Elastography

Recent clinical research studies on a new imaging technology are demonstrating amazing results in detecting cancer without so much as breaking the skin. The technology, elastography, is mainly utilized through ultrasound but also is used in MRI. How does elastography work? Below is the best diagram I could find that best visually demonstrates how elastography works.

Credit: MSNBC.com

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 preliminary study for detecting prostate cancer presented last month, elastography demonstrated excellent detection accuracy. The authors went so far as to state, "the cancer detection rate with real-time elastography was superior to the rates of other modalities..." This month a thyroid study conducted in Italy demonstrated encouraging results stating that elastography has "great potential" in certain tumor types.

Additionally, the costs for elastography 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.

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.

Gotham Prize for Cancer Research

I come across a novel approach to spur cancer research ideas today. The Gotham Prize for Cancer Research 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.

The Difficulty of Managing Clinical Research

We 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.

• FDA - Food and Drug Association

• NIH - National Institutes of Health

• NCI - National Cancer Institute

• CTSU - Clinical Trials Support Unit

• OHRP - Office of Human Research Protections

• RPC - Radiological Physics Center

• ITC - Image Guided Therapy QA Center

• CTEP - Cancer Therapy Evaluation Program

• QARC- Quality Assurance Review Center

• NSABP - National Surgical Adjuvant Project for Breast & Bowel Cancer

• RTOG - Radiation Therapy Oncology Group

• ECOG - Eastern Cooperative Oncology Group

• SWOG - Southwest Oncology Group

• GOG - Gynecologic Oncology Group

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

• IRB - Institutional Review Board

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.

If you're looking for a clinical trial a great website is

Clinical Trials.gov

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.

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.

Great Quote

I 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.

I'm Back

Wow. 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.

Continued Smoking Limits Chemotherapy Success

One 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.

But a new study, 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.

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.

For Profit Cancer Centers

In a recent article, Business Week takes a look at a growing trend, for-profit cancer specific centers such as Cancer Treatment Centers of America. 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.

What I find specifically interesting about the article is contained in the second to last paragraph,

" 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."

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.

But I digress.