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A Second Opinion Is Good, But A Third Or Fourth?

A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions:

Is It OK To Get A Second Opinion?

Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike.

When things can get out of hand, though, is when patients start “doctor shopping.” For example, I’ve cared for some patients with leukemia who’ve been to see over 10 oncol­o­gists. If you’re acutely sick, this sort of approach to illness can be coun­ter­pro­ductive — it can delay needed therapy. From the physician’s per­spective, it’s alien­ating: Who wants to invest her time, intel­lectual effort, and feelings for a patient who’s unlikely to follow up? Besides, oncology is the sort of field where each con­sulting doctor may have a dis­tinct opinion. (If you see 10 oncol­o­gists, you may get 10 opinions.) Beyond a certain point, it may not help to get more input, but instead will cloud the issue. Read more »

*This blog post was originally published at Medical Lessons*

Cancer Treatments: To Cost $158 Billion By 2020?

Medical expenditures for cancer are projected to reach at least $158 billion in today’s dollars by 2020. That’s a 27 percent increase, assuming that incidence and treatment costs remain at 2010 levels, according to a National Institutes of Health (NIH) analysis of growth and aging of the U.S. population.

But new diagnostic tools and treatments could raise medical expenditures as high as $207 billion, assuming that the costs of new treatments increases 5 percent, said the researchers from the National Cancer Institute (NCI), part of the NIH. The analysis appears in the Journal of the National Cancer Institute. Recent trends reflect a 2 percent annual increase in medical costs in the initial and final phases of care, which would boost projected 2020 costs to $173 billion.Chart generated at http://costprojections.cancer.gov/graph.phpProjections of expenses, assuming steady incidence and survival rates and no increase in treatment costs

Projections were based on the most recent data available on cancer incidence, survival and costs of care. In 2010, medical costs associated with cancer were projected to reach $127.6 billion, with the highest costs associated with breast cancer ($16.5 billion), followed by colorectal cancer ($14 billion), lymphoma ($12 billion), lung cancer ($12 billion) and prostate cancer ($12 billion). Read more »

*This blog post was originally published at ACP Internist*

Comparative Effectiveness Research: More Can Be Less

 

This is a guest post from Dr. Jessie Gruman.

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More Can Also Be Less: We Need A More Complete Public Discussion About Comparative Effectiveness Research

When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care.

I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments. 

Choosing a surgeon this September to remove my tumor shone a bright light for me on the need for research that evaluates current practices. Two of the three surgeons I consulted wanted to follow “standard treatment procedures” and leave a six-centimeter, cancer-free margin around my tumor. This would mean taking my whole stomach out, because of its anatomy and arterial supply.

The third surgeon began our consultation by stating that her aim would be to preserve as much of my stomach as possible because of the difference in quality of life between having even part of one’s stomach versus none. If at all possible, she wanted to spare me life without a stomach.

But what about the six-centimeter margin? “There isn’t really much evidence to support that standard,” she said. “This issue came up and was discussed at a national guidelines meeting earlier in the week. No one seemed to know where it came from. We have a gastric cancer registry at this hospital going back to the mid 1990s and we haven’t seen support for it there, either. A smaller margin is not associated with an increased risk of recurrence.” Read more »

Intensity-Modulated Radiation Therapy (IMRT) For Cancer: How Lucrative Is It For Doctors?

I’ve been traveling in Europe, including giving a talk at the Salzburg Global Seminar on involving and informing patients in healthcare decisions. In that presentation, I talked about promotion of a newer form of cancer radiation therapy called intensity-modulated radiation therapy (IMRT).

So I want to point out that while I’ve been away the Wall Street Journal published an important piece on this very topic under the headline “A Device to Kill Cancer, Lift Revenue.” An excerpt:

Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment.

The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It’s also about financial incentives.

Taking advantage of an exemption in a federal law governing patient referrals, groups of urologists across the country have teamed up with radiation oncologists to capture the lucrative reimbursements IMRT commands from Medicare.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Stem Cell Researchers Turn Skin Into Blood: Could Help Cancer Treatment

From The Australian:

Stem cell researchers have found a way to turn a person’s skin into blood, a process that could be used to treat cancer and other ailments, according to a Canadian study published today.

The method uses cells from a patch of a person’s skin and transforms it into blood that is a genetic match, without using human embryonic stem cells, said the study in the journal Nature.

Wow. Very cool. I wonder if hopefully someday this could be a replacement for random blood donation?

*This blog post was originally published at GruntDoc*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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