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Lessons we can learn from Mayo

Source: www.chron.com Author: Leonard L. Berry & Kent D. Seltman Three goals underscore our nation's ongoing health care reform debate: 1) insurance for the uninsured, 2) improved quality and 3) reduced cost. Mayo Clinic serves as a model for higher quality health care at a lower cost. President Barack Obama, after referencing Mayo Clinic and Cleveland Clinic, advised, “We should learn from their successes and promote the best practices, not the most expensive ones.” Atul Gawande writes in The New Yorker, “Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest 15 percent of the country — $6,688 per enrollee in 2006.” Two pivotal lessons from our recent in-depth study of Mayo Clinic demonstrate cost efficiency and clinical effectiveness. Patient-first medicine: Throughout its 140-year history, Mayo Clinic has never put money first but lives its primary value: The needs of the patient come first. Mayo doctors, as all employees, are on salary. And the physicians are not extravagantly paid as their salaries are targeted between the 70th and 80th percentiles of a national physician compensation survey that includes the leading academic medical centers in the U.S. No doctor earns more by ordering an extra test or procedure. No doctor earns less by referring a patient to another Mayo physician with more expertise. Core values guide organizational behavior, and Mayo Clinic's patient-first core value guides the more than 43,000 employees. For instance, the head of [...]

Vaccine debate shifts to boys

Source: www.buffalonews.com Author: Henry L. Davis Parents who face the dilemma of whether to protect their young daughters with a vaccine aimed at a sexually transmitted infection that causes cervical cancer now face a new question: Should they do the same for their sons? As evidence mounts of a rising number of other cancers linked to the human papillomavirus, or HPV, a debate has intensified over whether to give the vaccine to males. Advocates say vaccinating boys and men can prevent them from passing on the virus to their sexual partners. Critics still question the long-term safety and effectiveness of Merck & Co.’s Gardasil, despite studies indicating that its risks and lasting power are within the range of other vaccines. But a newer wrinkle in the debate is the discovery in recent years that oral HPV infections — most likely acquired from oral sex with multiple partners—significantly increase the risk of head and neck cancers. The rate of oral cancers is rising so steadily, especially in men, that, if the trend continues, there may be more oral cancers in the United States caused by HPV in 10 years than by tobacco or alcohol, a major study concluded last year. “We should be investing our care and dollars in preventing HPV infection instead of treating the cancers,” said Dr. Thom Loree of Roswell Park Cancer Institute. Physicians at the cancer center have begun publicly touting the benefits of the vaccine on males after seeing an increase in the number of throat [...]

RCT treatment for cancer in India

Source: timesofindia.indiatimes.com Author: staff This information might come as a breather for cancer patients who go through bouts of pain during chemotherapy. Regional Chemotherapy (RCT), a latest development, promises to deliver higher survival and recovery rates than conventional chemotherapy. Cancer specialist Dr Karl Reinhad Aigner, who introduced RCT in Germany, is discussing the possibility with Indian hospitals, including Kidwai Institute of Oncology. Aigner, who was in the city on Friday, said: "RCT is restricted to a part of the body or an organ, making it safer. There are fewer side effects despite the strong effect on the tumour." The drug is administered regionally, in the area of supply of an artery. Aigner, who has successfully treated many patients using RCT in Germany, said: "Side effects are greatly reduced. RCT is subjectively tolerated in 95% of the cases. The quality of life is often improved after treatment." A patient receives six cycles of therapy and requires no major surgery. Oncology surgeon Dr Vijay Kumar said: "When a patient is administered a low-dose concentration, efficacy is less and failure rate high. In RCT the dose is of high concentration and so the efficacy is more." More than 2 million people in India are cancer patients. Dr Kumar said to introduce RCT, infrastructure with required equipment has to be established. "RCT can be used for all types of cancer, and especially benefit patients suffering from oral cancer. Eighty per cent of the patients reach the hospital at an advanced stage," he explained. Note: [...]

Capturing cell ‘fingerprints’ to advance cancer screening

Source: www.physorg.com Author: staff Researchers at Northeastern University have developed an early-stage, highly accurate cancer screening technology that determines -- in seconds -- whether a cell is cancerous, precancerous or normal. The breakthrough technology, for which there is a patent pending, automatically captures a “fingerprint” of the cell’s biochemical composition, which is subsequently analyzed by a computer for abnormalities. The new method, which currently can screen for oral, cervical and head-and-neck cancers, is faster, more accurate, and enables earlier detection than current screening methods. Those methods rely on the visual detection, under a microscope, of a few abnormally shaped cells among thousands. Referred to as Spectral Cytopathology (SCP), the technology was pioneered by professor of chemistry and chemical biology Max Diem, head of Northeastern’s Laboratory for Spectral Diagnosis; chemistry and chemical biology research scientists Melissa Romeo, Ben Bird and Miloš Miljkovic; and several Northeastern graduate and undergraduate students. “We are looking beyond traditional methods by focusing on detecting cellular changes that happen in the earlier stages of cancer, which will have a tremendous impact on patients,” said Diem. “Cytologists [scientists who study the structure and function of cells] have the most difficulty identifying pre-cancers in the earliest stages,” said Romeo. “Our technology offers the ability to detect abnormal changes in cells even before (structural) changes become apparent.” Earlier detection combined with greater accuracy—SCP has a greater-than 95 percent accuracy rate compared to 65 to 70 percent for current screening methods—would make a significant difference in patient survival rates. The high death [...]

Aggressive head and neck cancer

Source: speech-language-pathology-audiology.advanceweb.com Author: staff Scientists at Albert Einstein College of Medicine of Yeshiva University in Bronx, NY, have identified genetic markers that signal poor outcomes for patients with head and neck cancer. These findings could one day lead to a genetic test that could help select or predict successful treatment options for patients with this type of cancer [American Journal of Pathology, 174 (3): 736-745]. Head and neck cancer refers to tumors in the mouth, throat or larynx (voice box). Each year, about 40,000 men and women in the U.S. develop head and neck cancer, making it the sixth most common cancer in the U.S. Surgery, chemotherapy and/or radiation are the main treatment options but cause serious side effects: surgery may involve removing large areas of the tongue, throat, or neck and can affect appearance, and any type of therapy can cause swallowing or speech problems that can significantly affect quality of life. Despite curative treatment attempts, on average only about half of patients survive beyond five years after treatment. This is greatly affected by the size and location of the tumor. The Einstein study focuses on microRNAs, a recently identified class of short RNA molecules that play key roles in regulating gene expression. Abnormal microRNA levels have been associated with all types of cancer yet examined. In previous research, the Einstein scientists and other groups reported that approximately 50 specific microRNAs were expressed at higher or lower levels in head and neck tumor cell lines compared with normal cells. [...]

Drug to treat anemia in cancer is harmful

Source: www.emaxhealth.com Author: ruzik_tuzik A new review of data confirms that erythropoietin — a drug to treat anemia in many cancer patients — might be harmful. The review found that patients with head and neck cancers who received erythropoietin in combination with radiation had poorer outcomes than those who received radiation treatment alone. The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic. Severe anemia in cancer patients can lead to decreased oxygen supply to tumor cells. A lower level of oxygen in tumor cells is associated with more rapid tumor progression and a poorer response to therapy. Many use erythropoietin, or EPO, a hormone that controls red blood cell production, to correct anemia. “It has therefore been thought logical that using erythropoietin to correct anemia before or during chemotherapy, radiotherapy or both would improve prognosis,” the review authors write. Dr. Philippe Lambin and colleagues at the MAASTRO (Maastricht Radiation Oncology) Clinic in the Netherlands conducted the review. The investigators analyzed data from five published clinical trials that looked at whether combined radiation and EPO was better than standard radiation therapy alone in the treatment of head and neck cancers. Nearly 1,400 patients were included in the analysis. The researchers compared overall survival, the length of time during and after treatment in which the [...]

Topical EGF may decrease severe mucositis in patients with head and neck cancer receiving radiotherapy

Source: professional.cancerconsultants.com Author: staff Researchers from Korea have reported that recombinant epidermal growth factor (EGF) delivered as a spray twice daily may decrease the severity of severe mucositis in patients undergoing radiotherapy with or without chemotherapy for head and neck cancer. The details of this study appeared in an early online publication on June 9, 2009 in Cancer.[1] Oral mucositis is a frequent clinical problem in patients receiving chemotherapy and/or radiation therapy. Mucositis can be a severe dose-limiting toxicity, especially in patients receiving high-dose chemotherapy. Keritonocyte growth factor (Kepivance®) has been approved for prevention of mucositis in patients undergoing autologous stem cell transplantation. Other methods of treating or preventing oral mucositis include oral antiseptics, cryotherapy, laser therapy, L-glutamine (Saforis® and velafermin). Previous studies of antiseptic, antibiotic, and antifungal mouth washes and lozenges have revealed no dramatic effects, but two recent randomized trials suggested a limited role for topical antibiotic and antifungal treatment of mucositis. This multicenter trial enrolled 113 patients who were receiving definitive chemoradiotherapy or adjuvant radiotherapy. Patients were randomly allocated to a placebo group or to a group receiving three doses of EGF. Responders were defined as patients who had an RTOG grade of 2 or lower at the fourth- and fifth-week examinations. By this criteria 64% of patients receiving a 50-microgram dose of EGF responded compared with 37% in the control group. These authors concluded: “The EGF spray may have potential benefit for oral mucositis in patients undergoing RT for head and neck cancer. Phase 3 studies [...]

New figures reveal ethnic minorities are not aware of their cancer risk

Source: www.medicalnewstoday.com Author: staff Despite growing evidence that cancer is becoming more prevalent amongst ethnic minority groups, news figures out today at the start of Ethnic Minority Cancer Awareness Week show that cancer awareness levels are critically low amongst this cohort. At least 46% of ethnic minorities are unfamiliar or not sure about the signs and symptoms of the various forms of cancer or how to reduce their cancer risk even though 61% have had a family member suffer from cancer1. These figures are alarming because studies examining specific cancers and ethnic groups have shown that African Caribbean men are three times more likely to develop prostate cancer than white men2 and that mouth cancer is more common amongst South Asian and Chinese communities3. Quite a high number of ethnic minority women (78%) are aware of the NHS breast cancer screening programme1, however research has shown that 45% of black ethnic minority women of screening age (50-70) have never attended a screening of which 76% said it was because they had never been invited4. Only 22% of those questioned are aware of the NHS bowel cancer screening programme1 despite this form of cancer being the second most common cause of cancer death in the UK. If diagnosed at the earliest stage, bowel cancer is highly treatable with an estimated 83% survival rate5. Ethnic Minority Cancer Awareness Week (6th - 12th July 2009) was launched last year by Cancer Equality in partnership with an alliance of leading cancer charities who have [...]

Intensity-modulated radiotherapy reduces xerostomia in head and neck cancer

Source: www.oncologystat.com Author: staff Intensity-modulated radiotherapy significantly reduces the risk of subjective xerostomia by about 50% in patients with pharyngeal tumors, according to the first results of the multicenter, phase III PARSPORT trial. Cancer Research UK's PARSPORT (Parotid-Sparing Intensity-Modulated Radiation Therapy Compared With Conventional Radiation Therapy in Treating Patients With Oropharyngeal or Hypopharyngeal Cancer Who Are at High Risk of Radiation-Induced Xerostomia) trial evenly randomized 94 patients with pharyngeal tumors to conventional radiotherapy (conventional radiotherapy ) or intensity-modulated radiotherapy (IMRT). A three-dimensional technique, IMRT produces highly conformal dose distributions that can reduce the radiation dose to the salivary glands and normal tissue. At 12 months, the incidence of grade 2 or higher xerostomia was 74% in CRT patients vs. 39% in IMRT patients, based on the subjective portion of the LENT/SOM (Late Effects on Normal Tissue-Subjective/Objective Management) questionnaire (P = .004). The benefit of IMRT appeared to continue over time, with an 18-month xerostomia incidence of 71% with conventional therapy vs. 29% with IMRT (P = .003), principal investigator Dr. Christopher Nutting reported in a late-breaking abstract presentation at the annual meeting of the American Society of Clinical Oncology. A similar pattern was observed using the RTOG (Radiotherapy Oncology Group) scale. The incidence of at least grade 2 xerostomia was 64% with CRT vs. 41% with IMRT at 12 months (P = .05), and 81% vs. 20% at 18 months (P less than .001). This is the first randomized IMRT trial in head and neck squamous cell carcinoma, although phase [...]

Follow doctor’s advice, have lesion removed

Source: www.cantonrep.com Author: Peter Gott, M.D. Patients' question: In 1999, my dentist saw a discoloration on the floor of my mouth. He told me to see a doctor about it. The doctor talked me into having the spot surgically removed. A while back, I remember reading in your column that, 95 percent of the time, discolorations in the mouth are nothing to worry about. Recently, I had a procedure done to see if I had oral cancer. That procedure revealed another abnormal area. I assume it is the same thing as what I had removed before but the doctors now want me to have the spot surgically removed with a laser. I am hesitant and would like your advice. I have enclosed copies of both pathology reports, the first from 1999 and the second from a biopsy taken during the screening. Dr. Gott's response: In your first pathology report, the lesion was examined under a microscope. Abnormal changes were noted. These changes were labeled as mild to moderate squamous epithelial dysplasia. Primarily, this means that the flat, platelike cells in the interior covering of your mouth were altered in size, shape and organization. It was not stated that this was cancerous, but in my opinion, these changes were probably precancerous. Thus, having the lesion removed was a smart choice. Now, to the pathology report of your new lesion. According to the report, it very clearly showed that you have oral squamous cell carcinoma in-situ. This means that you have a [...]

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