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Where Are We With Adjuvant Therapy of Stage III and IV Melanoma in 2009?

Leslie A. Fecher and Keith T. Flaherty

Adjuvant therapy options for advanced melanoma in 2009 remain active observation, high-dose interferon, or clinical trial participation. Close observation is currently the only required adjuvant management, with the purpose of detecting the emergence of regional or metastatic disease early, when surgical management may still be possible. The National Comprehensive Cancer Network guidelines for the workup and follow-up of all stages of melanoma must be tailored to specific patients by the treating physician. This article explores the factors to consider when individualizing care within the scope of these guidelines.

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The Cost of Hope: A Candid Roundtable Discussion

Amanda Bennett, Ronald M. Bukowski, Keith Flaherty, J. Cameron Muir, Craig D. Turner, and Sam Donaldson

For Amanda Bennett and her husband Terence Foley, a 7-year battle with kidney cancer resulted in a price tag of more than $600,000, most of it spent in the final 2 years of his life. Ms. Bennett’s memoir, The Cost of Hope, chronicles the couple’s emotional struggle and the financial irrationality she uncovered when navigating the cancer continuum. She shared her experience in her keynote address at the NCCN 18th Annual Conference, which was followed by a roundtable discussion in which panelists discussed the difficulties inherent in dealing with cancer “uncertainties,” the balancing act that seeks to maintain hope in the context of a poor prognosis, and the problem of a health care system that spends too much on some aspects of care while ignoring others.