Devita, Hellman, and Rosenberg's Cancer

LWBK1006-47 LWW-Govindan-Review December 12, 2011 20:55

586 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

industry funding on dissemination of trial results, including suppression

of adverse findings, delayed or lack of publishing negative results, and

multiple publications of results favorable to industry. Although personal

stock ownership by clinical investigators is a common concern, this is rare

in actual practice.

Answer 47.6. The answer is B.

The Orphan Drug Act of 1983 provides financial incentives to promote

the development of drugs for rare diseases including the potential for

7 years of marketing exclusivity on drug approval, tax incentives, and

eligibility for orphan drug research grants.

Answer 47.7. The answer is C.

Nonvoluntary active euthanasia is the intentional administration of

medicine or other interventions in patients who are incompetent and

unable to consent. Provision of a medicine that a patient can use to com-

mit suicide, termination of life-sustaining treatments, and causing death

in a competent patient who did not consent the procedure are examples

of physician-assisted suicide, passive euthanasia, and involuntary active

euthanasia, respectively.

Answer 47.8. The answer is D.

Voluntary euthanasia and physician-assisted suicide are legal in Belgium

and the Netherlands, with the latter also being legal in Switzerland and

the US state of Oregon. Passive euthanasia is considered ethical but invol-

untary active euthanasia is considered unethical and is not known to be

legal in any country.

Answer 47.9. The answer is B.

Genetic testing may be advisable for people with increased susceptibility

to cancer because of family history or other predisposing factors. Such

information may help guide patients and their families to seek further

interventions, such as early mammography or prophylactic mastectomy

in patients with BRCA1 mutations. Testing may be associated with poten-

tial psychological, social, or economic harm, and a proper informed con-

sent process should include discussion about the pros and cons. Genetic

counselors may provide help in this process.

Answer 47.10. The answer is A.

Quality measurement refers to the practice of evaluating care processes

to bring about improvement and include structural, process, and out-

come measures. Structural measures evaluate characteristics of providers

or the care system, such as rates of board certification or volume of pro-

cedures. Process measures examine the actions taken by providers, such

as delivery of a specific care component that has been demonstrated to

be favorable for patient outcomes based on clinical trials or guideline