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As often as not, the decision whether to treat or deny treatment to any elderly patient with cancer is a result of an oncologist’s impression of the individual person’s ability to benefit from and withstand the side effects of therapy. And that decision is usually based on a clinical assessment that is far more intuitive than it is scientific.

Localized prostate cancer treatment with surgery or radiation results in similar long-term side effects, such as erectile dysfunction and urinary incontinence.

My suggestion, as unrealistic as it is, would be to encourage the creation and maintenance of parallel groups of quality measures: one set to satisfy the reportable measures of quality that affect reimbursements and pay for performance, and a second set that would be developed by and adapted to each institution to measure and drive improvements in those things we felt were true measures of high quality care.

The reality is that new biological agents are often priced like a Ferrari, and patients who are covered under a pharmacy benefit are required to fork over not a fixed copay but a percentage of the pill’s cost, each and every month ‘til eternity or death, whichever comes first.

The same week that bevacizumab (Avastin) received a new indication for the treatment of metastatic colorectal cancer, results from two phase III trials involving the drug were presented at the American Society of Clinical Oncology 2013 Gastrointestinal Cancers Symposium (ASCO GI) held January 24–26 in San Francisco.

By Cary A. Presant, MD, FACP1, Linda Bosserman, MD, FACP1, Wendy McNatt1, Brandon Emilio11Wilshire Oncology Medical Group, La Verne, California

Cancer Network presents exclusive coverage from the American Society of Clinical Oncology (ASCO) 2013 Genitourinary Cancers Symposium. Check out the stories below for write-ups of the most important information to come out of this year's event.

The mTOR inhibitor everolimus (Afinitor) has been found to significantly reduce the size of angiomyolipomas, the slow-growing benign tumors commonly associated with tuberous sclerosis complex (TSC) and sporadic lymphangioleiomyomatosis, according to the results of the phase III EXIST-2 study.

Such a systematic review of the current status of mTOR inhibitors in the treatment of breast cancer demonstrates holes in our knowledge of the role of the tumor, the host, and metabolic factors in breast cancer progression.

Efforts to identify clinical biomarkers of response or resistance to mTOR inhibitors are ongoing. This review will summarize results of preclinical and clinical studies as well as ongoing clinical trials with mTOR or dual PI3K/mTOR inhibitors.

Reading the contents of the NCI Cancer Bulletin in recent years, I have become increasingly concerned by what I perceive as an irrational, pervasive, and persistent editorial bias against cancer screening.

The annual report to the nation on the status of cancer in the United States, published Monday, shows cancer death rates overall continue to decline. The number of people who die as a result of their cancer has been steadily declining since the 1990s, and over the 9-year period between 2000 and 2009, the report shows a 1.8% decrease in death rates per year among men and a 1.4% decrease among women.

There has been a decline in overall cancer screening among the US population. Only colorectal cancer screening rates met current screening goals. Cancer survivors specifically met current national screening goals with the exception of cervical cancer screening.

Without naming drugs, because there are several that fall into this category, has anyone else noticed that many of the new cancer drugs show an infinitesimal improvement in progression-free survival or overall survival?

Much study has been done on how to promote the most important attribute physicians must have in order to fulfill their sworn duty: that of professionalism. For practicing physicians such frustrations as the insurance bureaucracy and the pressure to generate visits can erode that duty.

In this interview we discuss what patients expect from their cancer treatment with Deborah Schrag, MD, MPH, associate professor at Harvard Medical School. Dr. Schrag recently published a study that aimed to discover how patients with advanced cancer understand the purpose of their chemotherapy treatment.

As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign.

Find out how your compensation, bonuses, and benefits compare to your peers. Data exclusive to Cancer Network.

The Come Home project will demonstrate that community oncology practices can aggressively manage the symptoms and complications of cancer and its treatment-and at the same time can save money by limiting the use of expensive sites of service like hospitals and emergency departments.

Initiating discussions about end-of-life care with patients with incurable cancers early in their disease was associated with a decrease in late-stage aggressive cancer treatments such as chemotherapy or acute care, and with an increase in the use of hospice care at the end of life.

A phase II study indicates that cabozantinib has strong antitumor activity in advanced castration-resistant prostate cancer and improves bone scan lesions.

Final results of a cohort from a phase II monotherapy trial of quizartinib in acute myeloid leukemia patients showed that more than half of patients 60 years of age and older who harbored an internal tandem duplication in the FMS-like tyrosine kinase 3 had a composite complete remission.

Giving patients at the end of life regular parenteral hydration of 1 L of saline per day did not improve symptoms associated with hydration, quality of life, or survival, according to a randomized, placebo controlled study.

An observational study has found that patients with chronic liver disease (CLD) who used aspirin or another NSAID had a reduced risk of developing hepatocellular carcinoma and a reduced risk of dying from CLD.

Although the number of metastatic cancer patients receiving radiation in the last year of life did not significantly change from 2000 to 2007, a new study has found a shift in radiation use from the simplest radiation treatments to more advanced treatment.

I see a time in the not too distant future when we’ll define tumors this way. What will our subspecialties be? Rather than a breast clinic or a lung clinic, will we perhaps be attending a “HER2 clinic” or an “mTOR clinic” instead?

Real healthcare reform would address these socioeconomic realities. Instead, the US is waging a regulatory “war” on exaggerated measures of waste, one that shows little promise of reducing costs or increasing quality but will assuredly crush “needed innovation by practicing physicians, who best understand the delivery of care.”

Including the entire course of care in the efforts to improve quality and contain costs will make the short-term implementation more complex and perhaps controversial. However it will reflect the way that contemporary oncology care is delivered, and will allow for holistic care management and an optimization of cost.