Aneuploidy screening: Newer noninvasive test gains traction

Favorable results from the 2 studies reviewed here have prompted ACOG to recommend that cell-free DNA screening be discussed with all pregnant patients. Practice changer: Discuss cell-free DNA testing when offering fetal aneuploidy screening to pregnant women

Integration of oncology and palliative care: a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Discovering the behaviors that facilitate or impede the dissertation completion of selected doctoral students having the all but dissertation (ABD) status

The purposes of this study were: 1) to better understand the doctoral experience as participants described the meanings they gave to their experiences, and 2) to increase understanding about the ways in which the meanings attributed to their doctoral experiences enhance our understanding of doctoral persistence and attrition. The descriptions of the behavior of the selected doctoral students interviewed may help current and future doctoral students, university administrators, and faculty in the common goal of having more scholars complete their dissertations. This study contains rich descriptions of the experiences of nine purposively selected doctoral students in Adult, Higher, and Community Education at a Midwestern university who have completed their doctoral coursework and their comprehensive examinations. All participants were in the all but dissertation (ABD) status at the start of the study. Four participants graduated with the doctorate after the evidence was gathered for this study. One participant remains as an ABD in two doctoral programs. The two interviews with each of the nine participants were semi-structured. They generated evidence that answered the research questions, but also generated additional descriptions of behavior over the entire time period of the participants' doctoral programs. These additional descriptions provided a greater richness to this study.This research study was guided by several research questions. The primary question was:What behaviors filled the three years following the completion of the course requirements and comprehensive examinations for the doctoral degree other than completion of a dissertation? The secondary questions were:What decisions accompanied these behaviors? What rewards were gained by completing the course requirements? A systematic phenomenological analysis identified three major themes: 1) "The value of the doctorate program and degree", 2) "The doctoral experience", and 3) "Facilitators, barriers, and distracters". The three themes each had sub-themes.Six recommendations were provided for facilitating the completion of the doctoral degree. Each study participant is a highly successful individual. Each agreed that this doctoral program has been a tremendous help professionally and personally. None are to be considered failures even if they remain an ABD.Department of Educational StudiesThesis (D. Ed.

Discovering the behaviors that facilitate or impede the dissertation completion of selected doctoral students having the all but dissertation (ABD) status

The purposes of this study were: 1) to better understand the doctoral experience as participants described the meanings they gave to their experiences, and 2) to increase understanding about the ways in which the meanings attributed to their doctoral experiences enhance our understanding of doctoral persistence and attrition. The descriptions of the behavior of the selected doctoral students interviewed may help current and future doctoral students, university administrators, and faculty in the common goal of having more scholars complete their dissertations. This study contains rich descriptions of the experiences of nine purposively selected doctoral students in Adult, Higher, and Community Education at a Midwestern university who have completed their doctoral coursework and their comprehensive examinations. All participants were in the all but dissertation (ABD) status at the start of the study. Four participants graduated with the doctorate after the evidence was gathered for this study. One participant remains as an ABD in two doctoral programs. The two interviews with each of the nine participants were semi-structured. They generated evidence that answered the research questions, but also generated additional descriptions of behavior over the entire time period of the participants' doctoral programs. These additional descriptions provided a greater richness to this study.This research study was guided by several research questions. The primary question was:What behaviors filled the three years following the completion of the course requirements and comprehensive examinations for the doctoral degree other than completion of a dissertation? The secondary questions were:What decisions accompanied these behaviors? What rewards were gained by completing the course requirements? A systematic phenomenological analysis identified three major themes: 1) "The value of the doctorate program and degree", 2) "The doctoral experience", and 3) "Facilitators, barriers, and distracters". The three themes each had sub-themes.Six recommendations were provided for facilitating the completion of the doctoral degree. Each study participant is a highly successful individual. Each agreed that this doctoral program has been a tremendous help professionally and personally. None are to be considered failures even if they remain an ABD.Thesis (D. Ed.)Department of Educational Studie

Clinical trial design in small cell lung cancer: Surrogate endpoints and statistical evolution.

7087 Background: Small cell lung cancer (SCLC) is a devastating disease for which little recent therapeutic advance has been achieved. SCLC trial design and reporting may have an impact on the interpretation of studies conducted. Furthermore the use of surrogate endpoints in SCLC has not been explored. Methods: Through examining all phase II and III SCLC trials published in the Journal of Clinical Oncology (8,471 patients from 66 trials between 1983-2010), we examined how SCLC trial reporting and design has evolved, determining if the type I error, power, and sample size calculations were provided. We assessed primary endpoints for all trials and sought to discover if response rate (RR) or progression-free survival (PFS) correlated with overall survival (OS). We analyzed response and survival outcomes for associations using Pearson correlation coefficient and differences between data groups by ANOVA followed by Tukey’s multiple comparison procedure. Results: There were increased reporting trends of statistical design in power (16.7% in 1986-1996 to 77.8% of trials in 2006-2010 [p=0.001]) and type I error (22.2% in 1986-1996 to 72.2% in 2006-2010 [p=0.005]). 72.2% of trials published in 1986-1996 failed to report a primary endpoint whereas only 5.56% of trials in 2006-2010 failed to do so (p=0.004). Of phase II trials, primary endpoint was identified as RR in 65%, OS in 25%, and PFS in 10% (p&lt;0.0001). There is a strong correlation between RR and both PFS (p=0.013) and OS (p=0.012) in extensive-stage disease (ED) but not limited-stage disease (LD) (p=0.978 for PFS, p=0.193 for OS). This correlation is for partial response rate (pRR) but not complete response rate. RR (p=0.029) exhibits a negative trend over time with a dramatic and significant decrease in RR across all studies starting in 2005. A strong positive correlation exists between PFS and OS for LD (p=0.036) and ED (p=0.058). We found no change in median overall survival (p=0.383). Conclusions: Over time there has been improvement in reporting the essential statistical data for proper interpretation of SCLC trials. No change in survival was seen over the past 28 years. RR should be evaluated as a surrogate endpoint for OS in ED but not LD. pRR correlates with OS and PFS in both LD and ED. </jats:p

ASFA Category IV becomes Category I: Idiopathic thrombotic thrombocytopenic purpura in a patient with presumed gemcitabine-induced thrombotic microangiopathy.

In the implementation of American Society for Apheresis national guidelines, the decision for therapeutic plasma exchange may be confounded by a clinical presentation that fits both a Category I and IV designation. We report the case of a 45-year-old female who presented with concern for a Category IV disorder, gemcitabine-induced thrombotic microangiopathy, and was ultimately diagnosed with a Category I disorder, idiopathic thrombotic thrombocytopenic purpura. This case highlights the importance of ruling out idiopathic TTP by a thorough evaluation for ADAMTS13 activity and inhibitor, even when an alternate thrombotic microangiopathy diagnosis may be likely