Tag Archives: Oncology

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

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

Feds Fund Two Cancer Information Apps

It sounds cute and perky, but Ask Dory! is actually an informative app that helps patients find information about clinical trials for cancer and other diseases.

©YANKIN CHAUVIN/fotolia.com

Along with another app, My Cancer Genome, the two recently won $20,000 each from the federal government.

Ask Dory! integrates data from www.clinicaltrials.gov. My Cancer Genome provides “therapeutic options based on the individual patient’s tumor gene mutations, making use of  National Cancer Institute’s physician data query clinical trial registry data set and information on genes being evaluated in therapeutic clinical trials,” according to a statement.

The two apps are part of the rapidly growing field of mHealth — or use of mobile devices for health purposes. Some are calling it an “mHealth bubble,” as thousands of groups large and small are rushing to develop the next great app for diabetes, cancer, infectious diseases, weight management,  addictions, and more.

Seeing the potential benefit for patients and providers, federal officials are providing incentives, and funding initiatives as simple as free text messaging reminders for pregnant women and new moms, to apps like Ask Dory!

“What makes these health IT challenges so powerful is their ability to catalyze the expertise and creativity of innovators both in and out of health care,” said Wil Yu, special assistant for innovation at the  Office for the National Coordinator for Health Information Technology (ONC), which awarded the prizes.

In collaboration with the National Cancer Institute, ONC launched the “Using Public Data for Cancer Prevention and Control: From Innovation to Impact” challenge in summer 2011. The two winners were among four semifinalists who submitted their products to the ONC challenge in November 2011.

—Naseem S. Miller (@NaseemSMiller on Twitter)

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Filed under Health IT, IMNG, mHealth, Oncology, Practice Trends

New Questions on Lung Cancer Screening

Would you allow patients to self-refer for a CT lung cancer screening? Would you screen a never-smoker? What size nodule would trigger a follow-up exam? What is your lower age limit and lower pack-year limit for screening?

These are just a few of the questions tackled during an interactive lung cancer screening session at the recent Radiological Society of North America meeting, and that highlight the uncharted waters physicians face in the wake of the pivotal National Lung Screening Trial.

The NLST demonstrated a 20% reduction in lung cancer mortality when low-dose CT screening was used, compared to chest X-ray, among 53,000 asymptomatic current or former heavy smokers. However, CT produced more than three times the number of positive results and a higher false-positive rate than radiography.

Without a clear plan to manage abnormal findings or a firm handle on cost, policymakers and payors are hesitant to back reimbursement for widespread lung cancer screening. Results of the ongoing NLST cost-effectiveness analysis are expected early next year. Based on already published data, however, a crude back-of-the-envelope estimate puts the incremental cost-effectiveness ratio at $38,000 per life-year gained, NLST investigator Dr. William Black told attendees.

“That actually is a pretty good deal compared to a lot of things we do in medicine, and in fact most people would put the threshold for acceptability somewhere between $50,000 to $100,000 per life-year gained,” he said. “So it certainly is feasible”

Dr. Black pointed out that low-dose CT saved one lung cancer death per 346 persons screened in NLST, which again is very favorable compared to the rate of 1 per 2,000 patients for mammography.

Although the session provided just a small snapshot in time, audience responses suggest there is much work ahead. A full 77% of attendees were not using low-dose CT to screen for lung cancer and 72% reported not being familiar with the recently published National Comprehensive Cancer Network guidelines for lung cancer screening.

One-quarter of the audience had no lower age limit for screening, and 34% said they did not provide either decision support or obtain informed consent.

Dr. Caroline Chiles. Image by Patrice Wendling/Elsevier Global Medical News

Radiologist and NLST collaborator Dr. Caroline Chiles said informed consent in NLST helped prepare patients for the potential risks of a screen, the likelihood of a positive result and that a positive result didn’t mean they had lung cancer.

“It made a huge difference once they got that letter saying they had a positive screen, because at that point you don’t want everyone rushing out to a surgeon to get that nodule resected,” she added.

What attendees and panelists could agree on is the need for smoking cessation to be included in any future lung cancer CT screening program, with 60% of attendees saying they already do so.

Dr. Chiles pointed out that 16.6% of participants in the NELSON lung screening trial quit smoking compared with 3%-7% in the general public, but that participants were less likely to stay non-smokers. She also cited a recent MMWR that found 70% of adult smokers want to quit smoking, but only about half had been advised by a health professional to quit.

“We really have to think of lung cancer screening as being a teachable moment,” she said.

She suggested physicians visit www.smokefree.gov for help in guiding their patients. Dr. Black also noted that the NLST team is working on a lung cancer screening fact sheet for physicians and patients that will be ready in a few weeks and made available on the Internet.

—Patrice Wendling

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Filed under Cardiovascular Medicine, Family Medicine, Health Policy, IMNG, Internal Medicine, Oncology, Physician Reimbursement, Practice Trends, Pulmonary Diseases and Sleep Medicine, Radiology, Surgery, Thoracic Surgery

Moving Beyond the Hospital

Recently, officials at Hoag Memorial Hospital Presbyterian, a regional health care system in Orange County, Calif., decided to rebrand their 60-year-old institution. The not-for-profit health care system is now known simply as Hoag. They weren’t just going for brevity. They specifically wanted to drop the word “hospital.”

Dr. Richard Afable, Hoag’s president and CEO, recently spoke to a small meeting of hospitalists in Las Vegas and explained that the name change reflects a shift toward providing more services outside of the hospital. Hoag’s hospitals do a great job treating the acutely ill, he said, but the leadership wanted to reach out to people in the community before they got sick enough to make it to the hospital.

Dr. Richard Afable. Photo by Mary Ellen Schneider/ Elsevier Global Medical News.

So officials at Hoag have been working to offer more services related to conditions that either slightly touch the hospital or don’t touch it at all, Dr. Afable said. For example, the system has beefed up its offerings around diabetes care and now provides counseling on how to manage the disease and prevent complications. In the old days, they would have waited for someone to have a heart attack or lose a limb before taking care of them, Dr. Afable said. They also are developing community-based programs for breast cancer, a condition that today is treated primarily outside of the hospital.

And Dr. Afable advised hospitalists to consider following Hoag’s lead and look how they can be involved in care outside of the hospital. He noted the example of CareMore, a medical group and health plan based in California, which is being acquired by the health insurer Wellpoint, Inc. Under CareMore’s model, hospitalists not only care for patients while they are in the hospital, but also after they leave. Once a patient is stable, they are sent back to receive the rest of their care from their primary care physician. Since CareMore uses a capitation payment model, there aren’t concerns about which physician gets the payment for the post-discharge care. The model is food for thought for hospitalists as care becomes increasingly less hospital centric, Dr. Afable said.

— Mary Ellen Schneider

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Geriatric Medicine, Health Policy, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Physician Reimbursement, Practice Trends, Primary care

Geriatric Oncology: The Elephant in the Empty Room

Kerri Wachter/Elsevier Global Medical News

It’s easy to tell which oncology topics are hot and which are not here at the Multidisciplinary Cancer Congress in Stockholm. Metastatic breast cancer? Thousands of people pushing their way into the cavernous meeting hall.  Advanced non-small cell lung cancer? I practically had to bribe the doorman to let me in.  Geriatric oncology? (crickets chirping)  It was kind of lonely in the geriatric oncology meeting room, one that was a tiny fraction of the size of the main hall.

Yes, it’s difficult to study cancer therapies in elderly patients.  They may have  comorbidities and poor performance status.  They may have impaired cognition or be unsuitable candidates for surgery. They may be frail. Then again, they may be none of those things. In fact, they may be in better health than younger patients. As one oncologic surgeon put it, “chronologic age should not be a primary factor in the decision-making process” for cancer treatment in elderly patients.

Courtesy Flickr/User TBOARD/Creative Commons License

What is clear is that we’re going to need lots of interest and research in geriatric oncology, now that the baby boomers are approaching old age. So far we have no good tools for separating the elderly patients who can handle more aggressive treatment from those who can’t.  We have little data on the effects of cancer treatments on elderly patients because they are typically excluded from trials. We don’t even have a clear definition of “elderly.”

The fact that we’re ill prepared to care for the growing population of elderly cancer patients  is the elephant in the room. Sadly, it’s a small room that’s pretty empty.

—Kerri Wachter (@knwachter on Twitter)

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Filed under Geriatric Medicine, IMNG, Oncology

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

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

Cancer Survivor and Oncologist Share a Moment of Joy

No more tumor growth.

That’s the news my friend Sterz received last week from his oncologist after a scare in November 2010, when a periodic MRI found an anomaly at the site where he had surgery for brain cancer 4 years ago—a procedure that left him with loss of motor control on the right side of body and occasional struggles with language production.

Sterz and his son, Calder.

An artist from my home town of Rochester, N.Y. , Sterz is like a brother to me. He lived with our family when I was a junior in high school, and I credit him for helping me to establish a healthy relationship with my older brother, who befriended Sterz in high school.

About a week before his follow-up MRI, Sterz reached out to me, despondent. He’s a single father in his 40s who adores his young son, Calder, and I could sense he was letting some dark thoughts in—chief among them wondering what kind of news this MRI would bring.

I share with his permission some passages from an e-mail he sent to me after his appointment:

“I went to have another MRI yesterday. An hour and a half on my back, I could not twitch an inch. Agonizing. The MRI center is in the basement of Strong Memorial Hospital and the Cancer Center is on the 1st floor. Special K (his nickname for oncologist Dr. David N. Korones) had viewed the scans already and was at the entrance door awaiting my arrival …

“I was anxious to see the scans and the Doc could tell. I pulled up a chair next to his. I looked at the scans, side by side. Viewing the scan I had 3 months ago, with the anomalies, and the scan I had only moments ago, I was astonished. On one image [the anomaly] was gone. Totally gone. On other scans, it had significantly diminished. Special K said, ‘I don’t know how you did it, but the tumor shrank.’ We sat there in his office, both kind of stunned and elated at the same time.

“I had confidence that I could stop the growth of the tumor and Special K had suggested it had dissipated somewhat in the past. I am a tenacious man and I have given up many, many pleasures and vices and I have many supporters to thank, but I can only assign credit for the abatement and the withdrawal of the tumor to the God that I pray to.”

Sterz savored the relief he felt at the good news he received that day. But what of the oncologist? What’s it like to prepare yourself to deliver devastation, but instead be able to hand joy back to your patient? It seems to me that that exchange is at the very heart of what it means to be a doctor — at least the kind of doctor I would want to care for me.

— Doug Brunk (on Twitter@dougbrunk)

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