Tuesday, April 19, 2005

Relay for Life Planning

I've been spending a lot of time lately as the head of our system's Relay for Life team. Not only do we have a participating team we're also the sponsor and host! I never knew how much planning goes into putting on an event like this. Part of the real challenge is to find time for planning along with continuing my day job. Needless to say, it has been experience.

We've held a couple of fundraisers for our team. One of them was a media sale where we sell used books, cd's, dvd's, vhs tapes, and software, that our system's employees donate, for a $1. We sold over 400 items in one day.

Our biggest fundraiser is a system wide "theme" basket sale. We challenge different departments in our system to create different theme baskets. Some of them this year were "Dinner & a Movie", "Fun in the Sun", "Baby Boy", I think you get the point. We set them out for a whole week and seek a$1 donation for a ticket to win the basket. Last year, one department used a wheelbarrow for a basket. This year coolers seemed to be the "basket" of choice. We had over 30 baskets this year and we broke last year's record by raising almost $7000 in donations for the baskets. Believe it or not, one lady won three baskets! I asked her if she wanted to go buy some lottery tickets after work.

Despite all the extra work, it has been fun working for such a great cause. Some of the best people you can meet are ones that volunteer their time for events such as the Relay. I'm planning on spending the whole night this year so wish me luck. Please share any favorable experiences you've had with Relay.

Friday, April 08, 2005

Major Radiation Overdoses at Florida Cancer Center

In the typical fashion of releasing bad news when most people are not focusing on the news, on Friday, April 2 H. Lee Moffitt Cancer Center & Research Institute released information that 77 patients received 50% higher radiation doses than prescribed. Whoa!

This is what we would call a major misadministration and the one thing that every Radiation Oncology professional fears. Boy, I can imagine the puckering sounds resonating in the executive and legal offices of that center. I'd say it is probably safe to say that there will be a few lawsuits filed in this case.

The technique used for these misadministrations is referred to as Stereotactic Radiosurgery. Basically this is a procedure that allows us to give higher doses of radiation by utilizing stereotactic techniques that minimize radiation doses to surrounding healthy tissues while delivering a therapeutic dose to the defined tumor volume. This is usually done in 1 to 5 fractions (treatments) instead of the normal 33 fractions for conventional Radiation Therapy. There are varying stereotactic techniques of which some require a frame screwed into the skull while others just require a thermoplastic mask that is molded into the shape of the patients head along with some type of bite block inserted into the mouth.

In most cases where a misadministration occurs, it is limited to a few patients. But in this case, it affected 77 patients from May '04 until last month. Not all of these were cancer patients. 21 of the patients were treated for benign processes such as AVM (arteriovenous malformation) or Acoustic Neuroma. Unlike most brain cancer patients, these individuals are expected to continue to live long healthy lives after their procedures are completed.

It was stated in the article that 12 patients have already died but didn't show any side effects of the overdose before passing. I would guess that these were most likely metastatic patients who were probably some of the first patients treated. Usually when initiating high risk procedures like this, you select patients that are going to die regardless of the results of the procedure. I know that probably sounds morbid but, the number one rule in medicine is to cause no more harm to a patient's condition than already exists. And in something like this, you sure want to have all possible problems eliminated before you perform the procedure on a curative or benign condition patient.

What is really sad about this unfortunate incident is that the effects of these misadministrations will not be realized for months or years in these patients. Radiation has a latent effect which means injury will not appear until a later time.

How did this happen? Good question. A place like Moffitt has at least 2 Medical Physicists and one Medical Dosimetrist. Probably more than that. That being said, if this staff was experienced, one would think that they would have questioned the higher than normal monitor units for the doses given. Monitor units are a measurement unit that we use to give the radiation doses on a linear accelerator.

Scuttlebutt in the field is stating that during the commissioning process of the new equipment there was data was converted to an MS Excel file and the cells were not protected. One of unprotected cells was then accidentally changed without anyone's knowledge. All subsequent QA was based on this incorrect data resulting in the dose errors.

There was an incident similar to this that occurred in a Nashville hospital in the early 90's. In that case a Medical Physicist inadvertently inserted a calibration factor twice. Luckily, this mistake was corrected early but still not until several patients had received large overdoses. A physician I knew saw one of these patients for a consultation to review the damage and it was not pretty.

Thank God for the RPC (Radiological Physics Center) in Houston. They are the organization that discovered this most recent error. This is an organization that tests Radiation Oncology facilities to assure that when they state they are giving a certain radiation dose they are indeed giving that dose. At major sites that perform clinical research protocols, they visit ever so often to test your equipment and check your QA. Our center participates in this program for the reasons mentioned above.

In the end, this will end up an expensive mistake that will cost the hospital lots of money, probably some people their jobs but most of all cost many patients their well being. One can only hope that the physicians were kind and caring physicians. Studies have shown that patients are least apt to sue if they fill that physician is caring and just made an honest mistake.

Wednesday, April 06, 2005

Peter Jennings Has Lung Cancer

I just saw a replay on Larry King of Peter Jennings announcing that he has been diagnosed with lung cancer and will begin chemotherapy next week. He sounded very hoarse and stated that he had smoked until about twenty years ago.

This will obviously bring lung cancer to the forefront of cancer discussions. We are seeing better success with lung cancer treatments but no where to the level you would like to see 5 year survival rates.

If you've ever seen a smoker's lung compared to a normal healthy lung you would be amazed. Lung cancer would be greatly reduced if people gave up the cancer sticks.

Occasionally there are still those cases where people who don't smoke but still develop lung cancer. We currently have a 33 yo female non smoker with a large upper lobe cancer that grew over 50% on two different chemo regimens. Luckily, with combined chemo (Gemzar)/radiation treatment the tumor regressed and was able to be resected. Amazingly enough, when the tumor was removed there was no evidence of disease. I put this one in the divine intervention category.

Tuesday, April 05, 2005

Let the Games Begin!

It was announced on April 1st, that CMS (Medicare) is launching a website, aptly named Hospital Compare, that will show comparisons of hospitals performance on certain key indicators. This has been long in coming and will only further develop as the "pay for performance" mantra continues to expand into the hospital environment.

Currently, there aren't any indicators for performance in the area of Oncology but I would be safe to say they're coming. The current indicators have to do with Cardiology and Respiratory results in the hospital environment. I was really intrigued by the results when I compared local hospitals in my region. You should definitely give it a try in your area.

What will really be groundbreaking is if they can develop a physician comparison database. Although, I think that will be a long time in coming. It would definitely be welcomed by the public. Can you imagine comparing the physician you've been scheduled to see to other like physicians? If his/her results aren't favorable than you might decide to cancel and schedule with the one that has favorable results. This would turn the healthcare marketplace on its ear and would help break the barrier to make "pay for performance" a reality.

There are many roadblocks to implementing such a database. One would be issues with tracking and reporting data which would only add to the cost of private practice. In the face of decreasing reimbursements, the physician lobby would prevent this from ever being mandated by the government. But we can dream!

Monday, April 04, 2005

Break from the Norm

Most of my posts here have focused on issues related to Oncology but I thought today I would take a break from the norm and talk about a topic that has been driving me crazy lately.

Have you noticed an increase in blurred spots on your TV screen as of late? In the latest "don't give any ad time for free" craze, TV stations and networks across the country have been blurring out anything from t-shirts and car logos to restaurant signs to the sides of soda cans.

First it started with t-shirts with less than proper usage of the English language but now it has escalated to anything that hasn't paid a fee to be cameoed on the show. Half the time I think there is something wrong with my TV. How would you like to have that job? I guess you would watch the show with your blur mouse and follow around the illegal ad as it moved throughout the show whether it is a hat, shirt, shoe, tattoo, door, chair, wall, sign, building, pizza, I digress.

I guess it is all stemming from the state of advertising today. If there is a place to put an ad its there. The only place I hadn't seen one yet is on the underside of a toilet seat. Don't tell anyone or it will be sure to appear. I can see it now, "Use Tidy Bowl for ..., " you get the point.