Community Oncology

Volume 6, Number 6 (June 2009)

Letter from the Editor

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(Trying to) lobby for a healthcare bill

David H. Henry, MD, FACP, Editor

Pennsylvania Hospital, Philadelphia, PA

Dr. David Henry goes to Capitol Hill and wends his way through a round of meetings with legislative aides and staffers, and the occasional member of Congress. Where are our legislators getting their healthcare information, he asks? It would be best, says Dr. Henry, if doctors, nurses, and administrators on the front lines every day were the ones educating them about what goes on in community oncology practices.

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Dr. David Henry discusses this month's issue:

Community Translations

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Update on HPV vaccination and HPV screening

Even though the incidence of cancer of the cervix is not that significant in the Western world, about half a million women worldwide will be diagnosed with cancer of the cervix worldwide. The American Cancer Society recommends HPV vaccination for girls aged 11–12 and for girls aged 13–18 who need to catch up on missed vaccines or to complete the series.

  

FROM THE ONCOLOGIST'S PERSPECTIVE
Risk-based strategy for vaccination of the 19–26-year-old female population

Sharmila Makhija, MD

Emory University School of Medicine, Atlanta, GA

  

FROM THE PATHOLOGIST'S PERSPECTIVE
HPV testing in cervical cancer screening: a pathologist’s perspective

Melina Flanagan, MD, MSPH

Department of Pathology, West Virginia University School of Medicine, Morgantown, WV

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Original Contribution

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Impact of NCD guidelines on Medicare patients with chemotherapy-induced anemia receiving erythropoiesis-stimulating agents: results from a community oncology practice

Bruce Feinberg, DO, James Gilmore, PharmD, Tom Gondesen, James H. Jackson, PharmD, MPH, and Mansoor Saleh, MD

Georgia Cancer Specialists, Atlanta, GA, and Xcenda, Palm Harbor, FL

In 2007, the Centers for Medicare & Medicaid Services issued a national coverage determination restricting the use of erythropoiesis-stimulating agents (ESAs) in patients with chemotherapy-induced anemia (CIA). The authors conducted a study to determine the impact of the government’s policy change on the clinical outcomes for Medicare patients with CIA receiving ESA therapy.

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Economics/Practice Management

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Marketing your practice

Caroline Helwick

Marketing your services is an important way to help yourself stay afloat in today’s healthcare climate. This article offers some specific things you can do, even on a small (or nonexistent) public relations budget.

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Review Articles

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Management of rectal cancer: part II

Jill Moore, MD, Kimberly A. Jones, MD, and Douglas G. Adler, MD, FACG, FASGE

University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT

Despite advances in screening, colon and rectal cancers remain widely prevalent. The use of neoadjuvant therapy in some patients with rectal cancer has become more widespread in recent years, but controversies still exist with regard to this practice. This article, the second of a two-part series, highlights the issues surrounding neoadjuvant therapy.

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Management of chronic lymphocytic leukemia: an update

Matthew Kaufman, MD, Jian Li Campian, MD, PhD, and Kanti R. Rai, MD

Long Island Jewish Medical Center, New Hyde Park, NY

Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the Western world. In the past several years, discoveries of prognostic markers have helped predict the disease course. The emergence of purine analogs and monoclonal antibodies, such as rituximab (anti-CD20) and alemtuzumab (anti-CD52), has significantly changed the landscape of therapeutic options available for CLL.

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Treating chemotherapy-induced anemia following the revised labeling for ESAs

Stacy S. Shord, PharmD, BCOP, and Michael Auerbach, MD

University of Illinois College of Pharmacy, Chicago, IL; Auerbach Hematology and Oncology, Baltimore, MD; and Georgetown University, Washington, DC

Erythropoiesis-stimulating agents (ESAs) are no longer indicated for patients with anemia of cancer not on chemotherapy and for patients receiving chemotherapy for hemoglobin levels greater than 10 g/dL. Transfusions once again appear to be the standard of care. However, transfusions can increase the morbidity and mortality in patients with cancers. The role of intravenous iron remains largely undefined despite seven randomized clinical trials demonstrating that intravenous iron added to ESAs improves outcomes compared to ESAs alone. No clear recommendation is available on iron supplementation.

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Practical Biostatistics

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P less than 0.05: statistical inference

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

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

In this article our intrepid biostatistician-tutors reveal the mysteries surrounding the magical “P value.” If the P value is sufficiently small, you can conclude that you have obtained a statistically significant difference.

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Brief Communications

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Small cell carcinoma of the lung with paraneoplastic features

Tobe Momah, MD, MSc, Arunbhai Patel, MD, FACP, and Meena Ahulwalia, MD

The Brooklyn Hospital Center, Brooklyn, NY

Most clinicians diagnose ectopic ACTH yndrome in patients with small cell lung cancer on the basis of clinical features and laboratory findings. Like the man described in this case study, most of these patients tend to have complaints of proximal myopathy, thinning of skin, easy bruising, hypertension, peripheral edema, hyperpigmentation, glucose intolerance, anorexia, weight loss, anemia, and psychiatric disorders.

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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.