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One Institution’s Experience With Implementation of EPIC/Beacon: Lessons LearnedA recent survey of the medical oncologists and oncology nursing staff at UCH showed that 71% of physicians feel Beacon has made patient treatment easier for providers.
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Achieving Meaningful Use of Electronic Health Records for the OncologistIn 2003, the Institute of Medicine (IOM) issued a report outlining key capabilities of an electronic health record.[1]
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Comparative Effectiveness and Comparative CostsKilbridge correctly points out that comparative effectiveness research (CER) does not require cost data. It should also be pointed out, however, that the composition of the quality-adjusted life-year (QALY) gain of one intervention over another-whether the QALY gain is achieved mainly in the dimension of longevity or in the dimension of quality of life-has real consequences in terms of comparative costs of the interventions. Basically, a longevity increase entails additional consumption costs and additional labor earnings, essentially negative costs, during the extended life that should be included in the “cost” of an intervention.[1-3] Because labor earnings tend to be negligible relative to consumption costs toward the end of one’s life, due to sickness or retirement, failure to incorporate consumption costs and labor earnings into the comparative costs of two interventions generates a bias in favor of the intervention with the larger longevity effect.
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What Is the Optimal Initial Treatment for Chronic Lymphocytic Leukemia?For decades, initial therapy for chronic lymphocytic leukemia (CLL) consisted of alkylators such as chlorambucil (Leukeran). The introduction of nucleoside analogs such as fludarabine and monoclonal antibodies such as rituximab (Rituxan) markedly changed the initial therapy of CLL, particularly in the United States. Fludarabine and combination regimens such as fludarabine/cyclophosphamide (FC) have achieved higher complete response (CR) rates and progression-free survival (PFS) than chlorambucil in previously untreated CLL, but long-term overall survival has not improved, due to concurrent improvement in salvage therapy of relapsed CLL patients. Upfront chemoimmunotherapy regimens such as fludarabine/rituximab (FR) and fludarabine/cyclophosphamide/rituximab (FCR) have similarly improved CR rates and PFS in previously untreated CLL patients, but it is unclear whether overall survival is improved. Advances in cytogenetic analysis and other biologic prognostic factors have greatly enhanced clinicians' ability to risk-stratify newly diagnosed CLL patients, and knowledge of such prognostic factors is necessary to properly interpret results of clinical treatment studies. The choice of initial therapy for an individual patient should depend upon the patient's age and medical condition, cytogenetic and other prognostic factors, and whether the goal of therapy is maximization of CR and PFS or palliation of symptoms with minimal toxicity.
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The Costs of Cancer Care in the United States: Implications for ActionThe total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high
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Could SBRT Have Role in Metastatic Kidney Cancer?This video examines a pilot trial that tested stereotactic body radiotherapy plus nephrectomy in patients with renal cell carcinoma.
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Commentary (Burke): Melanomas of the Vulva and VaginaDr. Trimble's review of female genital tract melanomas provides a well-organized summary of the published information on these rare cancers. His inclusion of the two recent population-based samples from the United States and Sweden [1,2] is particularly useful because all of the available data on genital tract melanomas comes from long-term retrospective case reviews. The cited incidence rates calculated in the studies represent the first legitimate estimates of the incidence of these uncommon cancers.
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How the Affordable Care Act Has Affected Cancer Care in the United States: Has Value for Cancer Patients Improved?Although data are anecdotal, there is no question that the increased numbers of patients with insurance resulted in cancer patients receiving care they previously could not.
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Erdafitinib in the Treatment of Metastatic Urothelial CarcinomaFrancisco Castro-Alonso, MD, and colleagues describe the effects of the use of erdafitinib in a patient with metastatic urothelial bladder cancer.
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Tagraxofusp in BPDCN: Practical Advice and Future Directions in CareAfter sharing key takeaways on the management of BPDCN, expert hematologist-oncologists highlight unmet needs and forecast evolutions in care.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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New Mutation Identified in Primary Myelofibrosis PatientsIn a late-breaking abstract presentation, Thorsten Klampfl, PhD, of the CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences in Vienna, presented data from a whole exome study of primary myelofibrosis patients, identifying a new specific molecular mutation
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Frontline Therapy for Non-Clear Cell RCCThe panel wraps up their discussion with a review of how they would approach treating frontline non-clear cell RCC.
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The Benefits of Achieving Stable Disease in Advanced Lung CancerDr. Kelly has written an excellentarticle demonstrating theclinical significance of achievingstable disease in advanced non–small-cell lung cancer (NSCLC)patients. This hypothesis is supportedby clinical data from two phase IItrials (Iressa Dose Evaluation in AdvancedLung Cancer [IDEAL-1 andIDEAL-2]) of the epidermal growthfactorreceptor (EGFR) inhibitor gefitinib(ZD1839, Iressa) in previouslytreated patients. She appropriatelypoints out that although tumor shrinkageis a conventionally used end pointfor cytotoxic drugs, it may not be appropriatefor the “novel” cytostaticagents. For these agents, stabilizationof disease without obvious tumorshrinkage may result in a clinicalbenefit.
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Genetic Testing: The Bigger PictureSchrader and colleagues provide four compelling examples of the power of genetic testing to impact medical management for probands and their family members.
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Incorporating Collaboration and Personalization of Treatment in Breast Cancer CareThe field of breast oncology is constantly evolving to include trial diversity and multidisciplinary care.
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Head and Neck Cancer: Changing Epidemiology and Public Health ImplicationsCharacterizing the epidemiology of head and neck cancers is challenging and has received limited attention in the medical literature. Traditionally, 80%–90% of head and neck squamous cell carcinomas (HNSCCs) have been attributed to tobacco and alcohol use, but with growing public awareness and tobacco control efforts over the past few decades, there has been a downward trend in smoking prevalence in the US. There is also emerging evidence that human papillomavirus (HPV) is responsible for inconsistencies in HNSCC trends, with oncogenic HPV DNA found in approximately half of oropharyngeal cancers and in a high proportion of oropharyngeal cancers in nonsmokers and nondrinkers. The risk to HNSCC epidemiology is that whatever gains continue to be made in tobacco control may become lost in the increasing numbers of oropharyngeal cancers due to HPV. The purpose of this review is to explore the changing epidemiology of HNSCC, focusing on how it has been shaped by health policy and advocacy interventions and how it will continue to have public health implications in the future, particularly in considering preventive strategies against HPV. Given that the majority of HNSCCs are the result of exposure to preventable public health risks, more focus should be given to this area.
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Long-Term Effects of Chemo on the Cognitive Function of Cancer PatientsIn this podcast we discuss the long-term effects of chemotherapy on the cognitive function of cancer patients and the current status of research in this field.
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The Long Road-and the High Road-to Successful Implementation of OncoEMRWhat distinguishes those practices that are successful in their use of the EMR is their commitment to the product and their recognition that it is the central element in the treatment of their patients.
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Current Strategies for the Immunotherapy of Multiple MyelomaHere we outline the most promising novel cellular immune strategies for patients with multiple myeloma. In addition, we highlight combinatorial approaches that, it is hoped, will further optimize cellular immunotherapies for myeloma and lead to deep and durable responses and, possibly, even cures.
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UFT/Leucovorin Plus Irinotecan in Advanced or Metastatic Colorectal CancerUFT (with leucovorin) and irinotecan both have single-agent activity in colorectal cancer, with non–cross-resistant mechanisms of action. Combining these drugs would be anticipated to increase response rates while maintaining the advantages of a regimen based on an orally administered fluoropyrimidine.
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Unrelated Donor StemCell Transplantation: The Role of the National Marrow Donor ProgramApproximately 70% of patientswith life-threatening diseasestreatable with allogeneic bloodstem cell transplantation do not havematched related donors. The NationalMarrow Donor Program (NMDP) wasestablished in 1986 to provide humanleukocyte antigen (HLA)-matched,volunteer unrelated donors for thesepatients. The NMDP performs thistask by maintaining a registry of morethan 4.9 million volunteer donors ofmarrow and peripheral blood stemcells (PBSC) and 12 cord blood bankscontaining more than 25,000 units ofumbilical cord blood.
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Current Combined Treatment of High-Grade OsteosarcomasThe evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to
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Managing Colorectal Cancer Liver MetastasesThe combined-modality care of the patient with colon or rectal cancer metastatic to the liver demands a team approach. It is little wonder that there is much confusion about this topic, given the number of unique treatment options that are delivered in a sequential and reiterative process. The concept of multidisciplinary approaches to complex cancer challenges has been adopted for a variety of tumor types and situations.
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Do Oncogenic Drivers Exist in Squamous Cell Carcinoma of the Lung?The Cancer Genome Atlas provides us with our first thorough insight into the genetic heterogeneity of squamous cell carcinoma of the lung; whether these findings will translate into personalized squamous cell lung cancer therapy is yet to be determined.
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Thalidomide in Solid Tumors: The London ExperienceInvestigators at the Royal Marsden Hospital and University College in London have studied thalidomide (Thalomid) as both low-dose (100 mg orally, every night) and high-dose (600 mg, given as 300 mg twice per day)
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Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the OncologistDr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.
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Small Steps Forward in the Land of Small TumorsMetastatic well or moderately differentiated neuroendocrine tumors of the gastrointestinal tract and lung (NETs) are a fascinating and markedly heterogeneous group of generally indolent, but relentless cancers.
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Commentary (Kinsella): Current Status of Radiation Sensitization by FluoropyrimidinesDrs. Pu, Robertson, and Lawrence provide a concise update of recent laboratory and clinical studies of fluoropyrimidine radiosensitization. From a clinical perspective, one can conclude that this drug-radiation interaction appears to be greater than additive and clearly has resulted in significant therapeutic gains, particularly for gastrointestinal cancers, as summarized in Tables 2 and 3 of their article. From a laboratory perspective, the focus has now shifted to trying to better understand the mechanisms of the interaction as related to molecular events at the G1/S interphase and in early S phase.
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Timothy Moynihan, MD, on ‘Death Cafés’ and the Importance of Discussing End-of-Life Issues With Your PatientsThis interview discusses the importance of discussing end-of-life issues with patients.
