss optimization of clinical infrastructures, processes, and education to support this strategy, and provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. The authors emphasize the need for health-care systems and institutions to tailor integration based on their resources, size, and the level of primary palliative care available.

Use of radiotherapy or chemotherapy generally increases the survival of women with breast cancer; however, the use of radiotherapy, chemotherapy agents, such as the anthracycline doxorubicin, or anti-HER2 agents, such as trastuzumab, confer an increased risk of adverse cardiovascular events in these patients. In this Review, the authors describe the incidence and management of treatment-induced cardiac disease in women with breast cancer, and highlight strategies that might be used to minimize this risk.

Cachexia, a syndrome where metabolic demands cannot be met by energy intake, can substantially reduce the quality of life and increase mortality of patients with oesophageal cancer. In this Review, authors describe the causes, and effects of cachexia in these patients throughout the disease trajectory, and during the survivorship period; suggestions are made on how best to manage the effects of, and minimize the occurrence of this syndrome.