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This Week in JAMA: Mar 23, 2011

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In JAMA this week, Mike Mitka comments on a recent paper in the Journal of Clinical Investigation in which researchers discuss their discovery of a novel biomarker that predicts cancer metastasis. If the biomarker is validated, Mitka says, it could help clinicians devise more efficient treatment strategies for their patients. The researchers who conducted the original study found that varying levels of an N-terminal truncated protein variant of carboxypeptidase E may be predictive of metastasis in certain cancers — patients with high levels of the protein were more likely to see their cancer spread than those with low levels, Mitka says, and the levels were predictive regardless of the stage the cancer was in.

Also in JAMA this week, Bridget Kuehn says patients with incurable advanced cancers should have "frank" discussions with their physicians about end-of-life care. Too few cancer patients are getting the information they need and fewer than 40 percent of patients are actively discussing their options with their doctors, according to a new policy statement from the American Society of Clinical Oncology. Although these kinds of talks can be difficult, emerging research shows that patients may benefit from them and from having the opportunity to make decisions earlier, Kuehn says. "Patients also did not report increases in anxiety or distress as a result of truthful discussions about their condition," she adds.

Kuehn also reports on cancer patients' "unrealistic" hopes for cancer trial benefits in JAMA this week. Studies show that patients with late-stage cancers who enroll in early-phase clinical trials "harbor unrealistic optimism about the potential benefits of participation," she says. Phase I and II trials can offer researchers important information on the efficacy and safety of a compound, but are usually of limited therapeutic benefit for patients. Researchers are searching for a solution to the problem — they have already found that giving the patients more information doesn't help as the overly optimistic patients are usually very well-informed to begin with, Kuehn adds.

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