ONCOLOGY Vol 9 No 11

Positron emission tomography (PET) can save hospitals tens of thousands of dollars in the evaluation of patients with

Most physicians are so poor at communicating medical information to their patients that up to half of all patients leave their

The Asscoiation of Community Cancer Centers (ACCC), at a meetingof the Collaborative Research Group (CRG), announced new study

Patients are often critical of quality -of -life programs because health -care professionals developed them with little

New research that is bringing ribozyme therapy closer to clinical trials was presented at the recent meeting of the American

Eventually, maybe within 2 years, oncology specialists will become the primary-care physicians for patients diagnosed with

Population growth is adding to the threat of massive epidemics, two Stanford scientists told a meeting at the Beijer Institute of

RTOG 91-11, a National Cancer Institute high priority laryngeal preservation protocol, has been streamlined and the accrual

By taking the initiative and addressing concerns about patient care and conservation of health-care resources, nursing staff at

In recent years, clinicians and researchers have noted that bloodtests made by different companies for the prostate-specific antigen

To adress questions relative to the safety of the blood supply ,the National Heart,Lung and Blood Institute, together

An experimental drug designed to help standard chemotherapy drugs maintain their disease-fighting power has cleared its first

The American Urological Association, representing 10,000 urologists worldwide, is encouraged that the Office of Technology

The safety and efficacy of a new chemoradiation approach to treating bladder cancer, which is designed to effect a cure while

Several developments are combining to move radiation oncology into a new era--the 3-dimensional conformal radiation therapy (3-D CRT) era. Modern imaging technologies provide a 3-D view of the cancer patient's anatomy that allows the radiation oncologist to more accurately identify tumor volumes and their relationship with other tissues. The power and reliability of computers continues to increase rapidly while the costs continue to decrease. These advances have spurred the development of CT-simulation/3-D radiation treatment planning systems that are the cornerstones of the 3-D CRT era [1-3].

The modern CT simulator is capable of interactive three-dimensional (3D) volumetric treatment planning; this allows radiation oncology departments to operate without conventional x-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter.

The history of systemic treatments for advanced cutaneous melanoma, which is reviewed thoroughly in the paper by Anderson et al, can best be characterized as a series of unrealized hopes.

The treatment of advanced cutaneous melanoma remains disappointing. Single-agent cytotoxic drugs usually produce response rates of less than 20%, though newer agents, particularly fotemustine and temozolomide, show some promise, especially in patients with brain metastases.

The current application of QOL measurements and outcomes in managed care organizations is minimal, but potential applications are significant, since a fundamental goal of managed care is to optimize member/patient

The federal government's involvement in cost-effectiveness studies, outcomes measures, and practice guideline development is haphazard, with a number of agencies taking part in the process. The Health Care Financing

Patients with advanced cancer or AIDS are frequently bothered by anorexia, decreased food intake, fatigue, weight loss, muscle wasting, and a decline in functional status. Nutritional support may afford these patients a

The article by Eckardt et al reviews numerous anticancer drugs presently undergoing clinical development in the United States. These drugs have an array of biochemical targets. Some agents, such as the camptothecin analogs, represent a novel class of antineoplastic drugs. Other drugs, such as docetaxel (Taxotere), are analogs of currently available drugs (paclitaxel [Taxol]) [1,2]. Still other agents, such as thymidylate synthase (TS) inhibitors (eg, ZD1694 [Tomudex], AG-331, and LY231514) and 5-ethynyluracil, a uracil reductase inhibitor, have been designed prospectively to inhibit specific enzymatic pathways [3-5]. Some agents discussed have preliminary activity in refractory diseases, such as that of irinotecan (CPT-11) in fluorouracil-refractory colon carcinoma and that of docetaxel in cisplatin (Platinol)-refractory non-small-cell lung carcinoma, or show activity in diseases for which standard therapies are less than optimal.

For nearly two decades, the development of novel cytotoxic agents progressed at a snail's pace. In the 1970s and 1980s--decades of instant gratification in which massive expenditures and manpower were expected to have immediate payoffs, the future of new cytotoxic drug discovery looked dismal.

A better understanding of the biology and biochemistry of the cancer cell has led to the development of various promising new antineoplastic compounds that are now undergoing phase I, II, and III clinical testing. These drugs include topoisomerase I inhibitors, such as camptothecin and its analogs 9-aminocamptothecin, irinotecan, and topotecan; the paclitaxel analog docetaxel; gemcitabine, an antimetabolite structurally related to cytarabine; and fluorouracil prodrugs and other thymidylate synthase (TS) inhibitors.

G-CSF has been available since 1991 for use in patients receiving high-dose chemotherapy/ABMT, and while it has been shown to effectively reduce the risk of febrile neutropenia, its cost effectiveness has been open to question. In this small retrospective study, five indicators of the consumption of health care resources were examined in stage III/IV breast cancer patients who received high-dose chemotherapy with ABMT or peripheral stem cell support. The study covered the time periods before and after the availability of G-CSF. The results showed that patients who received G-CSF had reductions in length of hospital stay of 20% (the purged marrow group) and 17% (nonpurged group), compared with similar groups that did not receive the growth factor; the shortest lengths of stay were seen in the peripheral stem cell group, all of whom received G-CSF. Other findings, including number of days the ANC fell below 500, total days of G-CSF use, and total days of antibiotic use, are presented. [ONCOLOGY 9(Suppl):107-110, 1995]

This paper reviews the current status of translation of quality of life outcomes from research to clinical practice. A major barrier in this process is the lack of mature results from quality of life studies in phase III randomized controlled trials. As more trials are completed, we can expect the diffusion of those results into clinical practice and decision making. Further, as quality of life measurement tools are used more widely and become more user-friendly, we can anticipate their adoption in the routine clinical assessment of patients in the oncologist's practice. [ONCOLOGY 9(Suppl):61-65, 1995]

The total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high

Control of chemotherapy-induced nausea and vomiting is a major concern for patients receiving cancer therapy and a major quality of life issue. However, the fact that antiemetic control improves quality (but not duration) of

The POpulation HEalth Model (POHEM) lung cancer microsimulation model has provided a useful framework for calculating the cost of managing individual cases of lung cancer in Canada by stage, cell type, and treatment modality, as well as the total economic burden of managing all cases of lung cancer diagnosed in Canada. These data allow an estimation of the overall cost effectiveness of lung cancer therapy. The model also provides a framework for evaluating the cost effectiveness of new therapeutic strategies, such as combined modality therapy for stage III disease or new chemotherapy drugs for stage IV disease. By expressing the cost of lung cancer treatment as cost of life-years gained, such analyses allows useful comparisons of the cost effectiveness of these treatments with those of other costly but accepted medical therapies. [ONCOLOGY 9(Suppl):147-153, 1995]

A variety of economic factors have created a growing demand for health care reform and the rapid expansion of managed care plans. Absence of a clear, commonly accepted definition of managed care constitutes one of the