Community Oncology

Volume 6, Number 2 (February 2009)

Letter from the Editor

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While we wait for the big fix...

David H. Henry, MD, FACP, Editor

Pennsylvania Hospital, Philadelphia, PA

Although the economy and the stimulus package still dominate the news these days, we remain hopeful that the new administration will very soon turn its attention to the broken medical care system in this country and begin to fix it. But in the meantime, we bring you an exciting issue this month, with articles on how electronic medical records can help manage chemotherapy-induced nausea and vomiting (CINV), treating multiple myeloma, practical biostatistics, genetic counseling in underserved rural areas, and more.

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Dr. David Henry discusses this month's issue:

Community Translations

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Advances in multiple myeloma treatment: lenalidomide and bortezomib

After waiting some 30 years, we now have three targeted treatments with which to treat multiple myeloma: thalidomide, bortezomib, and lenalidomide. As their use continues to evolve—offering them as single agents or in combination with traditional regimens—they will change the treatment paradigm completely.

  

FROM THE COMMUNITY ONCOLOGIST'S PERSPECTIVE
Choosing treatment options in newly diagnosed patients with multiple myeloma

Sattva S. Neelapu, MD

Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX

  

FROM THE NURSE'S PERSPECTIVE
Managing the side effects of lenalidomide and bortezomib

Tiffany Richards, RN, ANP-BC

Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX

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Original Contribution

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Data-driven medical decision-making in managing chemotherapy-induced nausea and vomiting

Bruce A. Feinberg, DO, James Gilmore, PharmD, Sally Haislip, RPh, Tom Gondesen, Mansoor N. Saleh, MD, and Wendy Hawke Lenz, MD

Georgia Cancer Specialists, Atlanta, GA

Using EMR and billing records, Georgia Cancer Specialists examined retrospectively whether using palonosetron rather than ondansetron reduced the incidence of resource-consuming extreme CINV events, including rescue antiemetics and office visits for CINV treatment. Initial use of palonosetron to prevent CINV reduced the incidence of extreme CINV events over a 5-day period by 76% in moderately emetogenic chemotherapy and by 54% in highly emetogenic chemotherapy, compared with ondansetron. In more than 3,000 patients evaluated, the use of palonosetron versus ondansetron was associated with an estimated reduction in staff management time totaling approximately 4 work months.

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Oncology Genetics

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Cancer genetic counseling in rural North Carolina oncology clinics: program establishment and patient characteristics

Adam H. Buchanan, MS, MPH, Celette Sugg Skinner, PhD, Brian Calingaert, MS, MBMA, Joellen M. Schildkraut, PhD, Robin H. King, MS, and P. Kelly Marcom, MD

Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, NC; Duke Hereditary Cancer Clinic, Duke University Medical Center, Durham, NC; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX; Department of Community & Family Medicine, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC

Because access to cancer genetic counseling (CGC) is limited in rural communities, several groups are underserved and little knowledge exists about characteristics and decisions of individuals who have CGC in a rural setting. The authors describe pilot data from an outreach CGC program at the Duke Hereditary Cancer Clinic to six rural North Carolina oncology clinics. Differences found between outreach and tertiary care patients in race, insurance type, risk of having a hereditary cancer syndrome, and genetic testing decision highlight the importance of continued research to characterize rural CGC patients and understand their decisions.

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Practical Biostatistics

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Randomized controlled trials

David L. Streiner, PhD, CPsych, and Geoffrey R. Norman, PhD

Department of Psychiatry, University of Toronto Senior Scientist, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, Toronto, Ontario, Canada, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Amusing, informative, practical. Not the way one would usually describe articles on biostatistics. But our authors make the study of this sometimes arcane topic a total pleasure. And more importantly, the information will help you better evaluate studies and treat patients, as community oncologists are increasingly asked to practice evidence-based medicine. In this second article of our new column, the authors explore the randomized clinical trial and deconstruct the reasons why it is considered the gold standard for evaluating treatments.

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Economics/Practice Management

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Building a patient-focused office culture

Patrick Young

Patient satisfaction is becoming a measure of practice quality. Indeed, some third-party payers see satisfaction as an element in determining reimbursement. This article continues our series on determining and increasing patient satisfaction. In our January 2009 issue, we published the first in the series, discussing ways to conduct surveys and gather feedback from patients. This month, we offer suggestions on how to create an office culture that focuses on patients and their needs. Future articles in the series will explore ways to improve communication with patients, both in person and online, and improve the physical environment of the office, which plays a subtle but important role in patient satisfaction.

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Brief Communications

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Ischemic myositis in a diabetic patient receiving chemotherapy

Mihaela-Alina Vatca, MD, Sheela Tejwani, MD, FACP, and Todd Yates, DO

Henry Ford Hospital, Detroit, MI, and Eisenhower Medical Center, Rancho Mirage, CA

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Adverse Events Alert

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Sildenafil- and tadalafil­associated optic neuropathy: implications for men after prostate cancer treatment

June M. McKoy, MD, MPH, JD, Carlos R. Bolden, MD, Athena Samaras, BA, Dennis W. Raisch, PhD, Kevin Chandler, MD, Charles L. Bennett, MD, PhD, MPP

Northwestern University Feinberg School of Medicine, The Robert H.Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Duke University Medical Center, Durham, NC; VA Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL; and The VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, NM

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Technology

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Web sites you can recommend to your patients

John J. Fried

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© 2009 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.

The opinions expressed herein are those of the authors or advertisers. The authors, editors, and publishers make every effort to ensure that no inaccurate or misleading data, opinion, or statement is published in this journal and that drug names, dosages, and recommendations are accurate. However, readers should confirm all dosage schedules against the manufacturer’s package information data. The Publisher, Editorial Board, and their employees accept no liability whatsoever for the consequences of any inaccurate or misleading data, opinion, or statement.