Tag Archives: ASCO

Cancer Research and Care Embrace Technology

Oncology is about to take a huge step toward changing the way that cancer is understood and treated with the development of a breast cancer-specific prototype for a rapid learning system in cancer care. This system takes advantage of health IT advances (such as EHRs) in order to connect oncology practices, measure quality and performance, and provide physicians with decision support in real time.

The prototype is part of the American Society of Clinical Oncology’s (ASCO’s) vision for CancerLinQ  a “system that assembles and analyzes millions of unconnected medical records in a central knowledge base, which will grow ‘smarter’ over time,” according to the organization.

Illustration courtesy of the American Society of Clinical Oncology

As part of ASCO’s focus on quality improvement, the protoype will use clinical practice guidelines and measures of the Quality Oncology Practice Initiative to build quality measurement and clinical decision tools. Next, breast cancer patient records and data (stripped of identifying information) imported from the electronic health records (EHRs) of academic centers and oncology practices will be added.

As a proof of concept, ASCO says that the prototype will:

  • provide the foundational information and lessons learned to allow ASCO to move into a full-scale implementation;
  • provide real-time, standardized, clinical decision support integration within a demonstration EHR;
  • demonstrate a set of value-added tools; including a physician’s ability to measure their performance against a sub-set of QOPI measures in real-time;
  • demonstrate the ability to capture data from a variety of sources and aggregate the data using novel methodologies;
  • and create a demonstration which will allow exploration of data in unprecedented ways and generate hypotheses related to breast cancer.

Once the full technology platform is completed, CancerLinQ ultimately is expected to improve personalized treatment decisions by capturing patient information in real time at the point of care; provide decision support to cancer teams to adapt treatment plans to each patient and his or her cancer; and report on quality of care, compared with clinical guidelines and the outcomes of other patients. It’s also hoped that the system will help to “educate and empower patients by linking them to their cancer care teams and providing personalized treatment information at their fingertips.” Lastly, the system stands to be a powerful new data source for analysis of real-world quality and comparative effectiveness, as well as to generate new ideas for clinical research. It’s hoped that in time, this approach can be adapted to all types of cancer.

Kerri Wachter

1 Comment

Filed under Health IT, IMNG, Obstetrics and Gynecology, Oncology

Here Comes the Super Committee: The Policy & Practice Podcast

photo courtesy of iStock

The names are in and the lobbying has begun. Physicians — and others — are weighing in with their priorities for the Joint Select Committee on Deficit Reduction — better known as the Super Committee. The group is charged with cutting $1.5 trillion of federal spending by Thanksgiving.

At the top of most doctors’ list: A permanent fix to the Sustainable Growth Rate (SGR) formula, which could lead to a 30% pay cut on Jan. 1. But physicians from several specialties have other concerns they want addressed as well.

Meanwhile, a federal appeals court in Atlanta ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional, pushing the law one step close to its much-predicted airing in front of the Supreme Court.

Regardless of legal wranglings, the feds are busy pushing ACA programs along, with announcements of more than $200 million worth of programs last week.

LISTEN:  For details, check out this week’s Policy & Practice Podcast. Let us know what you think.

—Frances Correa (@FMCReporting on Twitter)

Leave a comment

Filed under Blognosis, Health Policy, health reform, IMNG, Podcast

Video of the Week: Good News for Melanoma Finally

For a while, melanoma has been a bit of a red-headed stepchild of oncology. While advances have improved survival in a number of cancers in recent years, little progress had been made in melanoma. At this year’s ASCO annual meeting, new melnoma treatments generated a lot of buzz.

These new drugs are exciting and important because of their activity — meaning that they have an impact and clinical benefit in patients with advanced melanoma.      

Dr. Lynn Schuchter  

Overall survival was 11.2 months in melanoma patients who received  ipilimumab plus dacarbazine group and 9.1 months in the placebo plus dacarbazine group. The study was simultaneously published in the New England Journal of Medicine (2011 June 5 ;doi:10.1056/NEJMoa1104621). Ipilimumab was approved earlier this year as a first-line monotherapy treatment at a dosage of 3 mg/kg.

In another plenary presentation at ASCO, there was a 63% reduction in risk of death with vemurafenib, compared with dacarbazine alone, in metastatic melanoma patients with BRAF mutations. Vemurafenib is an investigational oral drug that inhibits BRAF kinase.

The read more about the results of these drug trials, check out the story in Skin & Allergy News

Leave a comment

Filed under Dermatology, IMNG, Oncology, The Mole, Video

Race Matters for Children With Neuroblastoma

Racial and ethnic disparities in survival have been reported for many adult cancers, notably breast and colon cancer, but until now, little has been known about these disparities in neuroblastoma, the most common cancer in infancy. 

 A new study by the Children’s Oncology Group involving 3,539 children shows that blacks, Asians, and Native Americans with neuroblastoma have significantly worse overall survival than do white patients.

An MRI of a 2-year-old girl with known neuroblastoma

When compared with whites in a univariate analysis, overall survival was significantly inferior for blacks (hazard ratio 1.37), Asians (HR 1.62) and Native Americans (HR 3.0), but not for Hispanics (HR 1.01),  said Dr. Susan L. Cohn, who presented the findings at the recent annual meeting of the American Society of Clinical Oncology.

Blacks and Native Americans also had inferior event-free survival than whites, due largely to a higher prevalence of high-risk disease, she said. 

When compared with whites, Asians had significantly more diploid tumors, while blacks had more unfavorable tumor histology. Surprisingly, MYCN amplification status, one of the most powerful prognostic factors identified to date, did not differ between groups. 

Finally, significantly more late-occurring events were observed in blacks, compared with whites, in multivariate analyses, suggesting that blacks may be more resistant to chemotherapy. 

Dr. Cohn acknowledged at the start of her talk that multiple factors such as socioeconomic status, environmental exposure, and notably genetic predisposition can contribute to the racial disparities in survival observed in various cancers. 

 “We hypothesize that genetic variables in black children contribute to their high prevalence of high-risk disease, chemotherapy resistance, and inferior outcome, and we plan to conduct future studies in which we will be genotyping germ line DNA samples to elucidate the genetic variables that account for the worse outcome observed in this cohort,” said Dr. Cohn, a pediatrics professor at the University of Chicago. 

The group’s hypothesis is based on studies showing that germ line genetic variables are strongly associated with clinically aggressive neuroblastoma in white children and play a critical role in drug metabolism as well as racial and ethnic diversity in drug toxicity and effectiveness. 

  – Patrice Wendling (on Twitter @pwendl)

Bookmark and Share

Leave a comment

Filed under Family Medicine, IMNG, Internal Medicine, Neurology and Neurological Surgery, Oncology, Pediatrics

Palliative Care, a Rose by Any Other Name?

  If the first things that comes to mind when you hear “palliative care” is “terminal,” you’re not alone.

 Part of the confusion is that hospital-based palliative care in the United States has been separated from home-based palliative care or hospice, which is intended for patients expected to die within six months.

 The stigma remains however.

 “They always say that when you get diagnosed with an illness palliative care is appropriate then, but in practice nobody was getting referred to us,” Dr. Shalini Dalal, from the M.D. Anderson Cancer Center in Houston, said in an interview.

Dr. Shalini Dalal, photo by P. Wendling

In a recent survey of oncology clinicians at the institution, the overwhelming majority perceived the name palliative care to be a barrier to early patient referral. Several other studies have come to the same conclusion.

Although the department is still called Palliative Care and Rehabilitation Medicine, M.D. Anderson opted in November 2007 to change the name of its inpatient and outpatient palliative care consultation service to “supportive care.”

 The composition of the interdisciplinary team did not change nor did their goal of relieving psychological and physical symptoms and enhancing quality of life for patients and their families.

 After the name change, new patient referrals jumped 41% from 1,950 to 2,751 in comparable 18-month time frames, according to data presented by Dr. Dalal at the annual meeting of the American Society of Clinical Oncology.

 The overall increase was driven largely by an increase in inpatient referrals, but something intriguing was also occurring outside the hospital.

 Patients in the outpatient setting were living longer after the name change – a median of 6.2 months from their first supportive care consultation vs. 4.7 months from consultation before the name change.

 Dr. Dalal credits the improved survivorship to seeing patients earlier in their illness. She noted that several leading national organizations including ASCO advocate a simultaneous care model with integration of palliative care services in early stages of the cancer patient’s illness trajectory.

 For those still not convinced, a separate study presented at ASCO may light a fire. To the investigators’ surprise, patients lived longer with metastatic lung cancer when started on palliative care soon after diagnosis. For details of that clinical trial, click here.

 – Patrice Wendling (on Twitter @pwendl)
Bookmark and Share

Leave a comment

Filed under Alternative and Complementary Medicine, Family Medicine, Geriatric Medicine, Hospice and Palliative Care, IMNG, Oncology, Practice Trends

Surgeons Turn Deaf Ear to NCCN Melanoma Guidelines

 The National Comprehensive Cancer Network has clear management guidelines for the management of cutaneous malignant melanoma. Unfortunately, few treating physicians seem to be listening. 

An analysis of 35,126 patients in the Surveillance, Epidemiology, and End Results database from 2004 to 2006 found that noncompliance with recommended resection margin management guidelines occurred in 64% of patients. 

An excisional biopsy was the only surgical resection performed in 11% of patients, Dr. Nabil Wasif and colleagues from the Mayo Clinic in Phoenix reported at the American Society of Clinical Oncology annual meeting. 

Image in the public domain

Among 14,031 patients eligible for sentinel lymph node biopsy, 53% underwent the procedure. 

 In patients with a positive SLN biopsy, completion regional nodal dissection was performed in 73%.  

The analysis excluded patients with in situ and stage IV disease. SLN biopsy is not indicated for in situ or melanoma less than 1 mm thick with no ulceration and no mitosis.  

“There is significant and worrisome heterogeneity in the surgical management of cutaneous melanoma in the United States,” the researchers concluded. “Guidelines supported by randomized trials are not being adhered to.” 

In a multivariate analysis, age older than 60 years, female sex, T1 stage, and having a head and neck primary were found to predict noncompliance. 

A possible solution may be found in the abstract’s provocative title: “…Time for remedial classes?” 

In addition to physician education, the authors suggest patient education and perhaps regionalization of melanoma is needed to improve compliance and potential outcomes. 

Patrice Wendling (on Twitter @pwendl)

Leave a comment

Filed under Dermatology, Family Medicine, IMNG, Oncology, The Mole

Cancer Quality of Life Research = FAIL

Image courtesy of Flickr user millermz (CC)

—from the American Society of Clinical Oncology’s annual GI Cancer Symposium in Orlando

It’s not just researchers and physicans, who hate trying to assess quality of life for cancer patients.  It seems the patients hate it, too.

During a discussion of quality of life research, Dr. David Cunningham of Royal Marsden Hospital in London remembered one study, in which patients were asked what was the worst thing about chemotherapy. “The worst thing about chemotherapy for those patients was nausea and vomiting. Number two was finding a place to park their car, when they came for chemotherapy. Number three was filling out quality of life forms.”

For patients, it seems to be the tedium of filling out the many-paged questionnaires that makes quality of life research so unpleasant.  For researchers and physicians, it seems to be the nebulous nature of the research itself that makes it troublesome.  There’s no universally accepted definition of health-related quality of life for starters. Which assessment tools should be used?  What aspects should be included in the tools–emotional, social, and physical function and adverse side effects of treatment?  How do you tease apart the  impact of the disease itself and the impact of the treatments?  What do the measurements mean?

Yet, it’s a crucial area of research. Patients can spend several years–and even their last days–on chemotherapy.  While researchers often seem jubilant that a new treatment regimen can extend overall survival or disease-free progression by even a month or 2, does it really matter if the patient has a very poor quality of life on the regimen?

On the bright side, quality of life can be improved for cancer patients.  Parking is a different story altogether.

—Kerri Wachter ( @knwachter on Twitter)

Bookmark and Share

Leave a comment

Filed under IMNG, Oncology

In these shoes?

from the annual meeting of the American Society of Clinical Oncology in Orlando

Image courtesy of Flicker user Porcelaingirl

Image courtesy of Flicker user Porcelaingirl

I spend a lot of time in convention centers.  I, and my sister medical reporters, also spend considerable time and energy on finding shoes that are both comfortable and still professional-looking.  You men out there have NO IDEA how hard this is.

So, we are always amazed by the choice of footwear of some of the female attendees at medical meetings in large convention centers.  I have special ASCO shoes.  Actually, I have two pairs.  ASCO shoes v 2.o are butter soft leather with great cushioning and I STILL had to fall back on ASCO shoes v 1.0 because I got blisters from all of the walking on the first day.

My fellow EGMN reporters—Patrice Wendling and Jane MacNeil—and I had many laughs over the incredible shoes that we saw at ASCO this year.  Gorgeous and high-heeled?  Yes, more than you’d think.  Weird?  Yes, there were some of those too.  Practical and flat? Yes, lots of those.

 Here’s a shot of some that I saw today (below).  All I could think was: Lady!  What are you thinking when you choose shoes like these, in which to cover all of that ground at ASCO?!

 

Photo by K. Wachter

Photo by K. Wachter

Want to see my shoes?  Here’s ASCO shoes v 1.0—some seriously sensible shoes.

Photo by K. Wachter

Photo by K. Wachter

 

OK, guys.  I’m done talking about shoes.  You can start paying attention to the blog again.

—Kerri Wachter

Bookmark and Share

4 Comments

Filed under Oncology, Uncategorized

Cancer As Chronic Disease

Courtesy of Flicker user Mel B (creative commons)

Courtesy of Flicker user Mel B (creative commons)

from the annual meeting of the American Society of Clinical Oncology in Orlando

It’s a rare treat for the lone medical reporter to get together with others of our kind.  I had dinner tonight with the other EGMN reporters and editors covering ASCO.  We can’t help ourselves and we mostly talk shop.  There was a lot of great discussion.

My oncology mentor and editor of The Oncology Report, Jane MacNeil, brought up the idea of cancer as a chronic disease.  The idea was pretty thought changing for me.  I’ve been covering oncology for 3 years now and cut my teeth on patient/survivor care stories. The topic is still an important one to me.

Still, all of this time, as I’ve been thinking about the issues and problems of who cares for cancer survivors—some types of cancers with increasingly long survival—-it hadn’t occurred to me that it might be possible to start to think about cancer as a chronic disease.  I admit that for some types of cancers, the idea seems laughable but for other types…well, it seems kind of plausible.

So, I put it out there to all of you ASCO folks: can or will we start thinking of cancer as a chronic disease that is managed?

Also, I’d like to give a big shout out to some of my new Twitter friends that I found through #ASCO: @drsteventucker, @djsampson, @amarantoblook, @MaverickNY, @PharmacistScott, and of course my good buddy @MedReporter.

—Kerri Wachter (on Twitter: @knwachter)

Bookmark and Share

Leave a comment

Filed under Oncology

Feeling Part of Something Bigger

Photo by K. Wachter

Photo by K. Wachter

From the annual meeting of the American Society of Clinical Oncology in Orlando, Fla.

This is my third year covering the annual ASCO meeting.  It’s still overwhelming and adrenaline-producing with more than 30,000 attendees from around the world.

But I’m also starting to feel a part of it.  I’ve followed some of the same studies every year, watching a small part of a specific type of cancer become better understood or witnessing better and longer responses with some very innovative therapies. For example, one of the first stories that I covered at ASCO was an investigational vaccine for glioblastoma multiforme aimed at epidermal growth factor receptor variant III (EGFRvIII) .  Today I caught up on the latest results and the immune response is still looking impressive (abstract 2021).

It made me realize that we all—patients, researchers, physicians, nurses, other health professionals, and even medical writers—have an important part to play in fighting cancer.

—Kerri Wachter (follow me at ASCO on Twitter @knwachter, #ASCO)

Bookmark and Share

Leave a comment

Filed under Oncology