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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%).

FORT LAUDERDALE, Fla--Opinions from a diverse panel of experts, expressed at a special session of the NCCN (National Comprehensive Cancer Network) third annual conference, reflect a nation heading toward convergence on the issue of providing broad access to peer-reviewed clinical trials.

SILVER SPRING, Md--On September 26, 1998, an event known to its organizers as simply "The March" will take place across the nation. Conceived by Ellen L. Stovall, executive director of the National Coalition for Cancer Survivorship, "The March: Coming Together to Conquer Cancer" is not a march in the traditional sense, but will encompass many different events in many cities.

ORLANDO--Whether women age 40 to 49 should have routine mammo-gram screening continues to be debated, but a University of Chicago study shows that women in this age group benefit from mammography screening as much as women over 50. Jeffrey D. Bradley, MD, lead study author, presented the finding at the annual meeting of the American Society for Therapeutic Radiation and Oncology (ASTRO).

WASHINGTON--Medicare patients who participate in most clinical cancer trials sponsored by the federal government would have their patient-care costs covered for the first time, under a proposal contained in President Clinton’s budget request for fiscal year 1999.

WASHINGTON--A survey of an industry trade group finds that US research-based pharmaceutical companies plan to spend $20.6 billion for research and development in 1998, an amount equal to 19.6% of the industry’s projected annual revenues. This represents an increase of 10.7% over last year’s R&D funding by the companies, according to the Pharmaceutical Research and Manufacturers of America (PhRMA).

DALLAS--The Susan G. Komen Breast Cancer Foundation, producer of the country’s largest series 5K runs known as Race for the Cure, today announced nine new race sites for the 1998 series, bringing the total number of run/fitness walks to 86. Sites added include Austin, Texas; Evansville, Indiana; Grand Rapids, Michigan; Greeley, Colorado; Madison, Wisconsin; Richmond, Virginia; San Antonio, Texas; Thibodaux, Louisiana; and Tupelo, Mississippi.

SAN BRUNO, Calif--Practice guidelines and outcomes measurement are increasingly viewed as the keys to lowering medical costs while maintaining quality. Once guidelines are devised, the next step is implementation, and this may best be achieved by making guidelines readily accessible via computer programs.