Monthly Archives: January 2006

The Search for Quality in Breast Cancer Care

Quality medical care is not a new topic for this blog. 


 


I have previously written about Medicare’s demonstration project designed to test the feasibility of collecting data from oncologists regarding their willingness to follow established practice guidelines as part of their routine patient care.


 


I have just spent the past two days involved in a (relatively) small group discussion about how we could improve our abilities to measure the quality of care received by women with breast cancer.  It was an interesting and productive session, including presentations and participation by some of the leading experts in quality improvement in medicine and other professions.


 


This is not a new interest for me.  Back in the early 1990’s I was a member of a guideline panel that looked at how we could improve the quality of mammograms.


 


The American College of Radiology had developed recommendations for quality mammography, and there was growing national concern that we were not doing our best to assure women that the mammogram they received met minimal quality standards.


 


To address the issue, the government decided that standards were necessary.  A panel was brought together to review the evidence Continue reading →

Using the Media: You Need to Get It Right

What started out yesterday as a routine request from a journalist to comment on a routine press release about a scientific report became one of the more interesting examples of why what you read may not always be what you think it is.


 


Several months ago, I discussed the information process and how it influences the behaviors of patients and physicians in cancer treatment.  An important element of that discussion is the need for everyone to be responsible in the process.  In fact, not just responsible, but exceptionally responsible, since the reports of cancer research outcomes may affect someone’s life very directly.


 


It is not just the doctors and the patients who are interested in what the media has to say about cancer treatments and breakthroughs.  So are the financial folks, who look for clues that a company has developed something important that may influence the performance of that company, and eventually impact their profits and their stock prices.


 


How a story is presented can influence those very important perceptions.  Presentations don’t have to be wrong to be misleading.


 


The “process” used to work differently years ago.  Companies or research … Continue reading →

New Hope for Patients with Bladder Cancer

Bladder cancer is one of those types of cancer that seems to fly under the radar screen of most folks.


 


It’s not that the disease is that uncommon.  There were estimated to be 63,000 new cases of bladder cancer in the United States this past year, and 13, 180 deaths.  The disease is more common in men than women in a ratio of about 3 to 1.  In terms of deaths in the United States, it is the 9th most common cause of death from cancer in men while for women it is much further down the list.


 


Maybe the reason we are somewhat complacent about the bladder cancer is that for many people it is not a life threatening disease.  It is frequently superficial, and requires repeated follow-up over a lifetime to look for recurrences which then require treatment. 


 


It is a cancer that is associated with smoking, and over the past several years there has been an actual decrease in its incidence, perhaps related to decreased tobacco consumption.  The decrease is most notable in African Americans.  It is also a disease of the elderly, with increasing … Continue reading →

Prostate Cancer Screening: The Confusion Continues

If you are a man, age 50 and over, and find all of the information you are hearing about prostate cancer just plain confusing, do not feel alone.  Because you are not the one with the problem.  In no small part, the experts you rely on to provide you with clear, concise medical information and direction have not been in your corner for some time.


 


That’s not necessarily the experts’ or the doctors’ fault.  There is so much confusing research and commentary about prostate cancer screening that someday someone will write a historical book on the subject.  It may not be a best seller, but it will reinforce the fact that you have not taken leave of your senses when it comes time to make a decision about whether or not to get screened for prostate cancer.


 


An article this week in the Archives of Internal Medicine didn’t do much to clear the clutter.  It certainly made the headlines, and the message delivered by our media friends was that prostate cancer screening is not effective.


 


Basically, the authors looked at medical records of men treated in VA Hospitals who had been diagnosed … Continue reading →

Dogs And The Early Detection of Cancer

The first time I heard about dogs being able to “sniff” cancer in a sample of urine was many months ago.  I have to admit that at the time I was very, very skeptical.


 


The research concept that was reported in an article in the BMJ (also known to many of us as the British Medical Journal) in September of 2004 was fairly straightforward: dogs have a very well developed sense of smell, and maybe they can smell something in a body fluid that may be able to detect whether or not the patient had cancer. 


 


As the researchers reported, up to that time there had been several anecdotal reports of pet dogs alerting their owners to the fact that something was amiss, and that something turned out to be cancer.


 


What the researchers found was that in a group six ordinary dogs they were able to train the dogs to detect something through their sense of smell in the urine of cancer patients that was different from the urine of people without bladder cancer. 


 


The test wasn’t perfect.   The dogs were right 41% of the time, compared to 14% which would have been … Continue reading →

Does Vitamin D Really Reduce The Risk Of Cancer?

The vitamin D issue has arisen once again.


 


Back in April, at a major national scientific conference, a Harvard researcher gave a talk on the role of vitamin D in the prevention of cancer.  The lecture, which is available online, was well done and based on scientific data.  (See presentation by Dr. Edward Giovanucci on this webpage.) It didn’t get much notice, however, until an Associated Press reporter did a story on it a couple of weeks later.


 


That’s when the proverbial “stuff” hit the fan.  Media outlets around the world jumped on the story immediately and fanned the flames that vitamin D was the answer to decreasing the incidence of several forms of cancer that afflict hundreds of thousands of people every year in the United States.


 


Other scientists were a bit more reserved in their thinking, but still were of the opinion that this is an area that needs further examination and consideration.


 


One of the major concerns of many, including me, was that the public would read only one half of the story, namely that sun exposure (the major source for the production of Vitamin D in the body) was … Continue reading →

Ovarian Cancer: Something Old, Something New

 


I do hope that you and yours had a very happy holiday.  I want to wish you health, happiness and success for the New Year.


 


I apologize to those who wonder where I may have been the past several weeks.  I took some much needed time off from work, with every intention of continuing to post the blog occasionally during the interval.  As situations dictated, I had to really take some time off for various reasons, so the computer remained closed for the duration.  But, we are back, and hopefully that won’t happen again—at least not until next December!


 


Now, back to the blog:



 


 


There is an article and editorial released for publication this afternoon in the New England Journal of Medicine about the use of intraperitoneal chemotherapy (giving chemotherapy drugs directly into the abdomen through a small tube, or catheter) in the treatment of advanced ovarian cancer.  They are accompanied by a press release from the National Cancer Institute, and I suspect this will get a fair amount of media coverage.


 


The article interests me for a couple of reasons:


 


First, the therapy isn’t really new.… Continue reading →