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BUFFALO, NY--Dendritic cells play a critical role in the immune response to cancer and to the human immunodeficiency virus (HIV). Their function is to migrate to sites of inflammation, take up antigen, and present the antigen to T cells to create an immune response. [See related story on page 7.]

PARIS--Although axillary dissection has long been a cornerstone of the surgical management of breast cancer, its role is now the focus of heated debate. Supporters of the procedure claim that it is justified because it provides important prognostic information, guides the choice of systemic therapy, and helps control regional disease. In addition, they say, the morbidity associated with today’s less extensive dissections is considerably lower than in the past.

PHILADELPHIA--Science in the courtroom has drawn increasing attention in recent years, and has generated proposals that justice would be better served if judges relied on their own panels of expert witnesses when they try complicated cases. A group of panelists at the annual meeting of the American Association for the Advancement of Science (AAAS) addressed this idea and the overall status of science and litigation.

NEW YORK--Contrary to the fears of restaurateurs and bar owners, smoking bans may actually be good for business. In a survey from the University of Massachusetts and Boston University, two-thirds of 2,356 adult Massachusetts residents sampled reported that smoking bans in restaurants and bars would not affect their patronage.

WASHINGTON--For the first time since 1973, when the government began tracking cancer rates, epidemiologists have documented a significant drop in overall cancer incidence in the United States. They also found that mortality rates for all cancers combined continued to drop in 1995.

The establishment through legislation of a national tobacco control policy based on a widely publicized negotiated deal between the tobacco industry and some state attorneys-general would be less effective than no federal legislation at all in promoting public heath and reducing smoking, concludes a new analysis.

ORLANDO--A group of San Diego County oncologists, spurred by the rapid advancement of managed care in California, felt they were taking the right step in forming an independent practice association (IPA) known as the Cancer Care Specialist Medical Group (CCSMG). But the group failed to survive. Joel Lamon, MD, a founding member, conducted a postmortem of this IPA at ASCO’s fall educational meeting.

ORLANDO--When Alice goes through the looking glass in Lewis Carroll’s classic, she finds her once familiar world turned upside down and inside out. This is how Rosemary McIntyre, MD, described her feelings during the formation of the Ventura County Cancer Network.

RESEARCH TRIANGLE PARK, NC--Alcoholic beverages and environmental tobacco smoke top a list of eight things the National Toxicology Program recently announced it would review for listing in the federal government’s Ninth Report on Carcinogens, which will go to Congress in 1999.

FORT LAUDERDALE, Fla--It is difficult to develop guidelines for managing fatigue in cancer patients because of what David Cella, PhD, termed a "shameful lack of research in this area." At its third annual conference, the National Comprehensive Cancer Network (NCCN), a coalition of 16 leading US cancer centers, invited Dr. Cella to offer suggestions on how such guidelines might be formulated.

There is no doubt that managed care is changing health care and the practice environment of all health-care providers. As Baird states, “The economics of health care will probably exert a greater influence on the future practice of nursing than any other single factor.”[1]

Traditionally, cytotoxic drugs have played a limited role in the treatment of brain tumors, but important advances in chemotherapy have occurred during the past decade. Certain central nervous system (CNS) malignancies are

Managed care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care’s rapid transformation of specialty practices,

Children, the elderly, AIDS patients, and former narcotic drug abusers pose special problems in pain management that may lead to undermedication even more frequently than occurs in the general population of cancer patients with pain. A multidisciplinary panel of six pain experts with clinical experience in caring for these special groups met in Santa Fe, New Mexico, to discuss assessment methods and pharmacologic approaches to the treatment of pain in these patients. A summary of the roundtable discussion follows.

The article by McDermott Blackburn describes advanced practice in oncology nursing in the managed-care environment. The strength of this article is its detailed description of the traditional roles of the clinical nurse specialist and the nurse practitioner. The author identifies the controversial trend to merge these two distinct advanced practice roles in oncology nursing, and highlights another significant trend-the evolving role of case management in comprehensive cancer care.

I am an emergency medicine physician who practices in a small town. We have one oncologist on our hospital staff. When oncology patients have problems outside of the oncologist’s office hours, they are routinely told to "go to the ER."

PARIS--The international cancer community appears to be taking an interest in the ongoing US state and federal efforts at tobacco control. Jennie Cook, national chairman of the board of the American Cancer Society, was invited to speak on that subject at the Eighth International Congress on Anti-Cancer Treatment (ICACT).

WASHINGTON--The Department of Health and Human Services has disqualified 1,402 health-care professionals from payments by the Medicare and Medicaid programs for failure to repay money borrowed under the Health Education Assistance Loans (HEAL) program. The total included 149 allopathic and 28 osteopathic physicians.

ROCKVILLE, Md--The Food and Drug Administration approved 121 new original drugs in 1997 and 431 generic products. Median approval time for new original drugs was shortened by 6%, falling from 15.4 months in 1996 to 14.4 months in 1997.

WASHINGTON--President Clinton has asked Congress to appropriate nearly $2.8 billion for the National Cancer Institute (NCI) for fiscal year 1999, and the Administration wants to increase funding for cancer research at the National Institutes of Health (NIH) by 65% over the next 5 fiscal years.

WASHINGTON--In his budget proposal, President Clinton has asked Congress to appropriate an additional $100 million for the FDA’s youth-tobacco prevention program. If approved, the increase would provide the program $134 million in fiscal year 1999.

ALEXANDRIA, Va--The Cancer Research Foundation of America (CRFA), a national, nonprofit organization dedicated to cancer prevention through scientific research and education, has awarded 16 new grants and fellowships totaling $528,605 for cancer prevention research. The money went to 14 institutions, most of it for 10 laboratory-based studies.

Clinical practice guidelines for gynecologic oncology were developed under the direction of the Medical Practice and Ethics Committee of the Society of Gynecologic Oncologists (SGO) in concert with national trends in medical care in the United States. The members of this committee are listed in Table 1, along with other individuals who contributed to the development of the guidelines. The guidelines, which were distributed in booklet form to the SGO membership in 1996, are being reprinted in this and successive issues of ONCOLOGY for distribution to the oncology community at large.

Scientists at Norris Comprehensive Cancer Center of the University of Southern California (USC) have found a new fork in a much-studied genetic pathway, and their work may lead to new cancer therapies, according to the center’s director.

ORLANDO--Just as oncologists base treatment decisions on disease stage, they may base business decisions on the stage of the managed care market in their area, said Paula Filler, vice president of the Sachs Group, Maplewood, NJ, in her presentation at an education meeting of the American Society of Clinical Oncology (ASCO).

The chairpersons of six National Cancer Institute (NCI)-sponsored cooperative groups have announced the formation of a new entity called the Coalition of National Cancer Cooperative Groups, Inc. The coalition was formed to establish a common platform upon which the cooperative groups can operate, while remaining complementary to the work already being performed within the existing NCI structure.

Researchers looking at a group of leukemia patients have found that a genetic defect that they discovered 2 years ago serves as an early warning signal, calling for a more aggressive approach to treatment in these patients.

BETHESDA, Md--Officials of the National Cancer Institute (NCI) and the Environmental Protection Agency (EPA) are attempting to resolve their conflicting interpretations of data regarding cancer in children. The NCI has forcefully challenged the EPA’s contention that the United States is in the midst of an epidemic of childhood malignancies.

SAN ANTONIO--Women who have locoregional cancer recurrence after breast-conserving surgery and radiation therapy can safely undergo immediate breast construction and use of a TRAM flap after mastectomy for the recurrent disease. However, the breast reconstruction procedure should include use of a free flap, which has a lower risk of necrosis and flap loss than pedicle flaps, Bonnie Baldwin, MD, said at the San Antonio Breast Cancer Symposium.

CHICAGO--The drop in AIDS mortality in 1997 in New York City, one of the epicenters of the epidemic in the United States, more than matched the overall US decline in deaths due to AIDS recorded in the first half of last year (48% vs 44%).