Toremifene for breast cancer: a review of 20 years of data.

Endocrine therapy is a cornerstone of medical treatment for estrogen receptor-positive breast cancer. The discovery of selective estrogen receptor modulators (SERMs) > 40 years ago represented a revolutionary advance in the treatment of breast cancer. As a therapeutic class, SERMs have either estrogenic or antiestrogenic activity, depending on the target tissue and the hormonal environment. In breast tissue, SERMs are antiestrogenic, making them a major treatment option for women with hormone-sensitive breast cancer. Toremifene citrate was developed > 20 years ago with the goal of achieving efficacy similar to that of tamoxifen and with an improved safety profile. Although studies to date have not confirmed a clear safety advantage or disadvantage for toremifene, clinical data support the efficacy and safety of toremifene for the treatment of breast cancer in postmenopausal patients. Toremifene also has a pharmacokinetic profile and metabolic pathway different from that of tamoxifen, which may provide a therapeutic advantage in certain patients. In addition, because of the selective estrogenic effects of SERMs in bone and on lipid levels along with a different side effect profile compared with the aromatase inhibitors (AIs), toremifene is a viable option to the AIs for some patients. Despite a number of clinical trials and over 500,000 patient years of use, many oncologists have limited familiarity with toremifene data. This article will examine the rationale for the use of toremifene in the treatment of women with breast cancer and review data from 20 years of clinical experience with this agent.

Systematic review of economic analyses of health care-associated infections.

BACKGROUND: Economic evidence is needed to assess the burden of health care-associated infections (HAIs) and cost-effectiveness of interventions aimed at reducing related morbidity and mortality. The objective of this study was conducted to assess the quality of economic evaluations related to HAI and synthesize the evidence. METHODS: A systematic review of research published between January 2001 and June 2004 was conducted. Quality of the publication was estimated using a Likert-type scale. All cost estimates were standardized into a common currency. Descriptive statistics and a logistic regression were conducted to identify predictors of high quality. RESULTS: 70 studies were audited. There was wide variation in these cost estimates. Publications estimating the cost attributable to an infection were almost 7 times more likely judged to be of higher quality than studies of the cost of interventions (P < .05). Papers in which the authors stated the perspective (hospital or societal) were twice as likely to be judged as being of high quality (P < .05). CONCLUSION: There are more publications and growing interest in estimating the costs of HAI. However, the methods employed vary. We recommend (1) the use of guidelines for authors and editors on conducting an economic analysis, (2) development of more sophisticated mathematical models, and (3) training of infection control professionals in economic methods.

Current treatment for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. In the United States, the incidence of HCC has increased by nearly 75% since the 1980s. The rise in HCC diagnoses in the United States has been attributed to an increased number of patients infected with viral hepatitis and better diagnostic techniques. The management of HCC begins with diagnostic confirmation, followed by accurate staging. Historically, the prognosis for patients with HCC has been poor; however, improved surveillance and radiologic imaging techniques have led to earlier detection of HCC and an increased opportunity to treat patients. Treatment options for HCC include surgical and nonsurgical modalities. Surgical therapy, by way of partial hepatectomy or orthotopic liver transplantation, is the only potentially curative treatment for HCC, but most patients are not eligible for these procedures by the time of diagnosis. Palliative options include ablative techniques, radiation, and systemic therapies. As the incidence of this malignancy continues to rise, oncology nurses, who are an integral part of the multidisciplinary team caring for these patients, must be aware of current management for HCC. This article will provide an overview of the complex management of patients with HCC in the United States.

Surgical and ablative modalities for the treatment of colorectal cancer metastatic to the liver.

Colorectal cancer is the second leading cause of mortality from cancer in the United States. Death from colorectal cancer usually results from metastatic disease to the liver. Complete surgical resection is the only potentially curative treatment option for metastatic colorectal cancer to the liver, with a five-year survival rate of approximately 30%-40%. The addition of adjuvant systemic or hepatic intra-arterial pump chemotherapy appears to improve survival. Treatment options for unresectable disease in the liver are cryosurgery (intraoperative freezing of tumors), radiofrequency ablation (intraoperative or percutaneous heating of tumors), hepatic intra-arterial infusion pump chemotherapy (regional chemotherapy), and systemic chemotherapy. This article describes metastatic colorectal cancer disease presentation, extent of disease evaluation, and nonchemotherapeutic treatment options, including surgical and ablative therapies. The nurse's role in caring for this population also will be discussed.