Cancer vaccines rise from the ashes
June 4th 2010Go back to the Eisenhower years and amid the gray flannel suits, rabid McCarthyism, and dread over nuclear war you’ll find rays of hope in the battle against cancer. Looking back from the 60s, it was easy to believe that this hope was unfounded, an unwarranted faith engendered by the conquest of polio. But it may have been that science simply was not ready.
Exploring the Interface between Cancer and Psychiatry
June 2nd 2010As a psychiatrist who has cancer, I have developed a deep understanding of the ways in which our training can help us help patients who find themselves forced to deal with the complicated emotional aspects that accompany this disease. My hope is that my insights will help psychiatrists as they wrestle with the problems that plague their patients who are coping with this difficult disease.
Dearth of data lowers the bar in debate over radiation and cancer
May 21st 2010Radiologists have come to expect rising demand for CT, which is why anecdotal reports of sudden and dramatic falls in CT volumes have sent a shudder through the community. All the more alarming is that the rumored drop-offs are coming at the request of patients who want nothing to do with CT because they fear its radiation will someday cause cancer. Instead they reportedly are demanding ultrasound or MRI because neither has ionizing radiation -- never mind that neither is indicated, nor, particularly in the case of ultrasound, has much chance of providing useful information.
Classifieds - Sentara Healthcare
May 19th 2010Sentara Healthcare, located in Hampton Roads, VA is seeking an Experience RN for a Unit Manager Position on an Oncology Unit. This full-time position is located at Sentara Norfolk General Hospital, the region’s first Magnet Hospital. This level one trauma/teaching hospital is located in Norfolk, VA. The Hematology/Oncology Unit (HOU) is an 18-bed, self-contained unit providing a wide range of oncology services to a variety of diverse patient populations including the newly diagnosed through end of life, with specialties in chemotherapy and peripheral blood stem cell transplant.
Giving Honest Information to Patients With Advanced Cancer Maintains Hope
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Comparative Effectiveness and Comparative Costs
May 15th 2010Kilbridge 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.
Quality-Adjusted Life-Years, Comparative Effectiveness in Cancer Care
May 15th 2010Recently, the American Recovery and Reinvestment Act (ARRA) set aside $1.1 billion for comparative effectiveness research (CER) to investigate what healthcare strategies and interventions offer the greatest benefits to individual patients and the population as a whole. The Institute of Medicine has identified CER in cancer care as a high priority research focus for ARRA funding. The ability to measure quality of life will be central to CER in oncology because survival and disease-free survival do not adequately capture outcomes important to policy makers, physicians, and patients. There are two ways to measure quality of life: descriptive health status and patient preference weights (utilities). However, only patient preference weights can be incorporated into the economic analysis of medical resources and be used in the calculation of quality-adjusted life-years (QALYs). Some of the advantages and limitations inherent in measuring quality of life with descriptive health status and patient preference weights are discussed. Both types of measurements face health literacy barriers to their application in underserved populations, an important concern for CER in all medical fields.
Cost, Quality, and Value in Healthcare: A New Paradigm
May 15th 2010In this issue of Oncology, Dr. Kilbridge details the incorporation of nontraditional outcome measures in the evaluation of cancer therapies-the importance of which is underscored by the passage of the sweeping healthcare reform bill that will alter the landscape of healthcare delivery for years to come.