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FORT LAUDERDALE, Florida-When managed care companies deny reimbursement for care decided upon by the physician and patient, have they crossed the line from managing medical care to practicing medicine? A panel of physicians, lawyers, patient advocates, and representatives from managed care held forth on this issue at a roundtable held during the Fifth Annual Conference of the National Comprehensive Cancer Network (NCCN).

SAN DIEGO-External magnets are being used to guide a novel, intra-arterially administered chemotherapy delivery vehicle directly to the tumor site (see illustration ). Scott C. Goodwin, MD, chief of vascular and interventional radiology, UCLA Medical Center, reported results of an ongoing phase I/II study of this new regional therapy technique at the annual scientific meeting of the Society of Cardiovascular & Interventional Radiology.

NEW ORLEANS-Pathologic examination of an intraoperative frozen section of the sentinel lymph node (SLN) is less sensitive for breast cancer patients with smaller tumors and/or micrometa-static disease. In a recent study, use of routine frozen section avoided reoperation in only 4% of patients with T1a cancers, but was more useful in other stages, reported Martin R. Weiser, MD, of Memorial Sloan-Kettering Cancer Center.

The National Library of Medicine has started posting information about clinical trials in its new Clinical Trials

WASHINGTON-The ongoing revolution in knowledge about the cellular processes that lead to cancer has created a new and potentially far more efficient approach to finding effective therapeutic agents, said Edward A. Sausville, MD, PhD, associate director of the NCI’s Developmental Therapeutics Program.

BETHESDA, Md-Officials of the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC) have signed a formal agreement to develop what NCI calls “a comprehensive, federally integrated cancer surveillance and cancer control research system.” The two agencies will pool and jointly release their data on cancer incidence and mortality, as well as coordinate various aspects of cancer registry management, including training and methodology development.

To assist in converting patients from one opioid agent to another in their daily practice, many oncologists carry pocket dosage conversion guides based on package inserts approved by the US Food and Drug Administration (FDA). One such guide issued by the manufacturer of transdermal fentanyl (Duragesic), reproduced in Table 3 of the expert consensus article written by Breitbart et al, presents the equivalent of 25 µg/h of transdermal fentanyl as 45 to 134 mg/d of oral morphine. In another guide, distributed by one of the manufacturers of controlled-release morphine, the 25 µg/h strength of transdermal fentanyl is said to be equianalgesic to 15 mg of controlled-release morphine administered every 12 hours (and both are deemed equivalent to 10 mg of controlled-release oxycodone every 12 hours). Faced with such a wide range of conversion factors, it is of little surprise-as Breitbart et al point out-that clinicians often fail to achieve equianalgesia when converting patients from one opioid to another.

The two research groups from Long Island Jewish Medical Center and Yale University have collaborated to write an excellent overview of the biological basis of radio-sensitivity, especially as it applies to radiotherapy. The content of the paper reflects the excellence of these investigators’ contributions to the field of radiobiology. It is particularly refreshing to read an account of radiobiology that does not resort to the mathematical overanalysis that has plagued the field in the past.

Rosen and colleagues have provided a comprehensive review of the biological basis of radiation sensitivity, including recent insights into the DNA damage response. They correctly emphasize that local control of tumors is still a major clinical problem, and that a better understanding of the biological basis for radiation resistance/sensitivity has significant potential to be exploited for therapeutic gain. They also assert that further progress in local tumor control is unlikely to be achieved by technologic improvements in the delivery of such radiation therapies as three-D (3D) conformal radiotherapy, intensity-modulated radiation therapy (IMRT), altered fractionation, or even chemosensitization.

The article by Sarkodee-Adoo and colleagues on the management of infections in patients with acute leukemia provides an authoritative review of approaches to the prevention and treatment of infections in this high-risk population. Indeed, among the different populations of patients with neoplastic diseases, those with acute leukemia, particularly acute myelogenous leukemia (AML), are at very high risk for the development of severe infectious complications.[1,2]

Improvements in outcome following treatment for acute leukemia have derived from various sources: the introduction of new chemotherapeutic agents; the development of effective drug combinations; the use of multistage approaches to induction consolidation, and maintenance therapy to optimize durable control; and advances in supportive care to reduce treatment-related mortality. Certainly, infectious morbidity and mortality have plagued effective antileukemic therapy for many years. As a result, control of infectious complications has been an important area of clinical study. Through the concerted efforts of many clinical investigators, progress has occurred, and, today, infectious mortality is an infrequent complication of antileukemic therapy.

The explosion of new knowledge about radiation sensitivity and radiation biology is such that even the scholarly, relatively extensive review of the subject authored by Drs. Rosen, Fan, Goldberg, and Rockwell covers but a small proportion of this vast, complex topic.

In 1999, metastatic breast cancer claimed the lives of almost 45,000 women. For the vast majority of patients, metastatic breast cancer is an incurable disease with a median survival of only 2 to 3 years after diagnosis. The

Several recent studies have addressed the management of infectious problems in patients with acute leukemia. Although those studies have served to emphasize the fundamental management principles formulated and proven

Based on an educational session featured at the 1999 annual meeting of the American Society of

BETHESDA, Md-To increase the number of cancer patients participating in phase III clinical trials, the National Cancer Institute has created the Expanded Participation Project (EPP). This pilot program encourages qualified oncologists outside of the 12 NCI-sponsored Cooperative Groups to enter patients into large clinical studies organized by groups.

NEW YORK-Sexual problems are common after cancer treatment, Sarah Auchincloss, MD, said at a Cancer Care Inc. teleconference on “Intimacy, Sexuality, and Love.”

CLEVELAND-Nearly 450 physicians have been trained to teach the American Medical Association’s curriculum on the appropriate care of dying patients. The program, known as Education for Physicians on End-of-Life Care, or EPEC, provides physicians with the basic skills and knowledge needed to care for the seriously ill and dying.

NEW ORLEANS-The arrival of new antibody-based radioimmunothera-pies may change the bleak prognosis for low-grade non-Hodgkin’s lymphoma (NHL) that transforms to a more aggressive histology.

MEMPHIS-In an effort to better understand the wide variation in patient response to therapy for neuroblastoma, researchers at St. Jude Children’s Research Hospital have initiated a pilot study in which chemotherapy doses will be individualized based on the patient’s personal pharmacokinetics.

NEW ORLEANS-Encouraging results have emerged for a gene therapy approach that stimulates a T cell response in chronic lymphocytic leukemia (CLL). William G. Wierda, MD, of the Human Gene Therapy Program at the University of San Diego School of Medicine, presented the results at the 41st annual meeting of the American Society of Hematology (ASH).

BETHESDA, Md-The number of cancer deaths in the United States remained flat for the first time between 1996 and 1997, at about 540,000 (Figure 1). And the decreases in the mortality rates of many cancers seen in the first half of the 1990s seem to have accelerated, a preliminary review of cancer data for 1997 reveals.

WASHINGTON-President Clinton’s proposed budget for fiscal year 2001 includes $3.505 billion for the National Cancer Institute (NCI), a 5.8% increase over the current fiscal year. The President also asked Congress to appropriate $18.813 billion for the National Institutes of Health, a 5.6% increase over its present budget.

Many oncologists are barraged with questions and declarations from patients regarding therapies and products that

CHICAGO-The Institute of Medicine (IOM) report to the Congress about research that relates to minority and medically underserved populations lauded many of the efforts the National Cancer Institute (NCI) has undertaken to conduct research and sponsor training programs involving ethnic minorities and the medically underserved, while making recommendations for improvement.

Deeply troubled by the profound and universal impact of cancer on human life, human suffering, and on the productivity of nations;

In a study of previously untreated patients with lowgrade or follicular non-Hodgkin’s lymphoma (NHL), all patients responded to the combination of tositumomab and iodine I 131 tositumomab (Bexxar) and fludarabine (Fludara). When compared to

CHICAGO-Last year’s Institute of Medicine (IOM) report to the US Congress about research that relates to minority and medically underserved populations was bound to generate controversy because part of its purpose was to look at the amount of resources spent on studying these groups.

BETHESDA, Md-Pharmacia & Upjohn’s Camptosar (irinotecan hydrochloride injection) found smooth sailing through the often roiling waters of the FDA’s Oncologic Drugs Advisory Committee (ODAC).

WASHINGTON-The Food and Drug Administration’s effort to prod pharmaceutical companies into earlier testing of anticancer agents in children and teens (see FDA Tries to ‘Jump Start’ Pediatric Cancer Drug Trials) has drawn rave reviews from the pediatric oncology community.