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When it comes to reimbursement for cancer treatments, the brave new world of managed care may seem like the La Brea Tar Pits. Through its Ombudsman program, the Candlelighters Childhood Cancer Foundation has made it a top priority to help families of childhood cancer patients navigate this treacherous terrain. At the Foundation's 25th anniversary conference, Grace Powers Monaco, jd, mentor to Gib Smith who directs the Candelighters Ombudsman Program and Director of the Medical Care Ombudsman Program of the Medical Care Management Corporation, described some sure-fire methods for prying money out of recalcitrant insurance companies.

SEATTLE--Fludarabine (Fludara) has demonstrated impressive results in previously untreated patients with active chronic lymphocytic leukemia (CLL) when compared with chlorambucil (Leukeran), Kanti Rai, MD, said at the American Society of Hematology (ASH) annual meeting.

CHICAGO--The American Cancer Society has presented its Humanitarian Award to C. Stratton Hill, Jr., MD, of the University of Texas M.D. Anderson Cancer Center. The award is given for dedication to thea improvement of cancer control and genuine accomplishment in human welfare.

In the past few years, this country has seen a major change in the financing of health care. According to a recent survey by Foster Higgins, an international employee-benefits consulting agency, at the end of 1994, 63% of all privately insured Americans were enrolled in a managed care plan.

MARINA DEL REY, Calif--Comparing the technical services portion of an oncology practice to a car that has been driven 25,000 miles, Dean H. Gesme, Jr., MD, managing partner of Iowa Cancer Care, P.L.C., said that he and his partners decided to spin off that part of their Cedar Rapids practice while it still had a high market value.

Patients reported with inflammatory atypia on Pap smears demonstrated a significantly improved rate of reversion to normal cytology following treatment with MetroGel-Vaginal (metronidazole 0.75% vaginal gel), according to a study presented at the District IV Junior Fellow meeting of the American College of Obstetricians and Gynecologists by Dr. Michael D. Randell, an obstetrician and gynecologist in Atlanta, Georgia.

The latest addition to the Contemporary Neurology series, devoted to the neurologic complications of cancer, is authored solely by Dr. Posner. Although this book has been written for both the student and trained professional, who can quickly adapt to the definitive nature of the tables, diagrams, and clinical approaches, it is likely to be most appealing to the neuro-oncologic specialist.

BUFFALO, NY--Renewed interest in cryosurgery may soon translate into a viable therapeutic option for patients with primary and secondary liver cancers.

Dr. Severin's article is a valuable asset for the practitioner--legal or medical--or academician concerned with the burgeoning of civil lawsuits over failure to comply with new approaches to the management and control of cancer. The article identifies two types of such suits and explores the history of medical malpractice litigation relating to cancer care. The focus is the physician who either misses or fails to make a timely diagnosis of hereditable cancer.

NEW YORK--Attaching iodine-131 to the anti-CD20(B1) antibody (radioimmunotherapy or RAIT) may provide durable remissions in relapsed non-Hodgkin's lymphomas (NHL), Oliver Press, MD, PhD, said at a symposium sponsored by the New York City-based Cancer Research Institute.

In order to keep its $90 million per year cancer research budget highly focused and not duplicative of government-sponsored efforts, the American Cancer Society (ACS) has announced a major restructuring of its research and professional training programs. The changes call for a new focus on beginning scientists and targeted research projects and an increased commitment to epidemiologic research, psychosocial, behavioral and health- care policy research, and cancer prevention--areas not currently being emphasized by other cancer research funding agencies.

SEATTLE--With advanced molecular genetic techniques now available to researchers for the identification and study of genes involved in cancer, the question arises: Is the study of chromosomal translocations, additions, and deletions still a worthwhile pursuit?

MIAMI BEACH--Sphincter-preserving surgical techniques can be safely and effectively combined with high-dose preoperative radiation for tumors in the most distal segments of the rectum, Mohammed Mohiuddin, MD, said at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.

NORWOOD, Mass--A new implantable pump with an inexhaustible power supply and a constant flow feature may allow lower morphine doses in patients with cancer pain.

Cancer cachexia may be an immunologic phenomenon related to increased cytokine production that occurs in response to the tumor itself or to the stress of surgery, John M. Daly, MD, said at the Society of Surgical Oncology's Annual Cancer Symposium. As such, the routine administration of preoperative total parenteral nutrition (TPN) may not be a useful strategy for all types of cancer.

The National Coalition for Cancer Survivorship (NCCS) recently surveyed health providers, government officials, professional and advocacy organizations, scientists, and others regarding a critical issue facing this nation's 8 million cancer survivors: quality cancer care. The responses were illuminating as they portrayed a system in flux. The United States is moving away from a health care system where fee for service insurance plans predominate to one where market-based alternatives are quickly gaining favor among employers, consumers, and other purchasers of health care coverage. What this fundamental transition will mean for survivors and individuals with other serious or life-threatening diseases and the people who care for them is an open question with important public policy implications

Multiple endocrine neoplasia type 2 (MEN-2) is known to be associated with missense mutations in the RET proto-oncogene, and specific RET mutations have been detected in families. This disease can be deadly since more than half of patients who harbor the genetic susceptibility present with metastatic medullary thyroid carcinoma. About 50% of patients affected with MEN-2 will develop pheochromocytoma (often bilateral), and 10% to 20% will develop functioning parathyroid adenomas.

Drs. Lerman and Croyle provide a quite thorough review of an area in need of continuing research-ie, patients' behavioral and emotional responses to genetic testing for cancer susceptibility. The authors present current information on what we do and don't know about the psychological characteristics of individuals likely to undergo testing, possible adverse reactions, issues specific to the genetic counseling process, family coping and adaptation, and possible ways of managing psychological sequelae of genetic testing. Admirably, the authors note that much of their discussion should be considered speculative until more empirical data specific to genetic testing is available. Given this "state of the science," I will raise some additional questions based on some of the statements made by Drs. Lerman and Croyle.

Increased knowledge about inherited susceptibility for cancer and the identification of genes associated with cancer risk has increased the need for individuals with training in genetics to work closely with oncology professionals in the familial cancer arena. Genetic counselors can provide a variety of useful services: They may function as clinical coordinators of a family cancer risk counseling (FCRC) program and serve as study coordinators on research teams.

NEW YORK--Dr. David W. Golde has been appointed Physician-in-Chief of Memorial Hospital, Dr. Paul Marks, president of Memorial Sloan-Kettering Cancer Center, announced. Dr. Golde succeeds Joseph V. Simone, MD, who is to become clinical director for the Huntsman Cancer Institute, Salt Lake City.

PALM SPRINGS, Calif--Women with HIV represent the fastest growing segment of the epidemic and are among the most vulnerable for the undermanage-ment of both pain and psychological distress, Robert Boland, MD, and Margaret McDonald, CSW, said at the Academy of Psychosomatic Medicine meeting.

At the 1995 American Society of Hematology meeting in Seattle, Washington, researchers from UCLA School of Medicine presented results from a 21-month, phase III clinical study showing that long-term pamidronate disodium (Aredia) therapy reduces skeletal-related episodes in patients with stage III multiple myeloma and also improves survival in those on salvage therapy. Pamidronate disodium is the first medical therapy proven to reduce pathologic fractures and other skeletal complications in patients with multiple myeloma.

PITTSBURGH--The Health Care Financing Administration's current re-evaluation of reimbursements for physician work and practice expenses could have "a major impact" on chemotherapy administration cost codes, Joseph S. Bailes, MD, said at the Association of Community Cancer Center's 1995 Oncology Symposium.

I would like to call your attention to a misleading statement that appeared in the Industry Watch section of the October, 1995, issue of Oncology News International under the title "Casodex Approved for Prostatic Cancer" (page 23).

OAK BROOK, Ill--Young physicians seeking careers in radiation on-cology may have severely limited employment opportunities in the foreseeable future, according to the American College of Radiation Oncology (ACRO). The College forecasts that up to 1,000 radiation oncologists will be either underemployed or unemployed shortly after the year 2000.

WASHINGTON--The new director of the National Cancer Institute envisions the NCI as an institute focused on science, but with a responsibility toward the community to disseminate information and be involved in larger issues.

The following recommendations have been developed to provide guidance to healthcare workers when educating women

In Los Angeles, the future seems to arrive a little sooner than in the rest of the country. The defense-based economy has crashed and burned, shifting hundreds of thousands of employees into managed care plans, mostly HMOs.

PHILADELPHIA--The clinical practice guidelines developed by the National Comprehensive Cancer Network (NCCN), to be presented at the coalition's first conference in March, represent the first step toward a larger goal--developing a database of how those guidelines are used throughout the network.

BETHESDA, Md--At its most recent meeting, the National Cancer Advisory Board heard a report on the Division of Cancer Treatment, Diagnosis, and Centers and its efforts to promote third-party payer support for clinical trials.