Monthly Archives: April 2012

Robotic Surgery Is Useful Option for Oral Cancer


transoral robotic surgeryMinimally invasive transoral robotic surgery (TORS), used alone or combined with adjuvant therapy, provides good functional and oncologic outcomes in patients with oropharyngeal squamous cell carcinoma (OPSCC), new research suggests.

The results were especially impressive in patients with human papillomavirus (HPV) infection, which is currently the most common cause of OPSCC in Europe and the United States.

Eric J. Moore, MD, associate professor of Otolaryngology at the Mayo Clinic in Rochester, Minnesota, and coauthors reviewed a prospective database of patients with previously untreated OPSCC arising in the tonsil or base of the tongue who underwent TORS at their institution during a recent 2-year period.

In 2011, about 12,000 individuals in the United States were diagnosed with OPSCC, according to the authors. The most common sites are the tonsillar fossa and base of the tongue. Customarily, OPSCC has been treated with combined modality therapy, including open surgical resection through mandibulotomy, neck dissection, and adjuvant radiation therapy or combined chemotherapy and radiation therapy. TORS was later introduced to improve access to these tumors.

Functional outcomes of the study included gastrostomy tube dependence and tracheostomy dependence. Oncologic outcomes included local, regional, and distant control and disease-specific and recurrence-free survival.

Overall, 66 patients who underwent TORS as their primary treatment were followed for a minimum of 2 years. Sixty-four patients, or 97%, were able to tolerate an oral diet and maintain their nutritional needs before initiating adjuvant therapy at 4 weeks. Only 3 patients, or 4.5%, required long-term gastrostomy tube use, and one (1.5%) had long-term tracheotomy.

Three-year recurrence-free survival was achieved in 92.4% of patients, and 95.5% were alive and disease-free at the latest assessment.

Importantly, the analysis also demonstrated a strong correlation between disease control and HPV status. The 3-year survival rate was 92% in protein 16 assay (p16)-positive patients versus 52% in p16-negative patients. Most patients in the study had HPV-associated OPSCC.

The authors cited numerous advantages of TORS as primary therapy in OPSCC, including “the ability to stage the tumor adequately, to eradicate the primary tumor and the involved lymph nodes reliably and completely in a single setting, and to add adjuvant therapy in a rational and individually designed manner.” In addition, the ability to preserve normal tissue and neurovascular supply helps patients heal faster and recover oropharyngeal function.

“The authors cited numerous advantages of TORS as primary therapy in OPSCC.”

The authors said that the major study limitation was the lack of an alternative treatment group for comparative analysis. Selection bias represented an additional drawback, given that patients with higher T-stage tumors that cannot be exposed or resected using a transoral approach were ineligible for the study.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2012|Oral Cancer News|

Exercise helps cancer patients

Author: staff

A small trial shows that rehabilitation therapy for head and neck cancer patients clearly improves their ability to swallow faster, something that’s often damaged with the cancer treatment.

Intense treatment for cancers of the head and neck often involves both chemotherapy and radiation.

With many important muscles involved in the region, preventing the areas targeted by radiation from weakening can be avoided with swallowing exercises.

The study compared a control group given no swallowing exercises to another group given the series of targeted rehabilitation therapy. It took nine months for the two groups to have equivalent ability, highlighting the importance of preserving muscle function prior to cancer treatment.

Importantly, rehabilitation after cancer treatment can prevent some of the worst side effects, and allows patients to get back to their normal day to day life.

The initial damage from cancer treatment was extensive, as both groups had equal ability immediately after cancer therapy. Yet the muscle function rebounded quickly in the rehabilitation group, as results at 3 and 6 months after treatment were improved as a result of the swallowing exercises.

The group given exercises also rated themselves as more comfortable eating in public, an important qualifier in showing how well the exercises worked.

“With improvements in swallowing function from post-treatment exercises, interest in the use of prophylactic swallowing exercises to prevent or minimize post-CRT swallowing dysfunction has grown” the authors write as background in the study.

“Indeed, some cancer treatment centers recommend prophylactic swallowing exercises for all their patients undergoing CRT.”

The study design used 26 patients that underwent chemotherapy and radiation for cancers of the head and neck, split into two equal groups.

Study authors recommended further trials, but given the low cost of rehabilitation therapy in comparison to the costs associated with chemotherapy and radiation treatment of cancers, it is hard to see why all head and neck cancer patients shouldn’t be given exercises to prevent complications after treatment.

The trial results were published online in the April edition of the Archives of Otolaryngology – Head & Neck Surgery.

1. Financial relationships regarding the study authors was not disclosed.

April, 2012|Oral Cancer News|

New technique to synthesize boron-nitride nanotubes

Author: Cameron Chai

Researchers at the Institute of Life Sciences, Scuola Superiore Sant’Anna in Pisa, Italy have used boron-nitride nanotubes (BNNT) to improve the effectiveness of the cancer treatment.

Irreversible Electroporation involves putting holes in tumor cell walls. It is used to treat soft tissue tumors in cancers that are difficult to treat, such as head and neck, prostate, pancreas, kidney, lung and liver. The treatment is being offered and studied for effectiveness at many centers in the USA.

Researchers belonging to the Department of Energy’s Thomas Jefferson National Accelerator Facility, the National Institute of Aerospace and NASA’s Langley Research Center provided the BNNTs.

A hole of an appropriate size in a cancer cell wall may cause the cell to commit suicide. The chief scientist at BNNT, Michael W. Smith, offered BNNTs to the researchers in Italy. These high-quality BNNTs are flexible, long, and have a small diameter. They are crystalline and have minimal defects.

The BNNTs were suspended in glycol-chitosan and then chopped into bits with sound waves. These bits were then put on human epithelial carcinoma (HeLa) cells. The amount of BNNTs that had the capacity to kill around 25% of the cancerous cells within a period of 24 hours was determined. Through an electroporation device, the researchers supplied electricity of 160 V to a solution which contained the particular amount of BNNTs. The HeLa cells were exposed to the solution. Further, unexposed cancer cells were also treated with the same amount of voltage.

When the BNNTs remained on the cell surface, the irreversible electroporation treatment killed 88% of the cells. Only 40% of the cancer cells without BNNTs were killed.

A novel pressurized vapor/condenser method for synthesisation of high-quality BNNTs was developed by researchers at Thomas Jefferson National Accelerator Facility, NASA and the National Institute of Aerospace. Jefferson Lab’s Free-Electron Laser was used for developing the method.

The laser beam was used to hit and vaporize a target in a nitrogen gas-filled chamber, which formed a boron plume. A condenser was used to cool the vapor leading to formation of droplets, which combined with nitrogen to form BNNTs.


April, 2012|Oral Cancer News|

Survey reveals most are unaware of the causes and symptoms of mouth cancer

Author: staff

A survey has revealed that most people are unaware of the major risk factors and symptoms of oral cancer.

The SimplyHealth Annual Dental Health Survey revealed that of the 11,785 adults surveyed, 70 percent were unaware of the symptoms of mouth cancer while only 3 percent knew that kissing could increase your risk of moth cancer as a result of exposure to the human papilloma virus (HPV).

A spokesperson for SimplyHealth said that most were aware that smoking and drinking increased the risk of oral cancer, but very few people were aware of the link between oral cancer and the HPV, a virus which is also responsible for some cases of cervical cancer. According to Cancer Research UK, some strains of HPV increase the risk of mouth cancer, which could explain why the disease is becoming more common in young people, as the virus is spread through physical contact.

Dentist Michael Thomas said that it was important for people to be aware of the symptoms of mouth cancer, as well as the causes. As with most forms of cancer, the earlier mouth cancer is diagnosed, the higher the chance of survival.

Only 28 percent of adults surveyed had discussed mouth cancer with their dentist and this is worrying, as dentists are in a prime position to spot the early warning signs and arrange further tests and treatment.

The most common symptoms of mouth cancer include lumps or swellings in the mouth or throat, sores or ulcers that take a long time to heal and red or white patches in the mouth.

April, 2012|Oral Cancer News|

Handheld probe shows promise for oral cancer detection

Author: staff

A team of American researchers have created a portable, miniature microscope in the hope of reducing the time taken to diagnose oral cancer.

Credit: Dr. John X.J. Zhang, Department of Biomedical Engineering, the University of Texas at Austin.

The probe, which is around 20 cm long and 1 cm wide at its tip, could be used by doctors to diagnose oral cancer in real-time or as a surgical guidance tool; dentists could also use it to screen for early-stage cancer cells. The probe has been presented today in IOP Publishing’s Journal of Micromechanics and Microengineering, and has shown good agreement with images of oral cancers obtained using conventional, much slower techniques at the University of Texas Health Science Centre at San Antonio, TX.
Historically, the death rate associated with oral cancer is particularly high; not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development.

Lead author of the study Dr John X J Zhang at the University of Texas at Austin said: “Today, that statement is still true, as there isn’t a comprehensive programme in the US to opportunistically screen for the disease; without that, late stage discovery is more common.”

The probe uses a laser to illuminate areas of the sample and can view beneath the surface of tissue, creating full 3D images. It can also take a series of images and layer them on top of each other, much like the tiling of a mosaic, giving a large overall field-of-view.
The key component of the probe is a micromirror. Micromirrors have previously been used in barcode scanners and fibre optic switches and are controlled by a microelectromechanical system, allowing the laser beam to scan an area in a programmed fashion.
The low cost and ease of fabrication of micromirrors, along with their easy integration into electronic systems for versatile imaging operations, make them an indispensable component of the probe.

Oral cancers have traditionally been diagnosed by biopsy. Based on a doctor’s visual inspection, medical practitioners remove a sample of tissue from the patient and send it off to a pathologist who will examine the tissue under a microscope to check for abnormal or malignant cells. Results will be sent back to the doctor for the next round of diagnoses or surgery; the whole process can take up to several weeks. Not only is this process time consuming, it can be costly, invasive and painful, often leaving scars.
“Due to the lack of real-time efficient oral cancer screening tools, it is estimated that approximately $3.2 billion is spent in the United States each year on treatment of such cancers”, Dr Zhang continued.

The researchers, from the University of Texas at Austin and the commercialization partner NanoLite Systems, Inc. are now planning clinical trials with a view to gaining approval from the Food and Drug Administration (FDA). They envisage that, with a few adjustments, the device could be built for a quarter of the price it costs to build the microscopes that are currently used in diagnosis, which is around $300 000.

April, 2012|Oral Cancer News|

It’s Time to Stop Letting Congress Stomp on Nonprofit Advocacy Rights

Source: The Chronicle of Philanthropy

Nonprofit organizations have fewer rights to speak out about important public-policy matters today than they did last year.

The latest assault on advocacy came in a spending bill Congress approved to provide money to education, health, and human-service groups.

These new restrictions on advocacy were passed as part of a coordinated campaign by conservatives to quash popular democracy. Unfortunately, as contrasted with past “defund the left” efforts, charity leaders didn’t find out about them in time to take action to prevent their passage.

The challenges to nonprofit advocacy began more than three decades ago when the Heritage Foundation started making new restrictions a priority. This attack was pushed by the Reagan White House in the early 1980s, took the form of major Republican congressional legislative efforts in the mid-1990s, and has arisen in various forms since then.

Some conservative lawmakers and Republican White House officials have tried to go so far as to limit what charities can do with private contributions; others have tried to restrict the types of activities that nonprofits can conduct with federal funds.

Most of their efforts were stopped by groups whose missions were to serve as watchdogs to protect charities’ rights and the coalitions they organized.

Nevertheless, conservatives succeeded in several attempts to chip away at nonprofit advocacy rights.

For example, Congress voted to prohibit social-welfare organizations classified under Section 501(c)(4) from receiving federal grants if they lobby. Additionally, grantees of the Legal Services Corporation face greater restrictions on advocacy than do other federal grantees.

Many grant-making foundations were alarmed by these attacks.

Like much of society, they recognized that strong nonprofits help build a vibrant democracy. And they know that the only way to do that is to preserve the ability of nonprofits to speak out on public-policy issues, to challenge institutional power, and to encourage Americans to get more involved in democratic decision making.

A legacy of attacks on charities’ advocacy was that a small number of foundations provided support for nonprofit watchdogs to monitor attacks on advocacy and to help train nonprofits to influence public policy. While laudatory, those grants were too limited and episodic.

Strikingly, in the past few years, even limited foundation grants for protecting and promoting nonprofit advocacy rights have dropped to minimal levels.

Many organizations that used to serve in the watchdog role no longer have staff members dedicated to monitoring advocacy rules, and some nonprofits that devoted all of their work to this cause no longer can. Such losses make it all the more likely that nonprofits will not be prepared to fight future attacks on their rights to influence public policy.

The blueprint for what to expect can be seen in the newly enacted appropriations law, which expands the list of advocacy activities beyond lobbying that nonprofits are forbidden to conduct with federal money.

With the new law, groups that receive money under the appropriations measure cannot use federal grants for “any activity to advocate or promote” any “proposed, pending, or future” tax increase (at any level of government) or any “future requirement or restriction” on a “legal consumer product” (e.g., tobacco and alcohol products, junk foods and beverages, and guns).

None of those key terms is defined. Suppose a group received federal aid to fight cancer by decreasing tobacco use and wanted to educate the public about the health dangers of cigarette sales, especially to minors. Presumably, that wouldn’t be allowed under the law. Or say another nonprofit won a grant to curb obesity. It might want to suggest a surcharge on sodas and other sugary foods as a way to deter consumption, but it probably couldn’t promote that idea.

The new law also forbids nonprofits from using federal money to influence some regulatory and executive-branch actions. That means a charity that receives federal money to provide care and support to families with disabled children, for example, would no longer be allowed to use any of its government money to comment on proposed state regulations that govern residential treatment or in-home services.

To be sure, the new law is limited in scope at this point to programs paid for through a single appropriations bill, the one that covers the Departments of Health and Human Services, Labor, Education, and several independent agencies. But close to one-third of nonprofit revenue comes from the federal government, so it is easy to see that more groups will be affected if this idea spreads to legislation that affects the arts, the environment, or so many other kinds of groups.

While charities are not permitted to use federal money to lobby, they certainly ought to educate both the public and policy makers and advocate on social problems if they receive government money to solve those issues. Policymakers need to receive information from independent, nonpartisan parties such as federally financed nonprofit groups. Their experience, research, and ideas are often vital to improving lives in our communities. But the new law makes this difficult in many cases and out of the question in others.

The new legislation is a case of the public interest losing out to private ones. Charities advocate on issues in which people’s voices are not adequately heard in the democratic process; they work to promote the common good. The additional restrictions on charities’ free-speech rights make that point clear; they demonstrate how monied interests impose their will on ordinary people and the groups that try to serve them.

The new law was drafted by Rep. Denny Rehberg, a Montana Republican, and supported by industry representatives, including the American Beverage Association.

Why would a trade association want new restrictions on nonprofit advocacy? Maybe because it wants to kill federal money to anti-obesity and other public-health programs that could affect how many sweetened drinks Americans buy. Knowing how hard that is, they go after the speech rights of health charities that get federal aid. And this appears part of a continuing conservative attack on nonprofit speech.

One of the leaders of the assault on nonprofits is Cause of Action, an organization established a few months before these restrictions were enacted, that is directed by Daniel Epstein, a former staff member of the House Oversight and Government Reform Committee, led by Rep. Darrell Issa, a California Republican. Before that, he was a legal associate at the Koch Foundation, which promotes free-market and limited- government groups.

Cause of Action has written to at least 20 groups that receive federal money to fight obesity and promote tobacco-use warnings indicating to them that they may have engaged in illegal lobbying activities. The group said it was writing “only as a convenience” to tell the grantees they may be subject to civil penalties and private lawsuits imposing triple damages and lawyers’ fees.

This is reminiscent of other right-wing efforts, begun in the 1980s, to stifle charitable advocacy work by suing nonprofits. These assaults on charities earned their own acronym describing their effect: They were called SLAPP suits (Strategic Lawsuit Against Public Participation) and were often filed by corporations and other deep-pocket conservatives.

Democracy depends on the ability of ordinary people to have a voice in public-policy decisions. It is most often nonprofits that help people advocate for policies and programs that improve their lives. So attacks on nonprofit advocacy end up undermining our democracy. That is yet another reason for foundations to invest in protecting speech rights for nonprofits.

Gary Bass is executive director of the Bauman Foundation. Mark Rosenman, professor emeritus at the Union Institute and University, works on efforts to improve how nonprofits and foundations serve the public.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2012|Oral Cancer News|

Pig mucus effective at blocking viruses associated with cervical and oral cancer

Source: American Chemical Society

Scientists are reporting that the mucus lining the stomachs of pigs could be a long-sought, abundant source of “mucins” being considered for use as broad-spectrum anti-viral agents to supplement baby formula and for use in personal hygiene and other consumer products to protect against a range of viral infections. Their study appears in ACS’ journal Biomacromolecules.

In the report, Katharina Ribbeck and colleagues point out that mucus, which coats the inside of the nose, mouth and vagina, is the immune system’s first line of defense. The slimy secretion traps disease-causing microbes, ranging from influenza virus to HIV (which causes AIDS) before they can cause infection. That has led to consideration of mucin, the main component of mucus, for use as an anti-viral agent in a variety of products. However, existing sources of mucins, such as breast milk, cannot provide industrial-sized quantities. Large amounts of mucus exist in the lining of pigs’ stomachs, and the authors set out to determine if pig mucus – already used as a component of artificial saliva to treat patients with “dry mouth,” or xerostomia – has the same anti-viral activity.

They found that pig mucus is effective at blocking a range of viruses, from strains of influenza to the human papilloma virus, which is associated with cervical and oral cancer. They report that pig mucins could be added to toothpastes, mouthwashes, wound ointments and genital lubricants to protect against viral infections. “We envision porcine gastric mucins to be promising antiviral components for future biomedical applications,” the report says.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2012|Oral Cancer News|

Study: Oral cancers take financial toll


April 26, 2012 — The cost of treating individuals with oral, orapharyngeal, and salivary gland cancers is significant, particularly for patients who undergo all three forms of treatment, according to a new study by Delta Dental of Michigan’s Research and Data Institute. And for many that is only the beginning of the financial impact of the disease.

The project, which involved Thomson Reuters, Delta Dental of Wisconsin, Vanderbilt University, and the University of Illinois at Chicago College of Dentistry, began in March 2010. It is the first retrospective data analysis of a large number of head and neck cancer patients in the U.S. analyzing direct and indirect costs and comparing those costs to a matched comparison group, according to the authors (Head Neck Onc, April 26, 2012).

Using data from the 2004-2008 Thomson Reuters MarketScan Databases: Commercial Claims and Encounters Database, Medicare Supplemental and Coordination of Benefits Database, Medicaid Multi-State Database, and the Health Productivity and Management Database, the researchers retrospectively analyzed claims data of 6,812 OC/OP/SG patients with employer-sponsored health insurance, Medicare, or Medicaid benefits.

They found that, on average, total annual healthcare spending during the year following diagnosis was $79,151, compared with $7,419 in a group comprising similar patients without these cancers. They also found that the average cost of care almost doubled when patients received all three types of treatment: surgery, radiation, and chemotherapy.

Healthcare costs were higher for oral cancer patients with commercial insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303), and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01), the study found. Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of care, from $96,520 in the Medicare population to $153,892 in the commercial population.

“The results of this research are significant in helping us to fully understand the cost burden of these three particular head and neck cancers on patients and health care providers,” stated Jed Jacobson, DDS, MS, MPH, chief science officer at Delta Dental and a lead contributor to the study, in a press release. “To our knowledge, this is the first study of its kind.”

One of the big problems with oral cancer is that it is uncovered so late in the disease that the chances of survival are terrible, he added.

“So the key is early detection and diagnosis,” Dr. Jacobson said. “In the last decade, we have seen a flurry of activity in new science and technology with the promise of being able to find it earlier. The problem is, should I as a purchaser of healthcare buy this benefit? The answer is often return on investment: if I spend a dollar on this new technology, do I save anything relative to finding the cancer earlier? So we need to know what oral cancer costs.”

Social, psychological, economic impact

The project examined other factors also, including:

  • Indirect costs associated with these cancers from diagnosis, treatment, and recovery, such as absenteeism, worker productivity, and the disabling and disfiguring side effects of treatment
  • The cost burden of oral cancer on taxpayers who fund Medicaid and Medicare
  • The comparative value of preventive care for these oral cancers versus treatment

“Most oral cancers require costly and disfiguring medical intervention, and even then the five-year survival rate is approximately just 60%,” Dr. Jacobson said. “Yet when the cancer is detected early, the survival rate increases to 83%. This study allows us to get a better handle on the cost impact these diseases have and how we can combat them better.”

Head and neck cancers have always piqued the interest of health care providers, patients, and insurers because of the high-morbidity, high cost of care, and high-mortality rates associated with them. Yet, it has largely remained an unexplored area when it comes to research and backing up these conclusions.

“The actual study of the social, psychological, and economic impacts of these cancers has been understudied,” states Dr. Joel Epstein, former professor of oral medicine and diagnostic sciences at the University of Illinois in Chicago, now adjunct professor, director of oral medicine at City of Hope in Duarte, CA. “These are the reasons we decided to conduct this important research and be able to shed more light on the cost burden of treating head and neck cancer.”

By including screening as part of regular dental exams, dentists and hygienists have the opportunity to detect these cancers early, decreasing morbidity and mortality, the study authors noted. In addition, educational programs to raise awareness among health care providers and programs instructing individuals on self-examination may result in earlier detection and greatly reduce the high cost and mortality of oral and head and neck cancers.

“The information [in this study] will be a great asset in determining the cost-effectiveness of any new technologies and early detection systems that could potentially help decrease costs, and more importantly, lower the mortality rate of these cancers down the road,” Dr. Jacobson concluded.

However, while the findings of this study are important, it does not address the additional financial burden many oral cancer survivors face after treatment, noted Brian Hill, executive director of the Oral Cancer Foundation.

“If you look at the financial consequences in this economy, by not finding this disease early, the morbidity associated with treatments is significant,” he told “But also, treatment is just the beginning of the financial cascade of events. There are larger consequences to the economy. It isn’t just about survival, but other long-term consequences insurance wise, personally, and at the government level also due to long-term disability.”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Debt Collector Is Faulted for Tough Tactics in Hospitals

Source: The New York Times

Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.

This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.

The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.

In some cases, the company’s workers had access to health information while persuading patients to pay overdue bills, possibly in violation of federal privacy laws, the documents indicate.

The attorney general, Lori Swanson, also said that Accretive employees may have broken the law by not clearly identifying themselves as debt collectors.

Accretive Health has contracts not only with two hospitals cited in Minnesota but also with some of the largest hospital systems in the country, including Henry Ford Health System in Michigan and Intermountain Healthcare in Utah. Company executives declined to comment on Tuesday.

Although Ms. Swanson did not bring action against the company on Tuesday, she said she was in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country. Regulators in Illinois, where Accretive is based, are watching the developments closely, according to Sue Hofer, a spokeswoman with the State Department of Financial and Professional Regulation.

“I have every reason to believe that what they are doing in Minnesota is simply company practice,” Ms. Swanson said in an interview, but declined to provide details.

In January, Ms. Swanson filed a civil suit against Accretive after a laptop with patient information was stolen, saying that the company had violated state and federal debt collection laws and patient privacy protections. That action is still pending.

An Accretive spokeswoman declined to comment on whether other states were looking into its practices and issued a brief statement, “We have a great track record of helping hospitals enhance their quality of care.” In its annual report, the company said it was cooperating with the attorney general to resolve the issues in Minnesota.

As hospitals struggle under a glut of unpaid bills, they are reaching out to companies like Accretive that specialize in collecting medical bills.

Hospitals have long hired outside collection agencies to pursue patients after they have left hospital facilities. But financial pressures are altering the collection landscape so that they are now letting collection firms in the front door, according to Don May, the policy adviser for the American Hospital Association, a trade group.

To achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.

Concerns are mounting that the cozy working relationships will undercut patient care and threaten privacy, said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. “The mission of these companies is in direct opposition to the supposed mission of these hospitals.”

Still, hospitals are in a bind. The more than 5,000 community hospitals in the United States provided $39.3 billion in uncompensated care — predominately unpaid patient debts or charity care — in 2010, up 16 percent from 2007, the hospital association estimated.

Accretive is one of the few companies specializing in hospital debt collection that is publicly traded. Last year, it reported $29.2 million in profit, up 130 percent from a year earlier.

Late last month, Fairview Health Services, a Minnesota hospital group that Accretive provided services to, announced it was canceling its contract with Accretive for back-office debt collection. After Accretive informed investors, its stock plunged 19 percent in a day. On Tuesday, the company’s shares closed at $18.49, down 2.7 percent.

Accretive says that it trains its staff to focus on getting payment through “revenue cycle operations.” Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota, according to employees and the newly released documents. Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.

“We’ve started firing people that aren’t getting with the program,” a member of Accretive’s staff wrote in an e-mail to his bosses in September 2010.

Collection activities extended from obstetrics to the emergency room. In July 2010, an Accretive manager told staff members at Fairview that they should “get cracking on labor and delivery,” since there is a “good chunk to be collected there,” according to company e-mails.

Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance, according to the documents. Employees in the emergency room, for example, were told to ask incoming patients first for a credit card payment. If that failed, employees were told to say, “If you have your checkbook in your car I will be happy to wait for you,” internal documents show.

Employees at Accretive’s client hospitals ask patients to make “point of service” payments before they receive treatment. Until she went to Fairview for her son Maxx’s ear tube surgery in November, Marcia Newton, a stay-at-home mother in Corcoran, Minn., said she had never been asked to pay for care before receiving it. “They were really aggressive about getting that money upfront,” she said in an interview.

Ms. Newton was shocked to learn that the employees were debt collectors. “You really feel hoodwinked,” she said.

While hospital collections at Fairview increased, patient care suffered, the employees said. “Patients are harassed mercilessly,” a hospital employee told Ms. Swanson.

Patients with outstanding balances were closely tracked by Accretive staff members, who listed them on “stop lists,” internal documents show. In March 2011, doctors at Fairview complained that such strong-arm tactics were discouraging patients from seeking lifesaving treatments, but Accretive officials dismissed the complaints as “country club talk,” the documents show.

Ms. Swanson said that the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay.

In the January lawsuit, Ms. Swanson said that by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act, known as Hipaa (pronounced HIP-ah). For example, an Accretive collection employee had access to records that showed a patient had bipolar disorder, Parkinson’s disease and a host of other conditions.

In addition, she said, the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.

Late Tuesday afternoon, Accretive announced it won a contract to provide “revenue cycle operations” for Catholic Health East, which has hospitals in 11 states.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2012|Oral Cancer News|

HPV Cancer Hits 8,000 Men, 18,000 Women a Year


HPV cancer isn’t just a female problem, new CDC figures show.

Although HPV causes 18,000 cancers in women each year, it also causes 8,000 cancers in men, the CDC calculates. To get the figures, CDC researchers analyzed data collected from 2004 to 2008 in two large cancer registries.

HPV, human papillomavirus, is the cause of nearly all cervical cancers. But that’s obviously not the only cancer caused by this sexually transmitted virus.

HPV also causes about two-thirds of mouth/throat (oropharyngeal) cancers, 93% of anal cancers, and more than a third of penile cancers. Men are four times more likely than women to get HPV mouth/throat cancer, while women are more likely than men to get HPV anal cancer.

Clearly, HPV is not just a female problem. Yet it was only last year that one of the two FDA-approved HPV vaccines was recommended for teen boys. Gardasil was recommended for girls in 2006; Cervarix was recommended for girls in 2009.

“HPV vaccines are important prevention tools to reduce the incidence of non-cervical cancers,” the CDC notes in a report in the April 20 issue of Morbidity and Mortality Weekly Report. “Transmission of HPV also can be reduced through condom use and limiting the number of sexual partners.”

HPV vaccines are most effective when given before people become sexually active. Yet in 2010, less than a third of teen girls had received all three doses of HPV vaccines. Numbers aren’t yet available for boys.

The slow uptake of the vaccine by teen girls is in stark contrast to the contribution HPV makes to women’s cancer risk. Taken together, HPV cancers are more common than ovarian cancers, and nearly as common as melanoma skin cancers in women.

Among men, HPV cancers are about as common as invasive brain cancers.

HPV Prevention

HPV is an extremely common sexually transmitted infection. At least half of sexually active people get HPV at some time during their lives. At any given time, more than 20 million Americans carry the virus.

Each HPV infection usually clears after a year or two. But that doesn’t always happen. Those HPV infections that persist can lead to the development of cancers.

Although condom use and limiting the number of one’s sex partners reduce HPV spread, vaccination — before a person becomes sexually active — is the surest way to prevent infection.

The Cervarix HPV vaccine protects against the two HPV strains most likely to cause cervical cancer. The Gardasil HPV vaccine protects against these and two other HPV strains.

Routine vaccination with three doses of Cervarix or Gardasil is recommended for girls aged 11 or 12. Routine vaccination with three doses of Gardasil is recommended for boys aged 11 or 12. Catch-up vaccination is recommended for females through age 26 and for males through age 21.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2012|Oral Cancer News|