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Objectives As complex novel cancer drugs are developed, supply may transiently fail to meet demand as production capacity established for research purposes is scaled up to meet anticipated clinical volume. There are no clear guidelines for how clinicians and medical centers should allocate scarce cancer care resources among patients who may benefit from the intervention. Materials and methods We describe a recent scenario in which demand exceeded supply for a novel immunotherapy, sipuleucel-T, that was newly approved by the FDA for castration-resistant prostate cancer. Production of this autologous cellular therapy was initially limited to one facility with supply projected to serve only 2,000 out of approximately 30,000 potentially eligible patients in the United States. Results and conclusions We propose basic guidelines that should be followed when allocating scarce cancer therapies and highlight ongoing challenges that must be resolved both with regard to rationing cancer care and with regard to access to high cost novel interventions in oncology in general.

Advances in early detection and adjuvant therapy have led to dramatic improvements in longevity after a cancer diagnosis. As a result, there are ~13.7 million cancer survivors alive in the United States, with this figure projected to increase to 18 million in 2022. Despite improvements in the 5-year relative survival rates, cancer patients with early-stage disease not only remain at high risk of cancer recurrence but also have sufficient longevity to now be at risk for late effects of adjuvant therapy, particularly cardiovascular disease (CVD). Against this background, we review here the risk factors common to cancer and CVD as well as the extant evidence supporting the potential efficacy of exercise therapy to modify the risk of cancer-specific and CVD-specific mortality in persons with cancer. We also evaluate evidence from clinical studies investigating the effects of structured exercise therapy to modify risk factors common to cancer and CVD. Findings of this review indicate that several major biomarkers/risk factors are predictive of both recurrence as well as non-cancer mortality in persons diagnosed with cancer. Such information is important to health professionals providing disease-risk screening as well as informing effective management strategies in long-term cancer survivors. In terms of the latter, there is growing but preliminary evidence that exercise may be efficacious in lowering both recurrence and CVD risk in cancer patients.

Background Following treatment for breast cancer, many young women are interested in having a child. There are few data available regarding actual fertility and menopausal outcomes in young breast cancer survivors. We evaluated these outcomes among young breast cancer survivors in collaboration with the Young Survival Coalition, an international advocacy group for young women with breast cancer. Patients and Methods All registered Young Survival Coalition survivor members were sent a link to the survey about fertility issues for women with early-stage breast cancer via e-mail; 440 women who completed the survey were eligible for this analysis. Survey respondents were a median of 2.8 years from diagnosis. Mean age at breast cancer diagnosis was 32.6 years. Results Of the 440 women in this cohort, 247 women (56%) recalled that they had desired a future pregnancy at diagnosis, and 43 women (10%) took steps to preserve fertility. A total of 384 women (87%) received chemotherapy. A total of 295 women (67%) reported that they remained premenopausal, and an additional 33 women (8%) were receiving ovarian suppression therapy at the time of the survey. Since diagnosis, 70 women (16%) had been pregnant ≥ 1 time; 40 women (9%) had ≥ 1 live birth. Out of the 247 women who reported wanting a future pregnancy at diagnosis, 59 (24%) had become pregnant. Of the 60 women who reported having tried to become pregnant since diagnosis, 34 (57%) were successful. Conclusion Most young women remain premenopausal after breast cancer treatment, including chemotherapy. A relatively small percentage of women in this series had become pregnant; however, the median time since diagnosis was relatively short.