June 22nd, 2011 by Elaine Schattner, M.D. in Health Policy
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Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem:
Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…
The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:
Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1): Read more »
*This blog post was originally published at Medical Lessons*
June 16th, 2011 by Glenn Laffel, M.D., Ph.D. in Research
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In recent posts on Web-based and mobile behavioral intervention programs, we reviewed evidence suggesting that social support, in one form or another, can improve participants’ adherence and engagement with the program. That didn’t always mean however, that participants achieved better outcomes as a result. In one study for example, an online community increased engagement with and utilization of a Web-based activity program, but it did not increase participants’ actual activity levels.
Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames as an example of such programs, I’ll do that here.
Re-Mission is intended improve medication compliance in teens and young adults with a history of cancer. In the game, players control a nanobot within a 3-dimensional body of a young person that has cancer. Play involves destroying cancer cells and managing chemotherapy-related adverse effects like vomiting and bacterial infections by using antiemetics and antibiotics. The game purports to help users understand Read more »
*This blog post was originally published at Pizaazz*
June 13th, 2011 by admin in Health Tips
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In today’s fast-paced world, waiting — whether it’s at the doctor’s office, in line at the grocery store or for an Internet connection — is rarely considered a good thing.
But when it comes to certain medical conditions, delaying treatment while regularly monitoring the progress of disease — a strategy doctors refer to as “watchful waiting,” active surveillance or expectant management — may benefit some patients more than a rush to pharmaceutical or surgical options.
Patients want to know what they’re waiting for, says urologic oncologist E. David Crawford, MD, chairman of the Prostate Conditions Education Council and associate director of the University of Colorado Comprehensive Cancer Center.
The purpose is to watch in order to see whether a condition progresses. That way, patients and physicians know what kind of threat a disorder poses and they can make a better decision about how urgently treatment is needed. Some people might never need treatment, for instance with a slow-growing cancer. Other people can delay treatment for months or years.
Precancerous conditions may also be monitored with active surveillance. One example is Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
June 12th, 2011 by DeborahSchwarzRPA in Expert Interviews
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Francine Johanna Castillo, MS
Administrative Director, The Pancreas Center
Administrator, Division of GI/Endocrine Surgery
NewYork-Presbyterian Hospital/Columbia University Medical Center
Patients usually seek treatment at centers such as NewYork-Presbyterian/Columbia because of the expert care they know they will receive from the hospital’s physicians and surgeons. Patients may be less aware that a vast network of dedicated, highly trained staff is quietly working behind the scenes, tending to every detail of their office visits, testing, procedures, and follow-up care. The contributions of such personnel in ensuring the quality of patients’ and families’ experiences at the hospital can not be overstated.
In this brief interview, we highlight one such person: Francine Castillo, MS, Administrative Director of the Pancreas Center. As John A. Chabot, MD, Executive Director of the Pancreas Center explains, Francine is “the heart and soul” of the Pancreas Center. She bears central responsibility for ensuring that all aspects of the center run well: financial operations, patient care, community outreach, and fund-raising events. In addition, she is the administrator of the Division of Endocrine Surgery/NY Thyroid Center. Francine’s commitment to providing patients and staff with the best services possible has earned her tremendous respect among both patients and colleagues, who rely heavily on her administrative expertise.
What are your responsibilities at the Pancreas Center? Read more »
*This blog post was originally published at Columbia University Department of Surgery Blog*
June 10th, 2011 by PJSkerrett in Health Tips, News
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If the recent announcement by the International Agency for Research on Cancer (IARC) that cell phones may cause brain cancer has you worried, you might want to wait a bit before trashing your mobile phone and going back to a land line.
Last week, the IARC convened experts from around the world to assess what, if any, cancer threat cell phones pose to the 5 billion or so people who use them. After reviewing hundreds of studies, the IARC panel concluded that cell phone use may be connected to two types of brain cancer, glioma and acoustic neuroma.
That sounds mighty scary. But the IARC said the evidence for this conclusion was “limited.” Most studies have shown no connection between cell phone use and brain cancer. In the relatively small number of studies that have observed a connection between the two, the positive result could be due to chance, bias, or confounding.
The decision puts cell phones in IARC’s Group 2B category of agents that definitely or might cause cancer. Group 1 are things like asbestos, cigarette smoke, and ultraviolet radiation. Things in Group 2B are “possibly carcinogenic to humans.” Other denizens of this group include coffee, pickled vegetables, bracken ferns, and talcum powder.
I think the IARC decision puts cell phones on notice—a formal “we’ve got our eyes on you” warning—more than it fingers phones as a cause of brain cancer. For one thing, the evidence so far is pretty weak. Writing on the Cancer Research UK Web site, blogger Ed Yong offers a peak at the data through 2009, taken from a review by Swedish researchers. A graph from the paper shows that only one of 28 studies shows a statistically significant association between cell phone use and cancer. We’ll know more about the strength or weakness of the evidence when the panel publishes its report online later this week and in the July 1 issue of The Lancet Oncology.
For now, I’m far more concerned about being rammed by someone talking on his or her cell phone while driving than I am about getting brain cancer from a phone. If you think the IARC report warrants action, the FDA offers suggestions for reducing your exposure to radiofrequency energy from a cell phone, like using the phone less, texting instead of talking, and using speaker mode or a headset to place more distance between your head and the cell phone.
*This blog post was originally published at Harvard Health Blog*
