tag:blogger.com,1999:blog-111530492024-03-07T21:50:07.887-05:00Joe OncologyJoehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.comBlogger30125tag:blogger.com,1999:blog-11153049.post-25852787177050718502007-09-27T01:16:00.000-04:002007-09-27T02:20:40.201-04:00ElastographyRecent clinical research studies on a new imaging technology are demonstrating amazing results in detecting cancer without so much as breaking the skin. The technology, <span class="blsp-spelling-error" id="SPELLING_ERROR_0">elastography</span>, is mainly utilized through ultrasound but also is used in MRI. How does <span class="blsp-spelling-error" id="SPELLING_ERROR_1">elastography</span> work? Below is the best diagram I could find that best visually demonstrates how <span class="blsp-spelling-error" id="SPELLING_ERROR_2">elastography</span> works.<br /><div style="text-align: center;"><br /></div><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9F0AVMNFuFB7ZIp-fE3RNHNfvuynFdkeVw9kUSJ0Ut6Jm6pfI4ZTfvO61HrbutqNzyHpHOI_5ObZP9sNVE2s8saPDpYLkJ4FsrrqXVZCaylCVhEmBnVJzvzyhNYFTYpK4VBHboA/s1600-h/AP_Cancer.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9F0AVMNFuFB7ZIp-fE3RNHNfvuynFdkeVw9kUSJ0Ut6Jm6pfI4ZTfvO61HrbutqNzyHpHOI_5ObZP9sNVE2s8saPDpYLkJ4FsrrqXVZCaylCVhEmBnVJzvzyhNYFTYpK4VBHboA/s400/AP_Cancer.gif" alt="" id="BLOGGER_PHOTO_ID_5114761582994855170" border="0" /></a></div><div style="text-align: center;"><span style="font-size:78%;">Credit: <span class="blsp-spelling-error" id="SPELLING_ERROR_3">MSNBC</span>.com<br /><br /></span></div>Recently, studies have demonstrated remarkable detection accuracy rates in thyroid, prostate, and breast cancer detection. Last year, a small breast cancer detection study involving 80 women accurately distinguished 100% of malignant tumors and 99% of non-malignant tumors. In another small<span style="text-decoration: underline;"> </span><a href="http://www.ingentaconnect.com/content/bsc/iju/2007/00000014/00000009/art00007;jsessionid=2p540n8jdbfn6.victoria">preliminary study</a> for detecting prostate cancer presented last month, <span class="blsp-spelling-error" id="SPELLING_ERROR_4">elastography</span> demonstrated excellent detection accuracy. The authors went so far as to state, "the cancer detection rate with real-time <span class="blsp-spelling-error" id="SPELLING_ERROR_5">elastography</span> was superior to the rates of other modalities..." This month a <a href="http://www.medicexchange.com/mall/departmentpage.cfm/MedicExchangeUSA/_81694/2549/departments-contentview">thyroid study</a> conducted in Italy demonstrated encouraging results stating that <span class="blsp-spelling-error" id="SPELLING_ERROR_6">elastography</span> has "great potential" in certain tumor types.<br /><br />Additionally, the costs for <span class="blsp-spelling-error" id="SPELLING_ERROR_7">elastography</span> are predicted to be remarkably less expensive then the cost for a typical biopsy today. The results will be almost immediate as well as you don't have to send tissue away for interpretation by a clinical pathologist.<br /><br />For now, further research on a larger scale is being planned with hopes of demonstrating similar results. If the technology demonstrates the same accuracy level on a wider scale, many are predicting that biopsies will drastically be reduced which will result in less unnecessary invasive procedures, less time loss from work, and overall better care for patients.<br /><br /><div style="text-align: center;"><img src="file:///C:/DOCUME%7E1/SWARWICK/LOCALS%7E1/Temp/moz-screenshot-1.jpg" alt="" /><img src="file:///C:/DOCUME%7E1/SWARWICK/LOCALS%7E1/Temp/moz-screenshot-2.jpg" alt="" /></div>Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-14929330708045514932007-09-19T22:38:00.000-04:002007-09-19T22:45:19.715-04:00Gotham Prize for Cancer ResearchI come across a novel approach to spur cancer research ideas today. The <a href="http://www.gothamprize.org">Gotham Prize for Cancer Research </a>is offering 1 million dollars annually to the most innovative cancer research idea. Anyone can submit an idea even without proof that it will work. A scientific panel reviews all applicants and decides if the idea is worthy of consideration. I applaud such efforts from the private community. We need more and more ideas such as this.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com1tag:blogger.com,1999:blog-11153049.post-77152923047485489762007-08-16T20:14:00.000-04:002007-08-16T22:30:33.017-04:00The Difficulty of Managing Clinical ResearchWe are offering clinical research for our patients. It is no easy task. The mounds of paperwork required by the multitude of agencies involved is unbelievable. It is even more than I imagined and I knew it was bad. I'm amazed that so many centers offer it as part of their programs. Here is a small example of what we faced when starting our program. Agency 1 will not approve you for x until Agency 2 approves you for y. While at the same time, Agency 2 won't approve you for y until Agency 1 approves you for x. I joke with our Clinical Research Coordinator when she gets frustrated with the red tape that she is like one of those show dogs who jumps through all the hoops except there never is an end. Below is a list of several of the agencies whose requirements and regulations we have to meet to offer clinical trials.<br /><br /><ul><li><span style="font-weight: bold;">FDA</span> - Food and Drug Association</li></ul><ul><li><span style="font-weight: bold;">NIH</span> - National Institutes of Health</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">NCI</span> </span>- National Cancer Institute</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">CTSU</span></span> - Clinical Trials Support Unit</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">OHRP</span></span> - Office of Human Research Protections</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">RPC</span></span> - Radiological Physics Center</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">ITC</span></span> - Image Guided Therapy <span class="blsp-spelling-error" id="SPELLING_ERROR_5">QA</span> Center</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">CTEP</span></span> - Cancer Therapy Evaluation Program</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">QARC</span></span>- Quality Assurance Review Center</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">NSABP</span></span> - National Surgical <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Adjuvant</span> Project for Breast & Bowel Cancer</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_10">RTOG</span></span> - Radiation Therapy Oncology Group</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_11">ECOG</span></span> - Eastern Cooperative Oncology Group</li></ul><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_12">SWOG</span></span> - Southwest Oncology Group</li></ul><ul><li><span style="font-weight: bold;">GOG</span> - Gynecologic Oncology Group</li></ul><br />There are many more. We have a legal agreement with each of these organizations and thus have to send them through the legal department for review which can take a considerable amount of time. And I haven't even mentioned what it takes to get a protocol approved through yet another acronym, the<br /><br /><ul><li><span style="font-weight: bold;"><span class="blsp-spelling-error" id="SPELLING_ERROR_13">IRB</span></span> - Institutional Review Board</li></ul><br />Another problem we have is recruiting enough patients to go on trial. Patients like the idea of clinical trials but they don't like the idea of possibly receiving a placebo. I wouldn't either. Thus many opt for traditional treatment until there are no other options. Many by then don't have the will, the energy, or the qualifications to go on a clinical trial. <br /><br />If you're looking for a clinical trial a great website is<br /><br /><a href="http://www.clinicaltrials.gov">Clinical Trials.gov</a><br /><br />You can search by drug, diagnosis, or just about any other thing you can think of. The only problem is it is hard to navigate or understand if you don't have much of a medical background. But by the time an individual or family member has resorted to searching for clinical trials they usually know enough to point themselves in the right direction.<br /><br />Now, don't get me wrong. Clinical Trials are a great thing. They should just be a lot easier to offer and manage especially with the continued declining reimbursement environment we are facing every year.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com2tag:blogger.com,1999:blog-11153049.post-21047549200642868482007-08-05T22:11:00.000-04:002007-08-05T22:13:30.245-04:00Great QuoteI heard a great quote today about faith based health care center. The person said there should be a sign above the door that says "The Great Physician Works Here." I like that.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-45755325196772526912007-08-03T10:23:00.000-04:002007-08-03T10:28:33.744-04:00I'm BackWow. What a hiatus. Over the last year family medical issues have precluded me from spending time on blogging. Actually, I've been blogging but on a personal level rather than professional. I've learned a lot about healthcare over the last year which has made me a better Oncology administrator. Additionally, my professional role has expanded to other related areas that will allow me to comment in a broader sense. I look forward to sharing that here.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1144122857757465842006-04-03T23:44:00.000-04:002006-12-05T19:16:37.360-05:00Continued Smoking Limits Chemotherapy SuccessOne of the most interesting things I've noticed about lung cancer patients is that many continue to smoke after their diagnosis. Many subscribe to the philosophy that they "might as well keep smoking" since they already have cancer. <br /><br />But a new <a href="http://www.medicalnewstoday.com/healthnews.php?newsid=40829">study</a>, has debunked that thinking. In the linked article it is stated that continued nicotine use seriously reduced chemotherapy effectiveness. This even applies to smoking cessation products that contain nicotine. <br /><br />I haven't had a chance to discuss this with our Med Oncs yet but it will be interesting to see if they use this information to attempt to convince all of their patients to cease smoking before chemotherapy begins.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com2tag:blogger.com,1999:blog-11153049.post-1143583526932292452006-03-28T16:45:00.000-05:002006-03-28T17:05:26.946-05:00For Profit Cancer Centers<span style="font-family:georgia;">In a recent </span><a style="font-family: georgia;" href="http://www.businessweek.com/magazine/content/06_14/b3978096.htm?campaign_id=rss_magzn">article</a><span style="font-family:georgia;">, Business Week takes a look at a growing trend, for-profit cancer specific centers such as <a href="http://www.cancercenter.com/">Cancer Treatment Centers of America</a>. CTCA is based outside of Chicago and provides a service specifically geared to end stage cancer patients who have been given no other hope by their own Oncologists. Its not so much that they offer any treatment greater than everyone else but they offer what the patient has lost; HOPE.<br /></span><br /><span style="font-family:georgia;">What I find specifically interesting about the article is contained in the second to last paragraph, </span><br /><br /><span style="font-family:georgia;">"</span><span class="text" style="font-family:arial,helvetica,univers;"><span style="font-family:georgia;"> The privately held company eschews physician referrals and advertises to people with late-stage cancer, promising to do almost anything they want to combat the disease."</span><br /><br /><span style="font-family:georgia;">If you talk to any administrator, they will tell you that this as your sole business strategy will never work. But, yet it is for CTCA albeit on a national basis. It makes you wonder if you indeed inform the patient enough about your services through marketing can you circumvent the normal referral process. Our organization subscribes to the non-marketing strategy. It's like pulling teeth to get them to market to the public. What they don't understand is that cancer patients are probably the most informed patients in the marketplace. If marketing to the public didn't work, you wouldn't be seeing umpteen (southern colloquialism) ads for Viagra, Levitra, and Cialis. </span><br /><br /><span style="font-family:georgia;">But I digress.</span><br /></span>Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1139514318658802732006-02-09T13:23:00.000-05:002006-02-09T14:52:17.140-05:00Another Radiation Therapy Treatment IncidentIn another unfortunate radiation <a href="http://www.medterms.com/script/main/art.asp?articlekey=4906">incident</a>, a 15 year old girl from Scotland who received Radiation Therapy for a rare brain tumor (<a href="http://www.medterms.com/script/main/art.asp?articlekey=4906">pineoblastoma</a>) was accidentally overdosed during her 17 treatments. It sounds as if she is already experiencing severe erythema. The amount of overdose has yet to be released.<br /><br />These type of incidents are going to occur despite how much quality assurance is performed. Especially when a center like the <a href="http://www.beatson.org.uk/">Beatson Oncology Centre</a>, where this occurred, that treats 6500 Radiation oncology patients a year on ten linacs. Most of the time something like this happens someone catches it while it can be corrected. But, like the incident at Moffitt in Tampa, sometimes it slips through the whole course. I've seen it happen before and it is amazing to see how many people can not pick up on the obvious.<br /><br />It is terribly unfortunate for they young lady but is also devastating for the workers involved in this mistake. Their professional careers are irreparably damaged not to mention the personal dismay at the damage they caused to this young lady. People in Scotland are already calling for their dismissal.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1130477620582699702005-10-28T00:47:00.000-04:002005-10-28T01:33:40.593-04:00Proton Therapy, Boon or Bust?<a href="http://photos1.blogger.com/blogger/1573/162/640/ptc_photo.jpg"><img style="CLEAR: all; FLOAT: right; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="http://photos1.blogger.com/blogger/1573/162/320/ptc_photo.jpg" border="0" /></a>There are really two issues when discussing MD Anderson's new $125 million proton therapy treatment center scheduled to open in the Spring of 2006. A recent <a href="http://http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3409510">article</a> in the Houston Chronicle touches on both of these issues. The first issue, a clinical one. Is proton therapy worth the enormous costs of providing it? The second is the controversial method to used to finance this behemoth.<br /><br />At one time, it was believed that proton therapy was the holy grail of Radiation Therapy. But with the advent and introduction of new technologies in Radiation Therapy such as <a href="http://http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3409510">IMRT </a>(Intensity Modulated Radiation Therapy) it may no longer be considered such. Proton Therapy deposits its dose in the planning tumor volume without exposing surrounding healthy tissues to high doses. IMRT, implemented in most areas of the country 4 years ago, accomplishes the same effect at a MUCH lower cost. There are no comparative randomized studies comparing the two technologies. But, the name of the game in cancer care today is differentiation from your competitors. You're always looking for that edge that will gain marketshare by offering a service your competition doesn't have. MD Anderson, the cancer center above all cancer centers, is taking this concept to a new level. It's occuring in our area with <a href="http://www.accuray.com/">CyberKnife</a>, <a href="http://www.elekta.com/healthcareus.nsf">GammaKnife</a>, and <a href="http://www.mammosite.com/index_mammo.asp">MammoSite</a> albeit on a much smaller scale.<br /><br />The second issue is also becoming an increasing trend in cancer care today; joint ventures. Most often these ventures are between a health system and physicians but, in this case it is between MD Anderson and many outside investors. MD Anderson stands to make a seven figure benefit if the investors make enough money. Part of the agreement states MD Anderson has to promote this type of therapy. This type of arrangement causes many concerns. One of which is will this incentive consciously or inconsciously cause patients to be steered toward Proton therapy rather than the cheaper and more efficient IMRT? You would hope that the Hippocratic oath and strong ethics would come into play here but, after experiencing similar situations myself, I know better. Just like in everything else, its ALL about the money. I report, you decide. <a href='http://picasa.google.com/' target='ext'><img src='http://photos1.blogger.com/pbp.gif' alt='Posted by Picasa' style='border: 0px none ; padding: 0px; background: transparent none repeat scroll 0% 50%; -moz-background-clip: initial; -moz-background-origin: initial; -moz-background-inline-policy: initial;' align='middle' border='0' /></a> Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1127922004412328972005-09-28T10:45:00.000-04:002005-09-28T11:47:04.240-04:00Identity Theft - Medical StyleI'm sure we're all aware of the recent phenomenon of identity theft and the financial issues it has caused thousands of people. Well, as I alluded to in my last post, I was made aware of an issue by our Medical Records Director that I hadn't ever given consideration. Medical Identity Theft!<br /><br />The Director described several instances in the last year of individuals presenting to the ER for medical care and using stolen insurance cards. The more I thought about it the more I surmised that this would be harder to catch than trying to nab people using stolen credit cards.<br /><br />Think about it. You go to the ER or your physician's office and give them your insurance card which, they copy and give back to you. You receive your service, make your co-pay, and you're out the door. Weeks later you receive your EOB of which you review, well, some of you review. Therein lies the problem. You won't even discover that someone has stolen your medical identity until weeks later and they're long gone. In the mean time, while you attempt to straighten this out, the medical providers turn you over to a collection agency and now you have issues not only with your medical records but your finances as well. Think its far-fetched? This <a href="http://www.nbc13.com/nbc13investigators/2057120/detail.html">poor soul</a> didn't even have his insurance card stole and he still became a victim on an ID alone.<br /><br />There are even more versions of medical identity theft. You could be <a href="http://www.mindfully.org/Health/2005/Medical-Identity-Thieves22feb05.htm">laid up in the ICU </a>and someone takes your identity and runs with it. Criminals are also <a href="http://www.sfbctc.org/011705-identity.htm">purchasing medical supplies and equipment</a> with health insurance info and then fencing them on the <a href="http://dictionary.reference.com/search?r=2&q=gray%20market">gray market </a>to support their other dubious endeavors. This widow <a href="http://www.ftc.gov/bcp/workshops/idtheft/comments/weaverlind.htm">reports</a> on the FTC website that she avoided possible tragedy when someone admitted herself into the hospital in her name with a different blood type than hers. Had she not checked when she needed an infusion she could have possibly received the wrong blood type.<br /><br />In a recent article, the University of Connecticut notes that it <a href="http://www.advance.uconn.edu/2005/050907/05090711.htm">has experienced this problem</a> to the tune of $76,000 for one patient alone and is taking aim at correcting it by requiring picture ID's for all services. They have already experienced positive results of their new policy. Several people have presented for care and have stated they left their ID in the car only to never return after going to retrieve it.<br /><br />How can you help protect yourself? Carolyn Pennington of UCONN states in her article that the State of Connecticut recommends the following:<br /><br />The state insurance department offers tips for protecting yourself: <ul> <li> Never give out health insurance information over the phone. </li><li> If you lose your card, call your insurance company right away. </li><li> Keep your health insurance information private, even from family members.</li> </ul> The ol' cliche, "It takes all kinds," seems to ring true here.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com1tag:blogger.com,1999:blog-11153049.post-1126791499755858482005-09-15T09:50:00.000-04:002005-09-15T09:43:55.546-04:00I Thought I Had Heard It AllEvery morning when I arrive at work there is usually a new issue/problem waiting for me. Today was no exception. I had a voice mail from a very stressed Medical Records Director concerning a patient of ours. This patient had received an implant on a certain date but now, he and his family are denying that they were ever here.<br /><br />I had to chuckle, for a couple of reasons. One because it reminded me of the old Eddie Murphy Delirious stand up comedy routine where he describes the situation where a wife sees her husband exiting a motel room with another girl. When she confronts him about it he continually denies it was him saying, "wasn't me." She tells him that she saw him with her own two eyes and he continues to state it wasn't him. After a few minutes, she begins to question herself and says "Maybe it wasn't you?" The second reason was I said to myself, "I just thought I had heard it all."<br /><br />So I go and review our records and just like I thought we have signature proof and detailed records demonstrating that he was indeed here on the disputed date. It is amazing the things people will do to avoid paying the bill. In my next post, I'll discuss a related issue that came up when trying to resolve this one. Something I hadn't even thought about or knew existed but, when I was told about it, it didn't surprise me in the least.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1126790576729665862005-09-15T09:17:00.000-04:002005-09-15T09:22:56.743-04:00Long Time No BlogWell, once again I have to apologize for avoiding my blogging duties. I can really tell the traffic has died off this month with no new updates. Between work, home, and church, blogging on a consistent basis is hard to do. Not to mention coming up with content that readers would be interested in reading. I have to give kudos to those that are able to blog daily with information worth reading.<br /><br />In my hiatus, several topics I would like to discuss have come on the horizon so I hope to get them out of my head and onto the blogosphere. So look for some new posts from here on out.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1122901966956856722005-08-01T09:06:00.000-04:002005-08-01T09:12:46.963-04:00JCAHOAs I prep for our JCAHO inspection next week I thought I might see if any of our readers have had a recent inspection. If you have send me any pointers or questions that you think I should prepare for before the inspection. I've been through several but none since the new tracer methodology has been implemented. <br /><br />I'm a little more nervous for this inspection since I won't be here for it. I scheduled vacation thinking the inspection would come later. Guess, what? It didn't. Oh well, they always say evidence of a good administrator is how well his staff performs while he is away. I guess I'll be finding out.<br /><br />Email me any pointers or questions you've been asked in any recent inspections.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1122787000409994502005-07-30T23:59:00.000-04:002005-07-31T01:28:13.763-04:00Budgets, Budgets, BudgetsMy apologies for the lack of posting here as of late. I've been covered up with capital budgets, operational budgets, productivity standards, and now moving to JCAHO prep for an inspection coming up next month.<br /><br />I always find it interesting that we're required to submit proposals for the next capital budget year in June. Number one, its hard to get quotes for equipment/software that will last until the new year. Secondly, for those in Radiation Oncology, ASTRO isn't until mid-October so you have to try to budget for equipment that will not be released or seen until after your budget is submitted.<br /><br />I find capital budgeting interesting. Basically, in our system, you're competing with other service lines for a limited amount of dollars. For us, our main competition is imaging. Since the dollars are limited, thorough proposals where the high tech lingo is explained in layman's terms for executive management teams with proformas that demonstrate revenue and income usually win out. You would be amazed at some of the shoddy proposals I've seen submitted.<br /><br />To top things off, our system heads right into operational budget prep after capital is submitted. Operational wouldn't be that bad if there were only one cost center. Even that isn't that bad but what is the real kicker that has came on the scene in the last few years is productivity monitoring.<br /><br />Percentiles, targets, yada, yada, yada. I think its all a bunch of hocus pocus in our field. I see where these type programs might work for service lines such as nursing that have large numbers of employees and can flex with volumes. But Rad Onc?, I can't see it. Number one you need a basic number of staff whether you treat 1 patient or 40. Number two, I haven't a center that accurately reflects the number of procedures they perform. They either under report due to incompetentcy or they over report to make themselves look better. Either way, in Rad Onc it is extremely hard to compare apples to apples. Thus, if your comparisons are flawed from the "get-go" the whole production is shot. I could go on but, that's another post another day.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1118535856288261492005-06-11T20:23:00.000-04:002005-06-11T20:24:16.293-04:00New Cancer Fighter: Big Mac Tax!The leading cancer specialist in Scotland, Dr. Anna Gregor, has called for a <a href="http://www2.netdoctor.co.uk/news/index.asp?id=119225&D=1&amp;M=6&Y=2005">special tax on Big Macs</a> and other fast foods to help battle cancer. Dr. Gregor believes that fatty foods and poor diet contribute to the poor health of her fellow Scots and she may be right. More and more<a href="http://rex.nci.nih.gov/NCI_Pub_Interface/raterisk/risks73.html"> research studies</a> have shown that a fatty diet increases risk for certain types of cancers.<br /><br />So since we have a tax on everything else it doesn't surprise me that someone is now proposing a tax on food. Now, I'm all for battling cancer but taxing Big Macs, Whoppers, and fries isn't the method to take. It will control people's desires for fast food about as much as it does for beer and cigarettes.<br /><br />I believe education about diet and making those choices available or two of the main keys to a better diet. If you don't know what to eat then obviously eating a healthy diet will be a little challenging to say the least. <a href="http://www.hsph.harvard.edu/nutritionsource/pyramids.html">Recent changes</a> to the food pyramid, the low carb craze, and other methods of the day have only confused people to what is a healthy diet. Secondly, if you know what to eat but those choices are not available then eating healthy is a mute point. What we need are some decent healthy fast food choices. One can only eat so much Subway. The message is getting there but a fruit bowl isn't enough for me.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1117085819072877662005-05-26T01:22:00.000-04:002005-07-31T01:19:06.093-04:00Break Out the L'OREAL!You can feel safe now in covering up the grey. In the latest edition of the J<a href="http://jama.ama-assn.org/">ournal of the American Medical Association (JAMA)</a>, the<a href="http://health.yahoo.com//news/62323"> latest study on hair dye</a> concludes that it doesn't cause cancer. Did anyone think it did? By the looks around my place of employment, a cancer center no less, you wouldn't have thought it, but I digress.<br /><br />What is the deal anyway with the new trend of not only having one color, but two? My brunette wife came home a few weeks with not ony auburn highlights but blonde as well. Of course you still have your single dye people such as the girl serving my mocha blast from Baskin Robbins last night. She had just a section of purple in her silky black locks which, kind of matched some of the flavors. To each his own I guess.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1115732026201313292005-05-10T08:28:00.000-04:002005-05-10T09:33:46.226-04:00Single Malt Whiskey: The New Cancer PreventativeNow, I have heard it all. An independent consultant for the global drinks industry, who has a PhD in Biological Sciences from <a href="http://www.hw.ac.uk/">Heriot-Watt University</a>, touts that <a href="http://www.sci-tech-today.com/story.xhtml?story_id=34508">"whisky can protect you from cancer -- and science proves it."</a><br /><br />According to Mr. Swan, the <a href="http://dictionary.reference.com/search?q=ellagic+acid">ellagic acid</a> in single malt whiskey acts as a "free radical scavenger" that "absorbs" or "eats up" <a href="http://cancerweb.ncl.ac.uk/cgi-bin/omd?free+radical">free radicals</a> produced from eating. "The free radicals can break down the DNA structure of our existing cells, which then leads to the risk of the body making replacement rogue cancer cells," he said. While it may be true that <a href="http://cancerweb.ncl.ac.uk/cgi-bin/omd?antioxidants">antioxidants</a> may help ward off free radicals, what he forgets to mention is that alcohol use can lead to liver damage, esophageal cancer and a myriad of other diseases. Not to mention the addictive habits that illicit many of today's social ills such as drunk driving and mental or physical abuse.<br /><br />Let's take a look at Mr. Swan's profile from the <a href="http://registration.meetingmakers.co.uk/euromedlab_2005/pdf/news7.pdf">EuroMedLab Glasgow 2005 News</a> March issue. Mr. Swan "assists the quality aims of blue chip brewers, wine makers, and spirits distillers as well as small producers in 5 continents...He is a member of the scotch malt whiskey society taste panel...(here's the kicker) His particular love is the quality and varied flavours of single malt scotch whiskies." Yea, I bet it is. Can you say "Major Conflict of Interest" here. I knew you could. Sounds like to me his particular love is lining the insides of his pockets with pounds, euros or whatever they're using over there now by espousing half truths that ordinary people will take as fact.<br /><br />Statements like this is just outright irresponsible. I found no more than <a href="http://news.google.com/news?hl=en&lr=&client=firefox-a&rls=org.mozilla:en-US:official&tab=wn&ie=ISO-8859-1&ncl=http://www.sci-tech-today.com/story.xhtml%3Fstory_id%3D34508&filter=0">28 articles</a> touting this supposedly great news! What Mr. Swan here is doing is taking a small part out of the whole picture and using it solely for the benefit of his clients. Most of these articles make small mention of the damaging effects of alcohol use.<br /><br />What is disappointing about irresponsible statements like this is that it sets back the healthcare industry's efforts to educate the public about true preventative measures for cancer. Yesterday, I was reviewing news articles of when our cancer clinic was first opened in 1937. Guess what one of the major challenges cited to the success of the program was? Education of the public to the truths about cancer prevention and treatment. Overcoming the belief that cancer was a communicable disease was a monumental challenge in that day. At least then they didn't have news articles stating that it was.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com1tag:blogger.com,1999:blog-11153049.post-1115182105136471972005-05-03T23:17:00.000-04:002006-11-13T15:20:31.530-05:00CT / MRI Physician Self ReferralsOne of the Cancer Centers I lead has an Imaging Center within it. It is an added convenience for all of our cancer patients to be able to have any of their diagnostic scans without leaving the building. This has worked great until the Medical Oncology group in our center decided to build their own Imaging Center twenty minutes away.<br /><br />Of course, we hear the "We're not going to send any patients from here there." Uhhhh, yea. If you build it, they will come (especially if you own a significant stake). We first noticed a drop in CT scans then we heard from a mutual patient that they had a scan at this new facility. We didn't even know it existed. While the state I'm in is a Certificate of Need state, it doesn't cover CT scanners under a certain price range if I'm correct. Needless to say we were a little surprised.<br /><br />Upon further investigation you would expect that we would find that they had purchased a new 32 or <a href="http://www.gehealthcare.com/euen/ct/products/products_technologies/products/lsvct_index.html">64 multi-slice CT scanner</a>. Only the best for their patients, right? Not a chance. What did they purchase and install? A refurbished Siemens unit. Let's say that it is not exactly top of the line.<br /><br />Soon, we start having patients ask our receptionist why they have to travel 20 minutes to have a CT scan when they can have one right here without leaving the building. Hmmmmm....... We have a very astute receptionist who questioned what reason the Medical Oncologist gave for sending them away. They stated that he said "we like the techs better down there." Yea, right. While the patient is thinking technologists we all know they were thinking "technical charges!" This was a patient that lives a half a mile away from our facility. This has been repeated several times. We even had a patient that lives in another state that presented for treatment and they sent them 20 minutes away to the new center. These are cancer patients for pete's sake. They would like to be home resting and not driving all over town.<br /><br />In the May 2 <a href="http://online.wsj.com/public/us">Wall Street Journal,</a> Donald Ryan of <a href="http://www.carecorenational.com/index.asp">CareCore National Inc</a>. a firm that analyzes imaging claims to help control costs for insurers, states that "Utilization goes through the roof" when physicians have a financial investment in a center that provides diagnostic imaging scans. Talk about a major conflict of interest. And not to mention the ethical issues this presents. But, it appears this is the wave of the future. I can go to my PCP and he'll attempt to send me to his group's Imaging Center 25 minutes away when we have the equipment downstairs.<br /><br />Guess what's next? A PET/CT Scanner. Rad Onc will be next to follow. Physicians are continually siphoning off the profitable business from hospitals and leaving the non-profitable non-insured patients for the hospital to provide care. To boot, they're doing it on inferior equipment and its usually non-PACS meaning it can't be visualized on multiple PC's. Hospital's better get a better lobby or there are going to be quite a few of them heading for closure.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com1tag:blogger.com,1999:blog-11153049.post-1115043217360124812005-05-02T09:41:00.000-04:002005-05-02T10:13:37.360-04:00Up for AirI would like to apologize for the lack of posts here as of late. Preparing for this year's Relay for Life had literally sucked the life out of me. Now that it is over I hope to get back to blogging on the issues of the day.<br /><br />Speaking of the Relay, while it was a huge fundraising success, the event left much to live for. As usual, we were deluged with heavy storms while setting up. Something about setting up a tent while it was beginning to thunder and storm just didn't seem very wise. I was beginning to wonder if the hospital would still cover my salary for the day if I got struck by lightening. Thankfully, the rain stopped before the event begin and didn't return until about 5 the next morning when it begin to fall from the sky like the day's of Noah. Needless to say they called the whole event around 5:30. Of course, there were only about 10 people left at the whole event so I'd say that had something to do with it.<br /><br />The <a href="http://www.cancer.org">American Cancer Society (ACS)</a> has killed this event in our city by splitting it into 5 separate events according to what region of the county you live. There just aren't enough teams to carry the event throughout the night. A good majority of the teams pack it up after the luminary ceremony and that just leaves a few of the hard core campers. Without enough teams, there isn't even enough people to hold the events scheduled throughout the night. In addition, the poor planning and organizational skills of the ACS committee only added to the demise of this year's event. But, I digress...Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1113967951421908952005-04-19T23:16:00.000-04:002005-04-19T23:32:31.423-04:00Relay for Life PlanningI've been spending a lot of time lately as the head of our system's <a href="http://www.cancer.org/docroot/GI/gi_1.asp">Relay for Life</a> 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.<br /><br />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.<br /><br />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.<br /><br />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.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1112964446814590952005-04-08T08:34:00.000-04:002005-05-03T12:44:36.773-04:00Major Radiation Overdoses at Florida Cancer Center<p class="MsoNormal">In the typical fashion of releasing bad news when most people are not focusing on the news, on Friday, April 2 <a href="http://www.moffitt.usf.edu/">H. Lee Moffitt Cancer Center & Research Institute</a> released information that <a href="http://news.tbo.com/news/MGBIKLZB17E.html">77 patients received 50% higher radiation doses than prescribed</a>. Whoa!<br /><br />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.<br /><br />The technique used for these misadministrations is referred to as <a href="http://virtualtrials.com/jhrs.cfm">Stereotactic Radiosurgery</a>. 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.<br /><br />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 <a href="http://www.ninds.nih.gov/disorders/avms/avms.htm">AVM (arteriovenous malformation)</a> or <a href="http://www.anausa.org/what_is_an.html">Acoustic Neuroma</a>. Unlike most brain cancer patients, these individuals are expected to continue to live long healthy lives after their procedures are completed.<br /><br />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 <a href="http://dictionary.reference.com/search?q=metastatic">metastatic</a> 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.<u><br /></u><br />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.<br /><br />How did this happen? Good question. A place like Moffitt has at least 2 <a href="http://www.aapm.org/publiced/what.asp">Medical Physicists</a> and one <a href="http://www.medicaldosimetry.org/article.asp?id=34">Medical Dosimetrist</a>. 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 <a href="http://www.radiologyinfo.org/content/therapy/linear_accelerator.htm">linear accelerator</a>.<br /></p> <p class="MsoNormal">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.</p> <p class="MsoNormal">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.</p> <p class="MsoNormal">Thank God for the RPC (<a href="http://rpc.mdanderson.org/rpc/">Radiological <st1:place><st1:placename>Physics</st1:placename> <st1:placetype>Center</st1:placetype></st1:place></a>) in <st1:city><st1:place>Houston</st1:place></st1:city>. 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.<br /><br />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.</p>Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com5tag:blogger.com,1999:blog-11153049.post-1112763317846879052005-04-06T00:34:00.000-04:002005-04-06T00:55:17.850-04:00Peter Jennings Has Lung CancerI just saw a replay on Larry King of Peter Jennings announcing that he has been <a href="http://story.news.yahoo.com/news?tmpl=story&cid=514&e=6&u=/ap/20050406/ap_on_en_tv/tv_jennings_cancer">diagnosed with lung cancer</a> and will begin chemotherapy next week. He sounded very hoarse and stated that he had smoked until about twenty years ago. <br /><br />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.<br /><br />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.<br /><br />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.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1112706206632901602005-04-05T08:39:00.000-04:002005-04-05T09:03:26.633-04:00Let the Games Begin!It was announced on April 1st, that CMS (Medicare) is launching a website, aptly named <a href="http://www.hospitalcompare.hhs.gov/">Hospital Compare</a>, 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.<br /><br />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.<br /><br />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.<br /><br />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!Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1112646559391174632005-04-04T16:03:00.000-04:002005-04-04T16:29:19.393-04:00Break from the NormMost 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.<br /><br />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.<br /><br />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.<br /><br />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.Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com0tag:blogger.com,1999:blog-11153049.post-1112110248718100332005-03-29T08:06:00.000-05:002005-03-29T10:30:48.723-05:00From the Patient's ViewIn the day to day hustle and bustle of our work its easy to get caught up in the minutia of it all. In doing that, sometimes we forget the plight of the cancer patient and what they experience when they are referred for our services. Thanks to the <a href="http://hospiceblog.blogspot.com/">Hospice Blog</a> this is brought back to mind with a patient's detail of their encounter for cancer treatment. <br /><br />The following link details a patient's initial experience with a brain tumor and the subsequent treatments which are followed by their last days in hospice. The wife of the patient saved all of her email concerning her husband's battle with Glioblastoma and decided to create an online diary to help others with a similar fate. I think it also serves us well in remembering the plight of our patients when in our care.<br /><br /><a href="http://www.lib.uchicago.edu/%7Erd13/bt/diary.html">Diary of a Brain Tumor Patient's Wife</a>Joehttp://www.blogger.com/profile/14561387770421776221noreply@blogger.com1