Oncology NEWS International Vol 8 No 5

Delirium Is Often Misdiagnosed in Advanced Cancer

May 01, 1999

CLEVELAND-Delirium, although common in patients with advanced cancer, is poorly understood, Donna S. Zhukovsky, MD, said at a conference on palliative medicine held at the Cleveland Clinic Foundation. Properly identifying delirium can be difficult, and the literature shows that it frequently goes unrecognized by physicians and nurses, said Dr. Zhukovsky, of the Cleveland Clinic Foundation’s Harry R. Horvitz Center for Palliative Medicine.

Preop Chemo Recommended for Locally Advanced Disease

May 01, 1999

ORLANDO-The most important aspects in treating locally advanced breast cancer are thorough preoperative chemotherapy and a treatment team that combines chemotherapy, surgery, and radiation, two experts said at a special session of the Society of Surgical Oncology’s Annual Cancer Symposium. The presenters were Frederick C. Ames, MD, of the University of Texas M.D. Anderson Cancer Center, and A. Marilyn Leitch, MD, of the University of Texas Southwestern Medical Center, Dallas.

High Degree of Variability in HIV Testing Throughout the US

May 01, 1999

ATLANTA–Human immunodeficiency virus (HIV) infection is one of the leading causes of morbidity and mortality in the United States. Testing for HIV, in conjunction with counseling and other preventive services, can reduce the risk for HIV infection and appropriately link infected persons to treatment. To characterize HIV testing by region, state, and sex, the Centers for Disease Control (CDC) analyzed data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate a high degree of variability in HIV testing throughout the United States.

Physicians Need ‘Coherent Game Plan’ for Care of Dying

May 01, 1999

CLEVELAND, Ohio-Decisions involving patients with advanced cancer must take place within a conceptual framework that takes into account quality of care, quality of life, and quality of death, Declan Walsh, MD, MSc, said at a conference on palliative medicine held at the Cleveland Clinic Foundation.

NCI Funds Pediatric Brain Tumor Consortium

May 01, 1999

BETHESDA, Md-Nine children’s cancer centers have joined together under the auspices of the National Cancer Institute (NCI) to form the Pediatric Brain Tumor Consortium. The NCI will provide the group $2 million a year for 5 years to fund collaborative efforts to develop and carry out pilot studies and early clinical trials of promising new therapies for children with brain malignancies.

Marketing Your Cancer Center to Today’s Savvy Consumers

May 01, 1999

ALEXANDRIA, Va-As cancer care increasingly shifts from inpatient to outpatient services and consumers use the Internet to educate themselves about their disease and their options, cancer programs must concentrate more carefully on marketing themselves as the answer to potential patients’ needs, said Patti Jamieson, MSSW, MBA, service line administrator for oncology, University of Illinois at Chicago Medical Center.

Axillary Irradiation Can Replace Dissection in Some Breast Cancer’s

May 01, 1999

ORLANDO-Breast cancer patients whose tumors respond to induction chemotherapy and who have no clinical axillary node disease following induction may be safely treated with axillary irradiation rather than axillary lymph node dissection, Jeffrey Lenert, MD, said at the Society of Surgical Oncology’s Annual Cancer Symposium.

Dr. Bailes Urges Oncologists to Act Against APC Proposal

May 01, 1999

FORT LAUDERDALE, Fla-Time is running out for lobbying against the Health Care Finance Administration’s (HCFA) proposed Medicare hospital outpatient fee schedules, based on ambulatory payment classifications (APCs). The deadline for comments is June 30, 1999.

Elective Lymph Node Dissection Supported in Some Melanomas

May 01, 1999

ORLANDO-Ten-year survival results from a major intergroup study support the use of elective (immediate) regional lymph node dissection (ELND) rather than watchful waiting for patients with intermediate-thickness melanomas (1 to 4 mm).

Broad Coalition of Health Care Groups Opposes APCs

May 01, 1999

ALEXANDRIA, Va-“Organized opposition to the Health Care Finance Administration’s (HCFA) proposal to reimburse outpatient Medicare cancer services according to ambulatory payment classifications (APCs) now includes many of the major players in the oncology community,” reported Lee E. Mortenson, DPA, executive director of the Association of Community Cancer Centers (ACCC), Rockville, Maryland.

Depression and Anxiety Difficult to Diagnose in Cancer Patients

May 01, 1999

Since sadness and anxiety are normal reactions to serious illness such as cancer, the challenge for the physician becomes determining which symptoms are appropriate to the situation and which are pathologic and require treatment, Susan J. Stagno, MD, said at a conference on palliative medicine at the Cleveland Clinic Foundation.

Tips on Distinguishing Good Metaanalyses From Poor Ones

May 01, 1999

SAN FRANCISCO-Although there are many good metaanalyses, derived from combining the results of numerous solid clinical trials, there are also many “filled with garbage,” Deborah Grady, MD, said at the Seventh Symposium on Clinical Trials: Design, Methods and Controversies. It is incumbent on the physician to be able to distinguish the good from the bad, said Dr. Grady, associate professor of epidemiology, biostatistics and medicine, University of California, San Francisco (UCSF).

How Patients Hear a Cancer Diagnosis Can Affect Long-Term QOL

May 01, 1999

COLUMBUS, Ohio-Hearing the words, “You have cancer,” is immediately upsetting. “That distress can echo through the years, negatively affecting a person’s quality of life [QOL] long after the initial diagnosis of cancer,” said Betty R. Ferrell, PhD, RN, research scientist, City of Hope National Medical Center. She spoke at a conference on cancer survi-vorship sponsored by the James Cancer Hospital and Solove Research Institute at Ohio State University. Indeed, she said, in a survey of cancer survivors, distress over initial diagnosis was ranked as the single most negative influence on quality of life, worse than fear of recurrent cancer, fear of cancer spreading, or physical symptoms like fatigue.

Neoadjuvant Hormonal Therapy in Prostate Cancer: Pro and Con

May 01, 1999

New Orleans-The advisability of neoadjuvant hormonal therapy in the management of prostate cancer is a hotly debated issue. At the American Society of Therapeutic Radiology and Oncology (ASTRO) spring refresher course, two opinion leaders in radiation oncology squared off on opposite sides of this issue.

Treating Patients on Protocol More Effective, No More Costly

May 01, 1999

ALEXANDRIA, Va-Treating a patient in a clinical trial-nearly always a cancer patient’s best treatment option-is no more costly and far more effective than giving supposedly less expensive “established” care, reported William P.Peters, MD, PhD, president, director, and chief executive officer of the Barbara Ann Karmanos Cancer Institute, Detroit. Dr. Peters discussed a series of cost and outcome studies that reached this conclusion at the Annual Meeting of the Association of Community Cancer Centers.

Careful and Correct Coding Crucial for Oncology Practices to Avoid Triggering a Medicare Audit

May 01, 1999

ALEXANDRIA, Virginia-Careful and correct coding has become crucial for oncology practices that wish to maximize reimbursement and minimize their chances of a Medicare audit, said Roberta Lee Buell, MBA, president and chief executive officer of Intake Initiatives, Inc./Documedics, San Bruno, California.

Targeted Cancer Drugs, Cytostatic Agents-Wave of the Future

May 01, 1999

MIAMI BEACH, Fla-The development of chemotherapy agents peaked between 1985 and 1990, Dr. Eric Rowinsky said at the annual meeting of the Network of Oncology Communication and Research (NOCR). “However, we saw the same types of drugs being developed (analogs of the platinums and anthracyclines) because we were using the same old screening system,” he said.

Oncologists Must Keep on Top of Health Care Legislation

May 01, 1999

ALEXANDRIA, Va-Although physicians and other health professionals are not taught how to create or pass legislation, it is vital “for each of us to be involved in the legislative process,” Edward L. Braud, MD, said at the 25th Annual Meeting of the Association of Community Cancer Centers (ACCC).

NCI’s CGAP Seeks to Map Complete Genetics of Cancer

May 01, 1999

ALEXANDRIA, Virginia-Genetic alterations very early in the disease process lie at the root of every cancer. Functional genomics, the study of which genes are actually functioning at a given time or stage, affords a “new approach” to fighting cancer, reported Kristina Cole, MD, PhD, a cancer research training fellow at the National Cancer Institute, Bethesda, Maryland.

ACCC Focuses on Off-Label Use Bills in States

May 01, 1999

ALEXANDRIA, Va-With 56% of cancer patients now receiving off-label therapies and “more than 50%” of physicians reporting problems getting reimbursement for these treatments, assuring coverage for such medications is a major focus of the Association of Community Cancer Centers’ legislative efforts at the state level, said Christian Downs, MHA, director of Provider Economics and Public Policy for the ACCC.

With Managed Care, Nurses Face Greater Exposure to Liability

May 01, 1999

ALEXANDRIA, Va-Although nurses traditionally have not been sued individually for malpractice, changes in technology, medical practice, and medical economics have made them increasingly vulnerable to being named in litigation, according to Susan B. Fink, RN, JD, an attorney with Koskoff, Koskoff & Bieder, PC, of Bridgeport, Conn.

Making Music in the Hospital Aids Rehab, Raises Spirits

May 01, 1999

COLUMBUS, Ohio-Many aspects of cancer patient care can be improved or enhanced with the use of music therapy, said Deforia Lane, PhD, resident director of music therapy, University Hospitals of Cleveland-Ireland Cancer Center/Rainbow Babies & Children’s Hospital, and assistant clinical professor of medicine, Case Western Reserve University. Dr. Lane, a board-certified music therapist, spoke at a conference on cancer survivorship sponsored by the Ohio State University’s James Cancer Center and Solove Research Institute.

Preop Combined Modality Treatment, Promising Oral Agents

May 01, 1999

ORLANDO-The new frontiers in colorectal cancer include multimodality treatment used preoperatively and a new group of oral fluoropyramidine drugs, according to presentations at the Society of Surgical Oncology’s 52nd Annual Cancer Symposium.

ODAC Rejects Temodal for Use in Advanced Melanoma

May 01, 1999

BETHESDA, Md-The Oncology Drugs Advisory Committee (ODAC) has voted not to recommend that the FDA approve Temodal (temozolomide, Schering) for the first-line treatment of patients with metastatic malignant melanoma. The 10 to 0 vote, with one member abstaining, followed a spirited discussion in which committee members not only questioned the value of Temodal in advanced melanoma, but also that of DTIC-Dome (dacarbazine, Bayer), which the FDA approved in 1975 for treating the disease.

Cancer-Related Fatigue Has Multiple Causes, and Many Are Treatable

May 01, 1999

COLUMBUS, Ohio-“Fatigue in the cancer patient has multiple causes and must be treated with a variety of strategies,” said Lois Almadrones, MSN, clinical research associate at Memorial Sloan-Kettering Cancer Center.

Anesthesiologists Have Increasing Role in Managing Pain

May 01, 1999

NEW YORK-In recent years, the practicing anesthesiologist has become more involved in the management of pain and has to be aware of the increasing number of treatments available, said Carol A. Warfield, MD, chief, Division of Pain Services, Beth Israel Deaconess Hospital, Boston.

Grapefruit Juice-Vinblastine Interaction

May 01, 1999

ALEXANDRIA, Virginia-Drinking grapefruit juice with certain medications, including at least one widely used in cancer treatment, may inhibit their absorption, according to an in vitro study in the April 1999 issue of Pharmaceutical Research, a publication of the American Association of Pharmaceutical Scientists (AAPS).

Dye, Intradermal Radiocolloid Find the Sentinel Node

May 01, 1999

ORLANDO-Both dye and radioactive tracer are required for finding sentinel lymph nodes most accurately in patients with operable breast cancer, but small intradermal injections of the tracer can be used instead of intraparenchymal tracer injections, researchers from Memorial Sloan-Kettering Cancer Center reported at the Society of Surgical Oncology’s Annual Cancer Symposium.

NCI Funds Range of Prostate Cancer Research

May 01, 1999

BETHESDA, Md-The National Cancer Institute is funding a wide range of prostate cancer research, including genetic epidemiology, molecular diagnostics, diet and nutrition, animal models, surveillance, diagnostic imaging, clinical trials, prevention and early detection, and the Cancer Genome Anatomy Project .

Eric Davis, Baseball Star, Leads New Colon Cancer Awareness Campaign

May 01, 1999

WASHINGTON-Baseball star and colon cancer survivor Eric Davis has launched “Score Against Colon Cancer,” a public awareness and screening campaign that will capitalize on the St. Louis Cardinals slugger’s celebrity status and personal experience.

Patients’ Bill of Rights Remains on Congressional Agenda

May 01, 1999

FORT LAUDERDALE, Fla-Before talking about the various “patients’ bill of rights” legislation before the US Congress, Harry D. Holmes, PhD, played the theme from the movie Back to the Future. “That’s what it seems like in managed care reform, since all of these bills were filed last year and here they are again, both in the House and the Senate.”

US Cancer Incidence, Mortality Show Overall Decline

May 01, 1999

WASHINGTON-Overall cancer incidence and mortality have continued to decline in the United States, but incidences of some cancers continue to rise, and significant differences in both incidence and mortality persist among different racial and ethnic groups.

Cannabinoid Drugs May Offer Symptom Relief

May 01, 1999

WASHINGTON-During the past 16 years, researchers have developed data that suggest cannabinoid-based drugs may be effective for a variety of medical uses, including pain relief, antiemesis, and appetite stimulation in cancer patients, an Institute of Medicine (IOM) committee has concluded. It warned, however, that such medical uses carry some risks, particularly the harmful effects of smoking marijuana, which it discouraged as a means of delivering medications.

Task Force to Evaluate Vitamins, Pharmacologics as Cancer Prophylaxis

May 01, 1999

ROCKVILLE, Md-Two cancer-related topics are among four new evaluations the Agency for Health Care Policy and Research (AHCPR) has asked the U.S. Preventive Services Task Force to make. The task force is an independent panel of preventive health experts that evaluates the effectiveness of a wide range of clinical preventive services.

NCI Program Aims at Reducing Cancer Burden Among Minorities, the Poor

May 01, 1999

BETHESDA, Md-The National Cancer Institute (NCI) has earmarked $30 million for use over the next 5 years to support a group of projects that will unite research scientists and community leaders in efforts to address disparities in national cancer rates among minorities and other underserved groups.

Preliminary Data on HDC/ABMT in Breast Cancer

May 01, 1999

ALEXANDRIA, Va-Preliminary findings from four of five randomized studies show no survival advantage for high-dose chemotherapy/autologous bone marrow transplantation (HDC/ABMT) in breast cancer patients with metastatic or high-risk disease (10 or more positive axillary lymph nodes), researchers said at an ASCO teleconference.

Legislation Would Carve Out Cancer From HCFA-Proposed APCs

May 01, 1999

ALEXANDRIA, Va-“The Health Care Finance Agency’s plan to reimburse for outpatient Medicare cancer treatment according to ambulatory payment classifications (APCs) would have a crippling effect on research and development of new drug therapies and lower the quality of care for present and future cancer patients,” Congressman Gene Green, Representative of the 29th District of Texas in the US House of Representatives, said at the Annual Meeting of the Association of Community Cancer Centers (ACCC).

‘High-Volume Centers Better at Complex Cancer Treatments’

May 01, 1999

WASHINGTON-Cancer patients are better off seeking treatment at high-volume institutions when they require complicated cancer surgery or chemotherapy, according to a new report from the National Cancer Policy Board (NCPB). It listed pancreatic cancer surgery, removal of all or part of the esophagus, and removal of pelvic organs as examples of such procedures.

NCI Announces Sites of First Endostatin Phase I Studies

May 01, 1999

BETHESDA, Md-The first human trials of the antiangiogenesis drug endostatin will take place at the University of Wisconsin-Madison and the University of Texas M.D. Anderson Cancer Center. The National Cancer Institute (NCI), which will sponsor the phase I trials, said that the studies will begin in late summer or early fall. Protocols for the two studies had not been worked out at the time of the NCI’s announcement.

New Agents Have Altered ‘Therapeutic Paradigm’ of NHL

May 01, 1999

We are entering an extraordinary era in the treatment of patients with indolent non-Hodgkin’s lymphomas (NHL). Several decades were devoted to expending resources on comparing combinations and permutations of conventional agents, but with no beneficial impact on survival.

Danish Perspectives in Oncology: Profiles From Aarhus

May 01, 1999

While in Denmark under an ASTRO/ESTRO fellowship travel grant, Dr. Brian Kavanagh spoke with a number of oncologists at the University of Aarhus about their research and the practice of oncology in Denmark. In this essay, he skillfully weaves Danish history, philosophy, customs, and landscape into his interviews with four eminent Danish physicians.