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Proposed changes in Medicare and Medicaid reimbursement have “enormous implications for appropriate cancer treatment,” according to Joseph S. Bailes, MD, winner of this year’s Association of Community Cancer Centers (ACCC) National Achievement Award. Accepting the prize at the ACCC’s 24th Annual National Meeting, Bailes, chairman of the Clinical Practice Committee of the American Society of Clinical Oncology (ASCO), added that he’s very concerned about the proposed changes. But he told of plans to streamline and strengthen ASCO’S public policy apparatus by: establishing a “more constant presence” in Congress; bringing all cancer professionals, advocacy groups, and academics under a single “big tent,” and solidifying ties with the patient community.

NEW YORK--Cancer Care, Inc. has just released the second edition of A Helping Hand: The Resource Guide for People with Cancer, with support from Zeneca Pharmaceuticals. The handbook is designed to show newly diagnosed cancer patients the kind of help that is available and where it can be found.

FORT LAUDERDALE, Fla--Given the existence of the cancer pain guidelines formulated by the Agency for Health Care Policy and Research (AHCPR), is there really a need for the National Comprehensive Cancer Network (NCCN) to develop practice guidelines on cancer pain? Yes, asserted Richard Payne, MD, at the NCCN’s third annual conference.

NEW ORLEANS--All acute pro-myelocytic leukemia (APL) patients who took part in a pilot clinical trial of arsenic trioxide went into remission, according to a paper presented at the 89th annual meeting of the American Association for Cancer Research (AACR).

BUFFALO, NY--Animal studies have shown that interleukin-15 (IL-15) effectively protects the host from chemotherapy-induced diarrhea, with maintenance of antitumor activity, said Youcef Rustum, PhD, of Roswell Park Cancer Institute, at the first meeting of the Regional Cancer Center Consortium for Biological Therapy of Cancer, hosted by Roswell Park.

NEW ORLEANS--An extract derived from the seeds of red grapes, currently available as a dietary supplement (Activin), has been shown to reduce tumor cell growth in human breast, lung, and gastric cancer cell lines, S. S. Joshi, PhD, of the University of Nebraska Medical Center, Omaha, reported at the American Association of Cancer Research 89th annual meeting. (See Figure showing the effects in breast cancer cells.)

SANTA MONICA, Calif--Just as physicians carry malpractice insurance for protection, managed care organizations also purchase insurance to protect against lawsuits. An insurance industry executive suggests that managed care plans may now need to increase their malpractice coverage, as risk liability appears to be shifting from the physicians who provide health care to the insurance plans that pay the medical bills.

BETHESDA, Md--The Oncologic Drugs Advisory Committee (ODAC) has recommended approval by the Food and Drug Administration of a new anticancer agent and favors a new indication for a previously approved agent.

ARLINGTON, Va--How do managed care organizations (MCOs) choose the physicians for their lists? The MCO’s ideal physician, as sketched by Melinda Privette, MD, JD, director of medical affairs for Blue Cross/Blue Shield of North Carolina:

BUFFALO, NY--Vaccines in bananas? The idea may not be farfetched, as researchers at the Roswell Park Cancer Institute have successfully tested transgenic plants that express a hepatitis B virus (HBV) antigen.

WASHINGTON--The mood in Washington is to press ahead with comprehensive anti-tobacco legislation with or without the participation of the tobacco industry.

FORT LAUDERDALE, Fla--The combination of topotecan (Hycamtin) and cytarabine (ara-C) has shown promising results in patients with myelodys-plastic syndrome (MDS), especially those with abnormalities of chromosomes 5 and/or 7 (-5/-7), but the findings for the combination are too preliminary to be included as standard of care in the NCCN’s practice guidelines for MDS.

NEW ORLEANS--In 1955, a man dies at age 45 of a hereditary type of colon cancer, yet his wife is told he had a bowel obstruction, not cancer. Now, 27 years later, the man’s daughter is your patient and you have diagnosed her with multiple polyposis and colon carcinoma. In constructing the daughter’s medical history, you discover the history of hereditary cancer in the father.

ARLINGTON, Va--The proposed regulations of Medicare reimbursement have "gone from providing the dollars for care to making the clinical decisions," James L. Wade III, MD, president of the Association of Community Cancer Centers, said at the ACCC’s 24th Annual National Meeting.

BETHESDA, Md--"Will an aspirin a day keep the oncologist away?" John Baron, MD, PhD, asked at a colon cancer prevention workshop held in conjunction with the American Society of Preventive Oncology (ASPO) annual meeting. "Absolute benefits and absolute risks are small," he said, "which means it’s a close call."

NEW YORK--Advances in immunotherapy are opening a wide array of potential uses in combination with chemotherapy in advanced cancers. Speaking at the Chemotherapy Foundation XV Symposium, Ezra M. Greenspan, MD, referred to the "mind-boggling" number of variables--optimum timing, dosing, and route of administration, for example--involved in putting together experimental combination regimens.

Dr. Charles H. Mayo performed one of the first successful operations to remove a tumor from the adrenal glands in 1927. After 187 days in the hospital, the patient recovered completely.

NEW YORK--An outbreak of tuberculosis (TB) in a stone-age Brazilian Indian tribe is producing mortality rates 100 times higher than were reported in New York City at the peak of the multidrug-resistant TB epidemic in 1994.

David E. Fisher, MD, PhD is the recipient of the sixth Gertrude B. Elion Cancer Research Award, sponsored by the American Association for Cancer Research (AACR). Since 1993, the award has been presented annually to one nontenured

WASHINGTON--The American Society of Clinical Oncology (ASCO) has announced its support of "The March . . . Coming Together to Conquer Cancer," which will take place in the nation’s capital, and in dozens of US communities, on Saturday, September 26.

SAN DIEGO--With the explosion of the hospice movement, the creation of pain management teams, and the use of pain ladders to guide treatment, "pain management is becoming a trendy area of medicine," said Daniel B. Carr, MD, Saltonstall Professor of Pain Research, New England Medical Center. "We didn’t hear much about treating cancer pain 20 years ago; it was on the fringes."

Detecting rare but serious side effects of drugs after they have been approved by the FDA is a difficult task. Postmarketing drug safety relies extensively on clinicians’ voluntary reporting of adverse effects to the FDA’s spontaneous reporting system, known as Med-Watch. The MedWatch program examines adverse effect reports and evaluates the possibility of drug causality. In some cases, the program identifies an adverse effect of a drug that was not reported in clinical trials.

Among the most challenging problems in medicine is the management of patients with simultaneous cancer, pain, and psychological chemical dependency (substance abuse). It has been our experience at the UT

Results of treatment for patients with salivary gland carcinoma have improved in recent years, most likely due to earlier diagnosis and the use of more effective locoregional therapy. Salivary gland tumors are treated surgically, often in conjunction with postoperative radiation therapy when the tumor is malignant. Good results rest strongly on the performance of an adequate, en bloc initial resection. Radical neck dissection is indicated in patients with obvious cervical metastasis, and limited neck dissection may be appropriate in patients with clinically negative nodes in whom occult nodal involvement is likely. Postoperative radiation therapy should be administered when the tumor is high stage or high grade, the adequacy of the resection is in question, or the tumor has ominous pathologic features. Neutron beam therapy shows promise in controlling locoregional disease but requires further study. No single chemotherapeutic agent or combination regimen has produced consistent results. At present, chemotherapy is clearly indicated only for palliation in symptomatic patients with recurrent and/or unresectable cancers. Patients with salivary gland carcinomas must be followed for long periods, as recurrence may occur a decade or more following therapy. Distant metastasis appears to occur in approximately 20% of patients.[ONCOLOGY 12 (5): 671-683, 1998]

The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the

Low-grade non-Hodgkin’s lymphoma (NHL) is an indolent form of the disease with a generally slow course of progression. Although still usually incurable, low-grade disease has shown responsiveness to some of the newer

This comprehensive, well-written review of small-cell lung cancer by Drs. Clark and Ihde covers nearly all of the important clinical issues. However, a few areas warrant additional comment and discussion.

Fort Lauderdale, Fla--Every cancer patient must deal with the psychological issues inherent to all stages of the disease, making the recognition, diagnosis, and treatment of distress critical to total care of the person with cancer, Jimmie Holland, MD, of Memorial Sloan-Kettering Cancer Center, said at the third annual conference of the National Comprehensive Cancer Network (NCCN).

Drug abuse presents a complex set of physical and psychosocial issues that complicate cancer treatment and pain/symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction.

PHILADELPHIA--An expanding understanding of chronic neuropathic pain has led scientists to promising new treatments. One drug is already approved, as an antiseizure medication, and others may be in use within 3 years, Gary J. Bennett, PhD, said at a special panel held at the American Association for the Advancement of Science (AAAS) meeting.