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This chapter describes the collaborative efforts and statistical results obtained in four five-year cycles of collection and analysis of individual patient data concerning breast cancer mortality. The presentation and discussion of preliminary results in two types of trial at a meeting in London 1984 initiated the collaborative effort. This resulted in the combination of individual data from 28 trials comparing surgery to surgery plus an additional treatment believed to inhibit tumour growth, and from a further 40 trials comparing surgery to surgery with additional chemotherapy. In total, about 40,000 woman participated in the 68 fully randomized trials followed up until 1985. The fourth cycle, which added medication thought to inhibit tumour growth and further chemotherapy, established that treatments used since the 1980s substantially reduced not only 5-year age-standardized mortality rates, but also the 15-year rates.

After the Al–Khubz al–hafi crisis ended, Magda al–Nowaihi and the author organized a panel at MESA 2000 on Censorship and the Arab Literary Imaginary. Magda was ready for all the battles, having fought yet another of her own battles against chemotherapy just before the scheduled panel. After the panel, she walked out of a full auditorium ready for commitments: list of contributors, areas to be covered, and joint editorial work for the book. However, the work remained unfinished. Magda passed away on June 2, 2002 after a long and courageous battle. This book serves as a tribute to her, a very similar project to what Magda and the author had planned.

Cancer progression is not affected by placebo treatments; however symptoms can be reduced by placebos. Nocebo effects are crucially involved in anticipatory nausea and vomiting before a cancer chemotherapy session, with a basic mechanism of classical conditioning. In sports medicine, physical performance in sports activities is boosted by placebos and this poses some important ethical questions about doping. Placebo surgery may induce improvement as well. However, surgical clinical trials with placebos raise many ethical questions. Some alternative and complementary therapies, like acupuncture, have both a specific effect and a big placebo component. It is also important to realize that placebo and placebo-related effects represent a good model for the better understanding of the mechanisms underlying the patient-provider interaction.

This chapter chronicles the discovery of the cure for puerperal disease. It discusses the contributions of German scientist Paul Ehrlich who worked in immunotherapy and coined the term chemotherapy, British bacteriologist Almroth Wright, English chemist William Perkin, and English physician Leonard Colebrooke. It highlights the introduction of sulphonamides in the mid-1930s as the first effective treatment of puerperal fever. Sulphonamides, which later became known as penicillin, was discovered by Scottish scientist Alexander Fleming.

This chapter relates a case of individualized decision making in a patient named Diane who was diagnosed with acute leukemia. In the author's conversation with Diane and her family about her condition and options, she remained very adamant about her wish not to undergo chemotherapy and to live whatever time she had left outside the hospital. Being an advocate of informed patient choice, the author agreed to Diane's wishes despite the possibility of having to face legal and professional problems.

Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a definitive histological diagnosis can be made. Indeed, some patients who present late with advanced disease may be too ill for invasive diagnostic investigations, and palliative interventions will be planned on the basis of a working diagnosis of lung cancer, guided on radiological findings and clinical history. This chapter discusses the prevalence of symptoms in cancer, causes and assessment of symptoms in cancer, approaches to symptom management, technical advances in radiotherapy delivery, chemotherapy, comprehensive palliation of symptoms, and management of effusions.

This chapter discusses the medical aspects of pediatric cancer, valuable to readers with little or no background in biomedical sciences and medical practice. It considers the etiology, clinical symptoms, diagnostic procedures, and different kinds of treatments of childhood cancers, and discusses the characteristics and late effects of the most common kinds of pediatric malignancies, including leukemias, brain tumors, lymphomas, and bone tumors. It helps those who are relatively unfamiliar with medical issues in pediatric oncology to better appreciate the nature of this disease and to establish a context for the discussion of psychological issues in the chapters that follow.

Problems associated with pain and symptom management among children undergoing treatment for cancer is a major area of concern for clinicians. This chapter discusses methods of assessing and treating chemotherapy-induced nausea and vomiting, pain secondary to invasive procedures, and other distressing symptoms. It also reviews methods of evaluating individual differences among pediatric cancer patients in their vulnerability to pain symptoms, managing children's procedure-related pain and distress according to the needs of the individual child, and relationships between children's acute and chronic pain reactions. Focusing on acute pain, the chapter builds a framework for understanding variation in symptoms across children undergoing the same procedure or chemotherapy and variation in symptoms for the same child at different points in time. It also provides a brief review of the anatomy and physiology of pain transmission and inhibition.

Cancer therapy can lead to complex oral and dental problems. These complications vary by patient, the individual's oral and dental status, the type of cancer, and the type of cancer therapy administered. In most cases, oral complications are influenced by the pre-existing conditions of the patient. Oral complications caused by cancer treatment can cause fatal effects and can hinder the progression of a treatment. Nevertheless, in some cases oral complications can be minimized and eliminated. This chapter describes the oral complications resulting from chemotherapy and head and neck radiation therapy. The chapter also presents a philosophy for preventing and addressing oral complications.

This chapter discusses the different methods of systematic therapy, with stress on the importance of chemotherapy, hormone therapy, and biological therapy in palliative care. Systemic therapy is advantageous compared to local treatment such as surgery and radiotherapy because of its ability to deliver tumouridical therapy throughout the body so that all sites are exposed to therapy. However, it can increase exposure of normal tissues to tumour cells. While this puts a negative light on the efficacy of systemic therapy for the alleviation and palliation of cancer, the chapter affirms that systemic therapy can play a major role in palliation by employing drugs that have limited toxicity and considerable efficacy. Those drugs that are significant in systemic therapy and in palliation are discussed in the chapter, together with the methods and administration of chemotherapy and hormone therapy, the management of patients undergoing chemotherapy, and the biological agents that can be used in the management of diseases.

Nausea and vomiting are reported to occur in up to 62% of terminally ill patients, with 40% experiencing these symptoms in the last six weeks of life. Most of the existing research on antiemetics involves chemotherapy-induced or radiation-induced nausea and vomiting and may not be relevant to the treatment of symptoms resulting from advanced disease. Prospective studies with symptomatology documented at entrance to a palliative care program or hospice care and careful reporting of symptoms and treatment thereafter are needed. There are numerous problems inherent in the study of people with advanced disease. Such patients have a myriad of symptoms interacting with each other and each requiring treatment. Treating one symptom may exacerbate or improve another or cause entirely new problems. Determining whether improvement or exacerbation is part of the disease process, the treatment, or another emerging problem is often very difficult.

There are three services that a palliative care team may be specifically involved with: the pain clinic, radiotherapy, and medical oncology. This chapter reviews the contribution of these services to the care of patients with advanced cancer. The pain clinic and oncology services have an important role in treating pain and other symptoms of advanced cancer. Obviously, the role of the palliative care team can overlap with these services. There is the potential for misunderstanding and conflict; although such services may feel threatened by a palliative care team, the problem is not one-sided. If palliative care team members have not worked in a pain clinic or oncology ward, they may be ignorant of the benefits these services can offer. The chapter also considers the available techniques, hormone and chemotherapy, and working with oncology services.

Acupuncture is a therapeutic technique that evolved from ancient Oriental theories and practices of medicine. Since the 1970s, it has become increasingly popular in the West as a means of preventing and treating a variety of disorders. In cancer care, it is used to complement conventional management, helping to control cancer symptoms and the side effects of treatment, as well as being used in the supportive care of cancer patients. It is suitable at any stage of the cancer experience, from diagnosis through active treatment, in palliative and end of life care, and to support survivors in re-establishing their lives. This chapter focuses primarily on the use of needling and moxibustion, as used in traditional forms of acupuncture. First, it defines acupuncture and discusses its history as well as modes of action. It also examines the evidence base on the effectiveness of acupuncture in managing cancer pain, chemotherapy-induced nausea and vomiting, breathlessness (dyspnoea), dry mouth (xerostomia), hot flushes and night sweats, anxiety and depression, immune function, and in treating overall well-being. The contraindications of acupuncture are also considered.

Mathematical models of cancer evolution can provide helpful insights. This chapter describes a way to model cancer in which carcinogenesis is a microevolutionary process inside an organ. It uses both stochastic methods and methods of evolutionary population dynamics and focuses on two particular problems: (a) the role of genetic instability in cancer initiation and progression; and (b) the problem of resistance in cancer treatment with small molecule inhibitors. The dynamics are generated by cell reproduction and mutation, and by the selection pressures that act on the different cell variants. These dynamics can be captured in equations which yield insights into the outcome of these complex processes that would otherwise not be possible. The general message of this review is that population dynamics and evolutionary thinking can provide a new dimension to cancer research, which complements the molecular and cell-focused approach that is primarily used.

Echocardiography represents the most widely used diagnostic tool in cardiology. From its beginnings, in 1953, when Professor Inge Edler first used it in Lund, Sweden, there always was a clinical question underlying its use and development. This might be one of the main reasons why echocardiography has always been one of the most popular diagnostic methods to be used clinically and several authors have named it as the fastest growing technique in cardiology. In fact, there are a variety of areas where echocardiography has proven to be fundamental not only for clinical orientation but also for significantly increasing the understanding of the underlying pathophysiology of the disease process. The other important aspect is the fact that, at the same time, significant technological developments have occurred that have made it possible to develop adequate transducers able to accompany the clinical questions. Some of the main features and contributions of echocardiography in different clinical conditions can be summarized as follows. Heart failure remains one of the main killers in the developed world with its prevalence increasing worldwide mainly as the result of coronary artery disease (CAD), responsible for almost two-thirds of cases of left ventricular (LV) dysfunction. Echocardiography has played a major role in the understanding of the different mechanisms involved in the development of the different types of heart failure. In addition, it has helped to monitor and develop new therapeutic targets and strategies in heart failure. LV function represents the most important prognostic indicator in patients with heart disease regardless of their aetiology. Echocardiography has been the main diagnostic tool to assess how much systolic and diastolic function are involved in the mechanism of heart failure in a particular patient. Regarding systolic function, echocardiography can provide different measurements that contribute to a more objective assessment of function, including: global and regional function, degree of ventricular remodelling, contractile reserve, presence of ischaemia and/or viability, particularly in patients post-acute coronary syndromes or post-myocardial revascularization, and the concomitant presence of valvular heart disease, which may significantly impact on the assessment of LV function (particularly the presence of significant volume overload, such as in mitral and/or aortic regurgitation).

This chapter is a narrative of the author whose mother was suffering from cancer. The author recollects the memories of one of her visits along with her mother to the Kenneth Norris Cancer Hospital on the University of Southern California campus to meet the doctor. She recalls feeling disturbed when the doctor under whom his mother is going through treatment, suggests to her mother an experimental chemotherapy treatment where two kinds of chemotherapies are mixed to test the toxicity levels in humans. The author remembers interrupting the doctor's conversation saying she would not let her mother to be their guinea pig. However, despite the author's opposition, her mother readies for the experiment as she believes in the quality of life, not in the quantity of life. Furthermore, this chapter also peeps into the memories of the author's father.

Ovarian cancer is the seventh most-common cancer of women worldwide. Although it is generally regarded as a chemo-sensitive malignancy, the majority of women afflicted with this disease develop chemo-resistance and eventually die of their disease. Of the women diagnosed with ovarian cancer, only 15–20 per cent are curable with a combination of chemotherapy and surgery. However, when patients relapse, the prospect of cure diminishes, and the aims of treatment change to palliation of symptoms and prolongation of life. This chapter highlights some of the evidence-based treatment for decisions facing oncologists in the management of women with advanced or recurring ovarian cancer. It places emphasis on the role of chemotherapy in this setting. The aims of treatment in these patients differ considerably based on the progression of the disease, performance status of the patient, co-morbid illnesses, and the patient's individual wishes. Included in the chapter are three cases that highlight some of the clinical scenarios and different management decisions.