Mon 31 Dec 2007
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I wish you all the best for the new year!
Yours truly,
Galia
Sun 30 Dec 2007
The study, by researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Roudebush Veterans Administration Medical Center, is the first to look at the effect of primary care on health outcomes in cancer patients.
Receiving care from a primary care physician (a general internist or family practice doctor) during cancer treatment from an oncologist appears to improve cancer survival rates, likely due to the comprehensiveness of care that is received in primary care, according to study authors Caroline Carney Doebbeling, M.D., M.Sc. and Laura Jones, Ph.D. The researchers focused on lung cancer because of the low one-year lung cancer survival rate in these patients.
"We cannot afford to ignore the chronic medical conditions that most cancer patients have because treating these conditions may bring increased longevity as well as improved quality of life. Lung cancer patients are often faced with many additional health issues, such as high blood pressure, emphysema and other respiratory conditions, all of which can and should be treated," said Dr. Carney Doebbeling, associate professor of medicine and of psychiatry at the Indiana University School of Medicine and a Regenstrief Institute research scientist.
"When doctors think their patients have a higher risk of mortality, as they do with lung cancer, chronic disease management may be not as big a focus," said Dr. Jones, who is with the Roudebush VA Medical Center's Center of Excellence on Implementing Evidence-Based Practice and is a health services researcher.
Lack of primary care utilization in the first six months following lung cancer diagnosis had a marked effect on survival even when controlling for extent of the disease. The researchers looked at electronic medical record data of 323 male veterans diagnosed with lung cancer. The median survival rate was only 3.68 months for those without primary care utilization, but increased by a factor of more than four if the patient had at least 3 primary care visits during the first 6 months following cancer diagnosis.
"Further investigation is needed to gain a better understanding of how and why primary care utilization improved outcomes in lung cancer patients. What we do know is that over 80 percent of lung cancer patients have at least one additional serious medical condition. The take home message to cancer patients is to not stop seeing your primary care doctor even if you have cancer," said Dr. Carney Doebbeling. "The importance of managing the health of the whole person, not just one disease at a time, cannot be overstated."
Sun 30 Dec 2007
In the latest edition of the New England Journal of Medicine, Dr. Hoffman posits that the results of a small clinical trial involving a new treatment for Duchenne muscular dystrophy provides a proof-of-principle for personalized molecular medicine. Practical implementation of the 'exon-skipping' approach described in the co-published report of vanDeutekom et al. will require advances in systemic administration of large amounts of customized DNA-like drugs, and proof that long-term delivery is not toxic. However, these advances are likely to come in short order, with the oversight and regulations of the FDA critical for appropriate labeling and marketing of such personalized molecular target drugs.
Though this particular treatment remains in its early stages, within the foreseeable future the now-standard Phase I, II, and III pathway to drug approvals may need to be re-evaluated.
How can DNA-like drugs specific to a single patient's mutation go through the existing approval process" Are the current standards of rodent and monkey toxicity studies relevant and appropriate for DNA-like drugs, when the animals do not have the same DNA target (or off-target) sequences as humans" These and other questions are certain to pose exciting challenges to both the approval and marketing processes of drugs.
The study featured in the latest edition of The New England Journal of Medicine, involves application of a nucleic acid drug called PRO051. It shows some success at restoring the expression of the specific protein--dystrophin, that is linked to healthy muscle tissue. This approach was shown to reactivate dystrophin protein production in small areas of muscle tissue at the injection site of muscular dystrophy patients.
"Dozens of specific sequences will be required for effectively treating the majority of patients with Duchenne muscular dystrophy," writes Dr. Hoffman. "But in order to realize the promise of personalized molecular medicine in muscular dystrophies and, ultimately, other disorders, it will be important to re-evaluate current measures of toxicity, efficacy, and marketing that ensure both safety for the patient, as well as rapid development and distribution of life-saving drugs."
Dr. Hoffman envisions that some parts of the approval process may be developed for DNA-like molecular medicine as a 'class' of drugs, rather than individual testing of hundreds of different sequences.
"The patients and their families are crossing their fingers that the drug's overall chemistry can be shown to be safe," he says.
Sun 30 Dec 2007
The analysis shows that only one in three patients eligible for mastectomy or breast conserving surgery have such discussions. The study is published in the February 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
The option of breast reconstruction has increased treatment choices for women with breast cancer. Women with early stage disease who are not likely to need post-mastectomy radiation are considered eligible for reconstruction at the time of surgery. However, little is known about how often surgeons discuss breast reconstruction with patients.
Led by Dr. Amy Alderman of the University of Michigan Medical Center, researchers surveyed a 1,178 women aged 79 years or younger who had undergone a surgical procedure for stage I, II, or III breast cancer between December 2001 to January 2003.
The researchers found only 33 percent of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients. Patients who discussed reconstruction with their surgeon were more willing to consider having a mastectomy and were more than 4 times likely to undergo the surgery. The findings suggest that discussing reconstruction will impact women?s decisions regarding initial surgery for their breast cancer.
According to the authors, these results have important implications for patient care and policy. "This research suggests that patients should be informed of all options in order to be educated consumers of healthcare and ensure maximal breast cancer treatment decision quality," they conclude. "Our results suggest a need for comprehensive breast cancer treatment decision aids, including information on initial surgery and other treatment options such as reconstruction."
Sun 30 Dec 2007
Dr. Donatus U. Ekwueme of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention in Atlanta and colleagues found that the median cost of screening a woman for breast cancer was $94, and the cost per breast cancer detected was $10,566. For cervical cancer, these costs were $56 and $13,340, respectively. The study is published in the February 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
Many deaths from breast and cervical cancer would be avoidable through the use of mammography and Pap tests, respectively. In 1990 Congress established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)?which is now the largest cancer screening program in the United States?to provide support and assistance to increase breast and cervical cancer screening among medically under-served, low-income women. Program services are available in all 50 states, the District of Columbia (DC), 4 U.S. territories, and 13 American Indian/Alaskan Native organizations. To help determine the level of funding required to reach and screen eligible women, Ekwueme and colleagues set out to estimate the costs per woman served, per woman screened and per cancer detected through this program.
The investigators collected data from July 2003 through June 2004 from nine of the 68 NBCCEDP programs operating in the United States. They found that when non-federal contributions are included, the median cost of all screening services combined was $555 per woman. Screening tests accounted for the highest cost, $221 per woman served, and public education/outreach incurred the second highest cost, $63.
The analysis revealed that 58.2 percent of the program?s resources were allocated to clinical services, including screening and diagnostic follow-up, referral for treatment, and case management. The remainder of NBCCEDP?s funds were used to support non-screening activities such as data management, public education/outreach, professional education and quality assurance and improvement.
The authors note that the study "provides the first systematic cost analysis in the selected [NBCCEDP] programs and is unique in that it attempts to determine the real costs of providing comprehensive screening and diagnostic follow-up services to low-income, uninsured women." The Centers for Disease Control and Prevention is currently assessing the long-term economic issues in all of the programs within NBCCEDP. These analyses "will provide invaluable information that program directors and managers can use to make informed decisions on how to allocate NBCCEDP resources more efficiently," the authors conclude.