Community oncology最新文献

{"title":"Conceptual changes needed to improve outcomes in rehabilitation medicine: A clinical commentary.","authors":"Amiram Catz","doi":"10.3233/NRE-220069","DOIUrl":"10.3233/NRE-220069","url":null,"abstract":"<p><p>Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients' interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.</p>","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"5 1","pages":"341-345"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78682685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Riding the wave","authors":"L. Schwartzberg","doi":"10.1016/S1548-5315(11)70316-3","DOIUrl":"https://doi.org/10.1016/S1548-5315(11)70316-3","url":null,"abstract":"","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1548-5315(11)70316-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56725455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy prescriptions to fix our ailing delivery system","authors":"Matthew E. Brow, T. Okon, B. Brooks, M. Thompson","doi":"10.12788/j.cmonc.0080","DOIUrl":"https://doi.org/10.12788/j.cmonc.0080","url":null,"abstract":"We are proud to represent the principal contributors to the world’s most effective and successful cancer care delivery system: oncologists and allied medical professionals who care for Americans who are battling cancer in community clinics throughout the United States. The success of these women and men on the frontlines is clear: after nearly 100 years of increasing cancer death rates in the United States, cancer mortality has fallen 20% from its 1991 peak. Cancer patients from around the world seek care here because Americans enjoy the best cancer survival rates in the world. Yet we still have not realized our potential to eradicate cancer. The American Cancer Society has estimated that 1.6 million Americans were diagnosed with cancer in 2013 and that more than 580,000 will die of the disease during that time. As has been the case for decades, only cardiovascular disease will kill more Americans. To win this important fight, we need a stable and sustainable cancer care delivery system. That’s where Medicare and community-based cancer clinics are so important. Community cancer clinics provide patients with convenient, comprehensive, state-of-theart cancer treatment facilities close to home. And more than 60% of cancer patients rely on Medicare to pay their medical bills. As the single largest payer of cancer care, Medicare has inordinate influence on the health care delivery system and often guides how private insurers pay for cancer care. As a result, Medicare policies have an impact on cancer care for all Americans, not just those who are covered by Medicare.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"368-370"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality therapy for uterine serous carcinoma and the association with overall and relapse-free survival","authors":"H. Nagar, L. Rosen, M. Warhol, M. Welshinger, M. Tsatsas, D. Nori, A. Ravi","doi":"10.12788/J.CMONC.0068","DOIUrl":"https://doi.org/10.12788/J.CMONC.0068","url":null,"abstract":"Himanshu Nagar, MD, Lisa Rosen, ScM, Michael Warhol, MD, Marie Welshinger, MD, Manolis Tsatsas, MD, Dattatreyudu Nori, MD, and Akkamma Ravi, MD Department of Radiation Oncology, Weill Medical College of Cornell University, New York; Department of Biostatistics, the Feinstein Institute for Medical Research, Manhasset, New York; Department of Pathology, New York Hospital Queens, Flushing, New York; Department of Surgery, New York Hospital Queens, Flushing, New York","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"345-350"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mindfulness: valuable medicine for patients and clinicians?","authors":"L. Bosserman","doi":"10.12788/j.cmonc.0082","DOIUrl":"https://doi.org/10.12788/j.cmonc.0082","url":null,"abstract":"Mindfulness can be described as an attentive awareness of the reality of things in the present moment that can impart power when coupled with a clear comprehension of what is taking place, or put another way, as a calm awareness of body, mind, and spirit supporting analysis that can lead to wisdom. Although many of us promote this practice to our patients to help them more fully live their days whether few or many, it is worth considering how this consciousness could help us, practicing oncologists, through the challenging changes we currently face in our clinical practices and to more fully participate in the transitions to high-quality cancer care, as was recently outlined in a report by the Institute of Medicine. The report emphasizes that “studies indicate that cancer care is often not as patient-centered, accessible, coordinated, or as evidence-based as it could be, detrimentally impacting patients.” Mindfulness in clinical practice would marry the scientific principles of medicine and the patient-centered art of medicine to forge a system that is better aligned with the principles of high-quality cancer care. The report recommends “a conceptual framework” for improving the quality of cancer care, which includes patients who are engaged in decisions about their care; an adequately staffed, trained, and coordinated workforce; the use of evidence-based care to inform decisions about therapies and disease management; improved information technology that can generate “real-time” analyses of patient data and thus allow for the rapid translation of evidence into clinical practice; measurement of quality of care and improvements in performance; and care that is accessible and affordable. As we finish what I believe has been a tippingpoint year in community oncology, we have seen a third of community oncology practices join larger systems of care, according to a report by the Community Oncology Alliance (see p. 368). (It’s important to note that the report does not reflect the impact of the sequester cut to cancer drugs, which is expected to further fuel hospital acquisitions of community clinics.) Many other practices have continued to close satellite clinics or even the entire practice, and some have been forced into bankruptcy. Both community and academic clinicians note increasing demands for them to see, care for, and treat higher numbers of ever more complex patients under flawed payment systems that incentivize treatment over high-quality cancer care to improve a patient’s overall health. However, a ray of light on the horizon of this burgeoning clinical care crisis is the growing number of health plan, health system, and clinician pilots for what has become known as the medical oncology home. The MOH involves a change in practice culture that involves teambased care that fully engages patients, clinicians, and payers in a patient-centered care system that delivers the most cost-effective care while minimizing suffering and maximizing a patie","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"337-339"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal failure in multiple myeloma","authors":"N. Berman","doi":"10.12788/J.CMONC.0051","DOIUrl":"https://doi.org/10.12788/J.CMONC.0051","url":null,"abstract":"This report details the case of a 65-year-old man who was diagnosed with multiple myeloma in 2006 and since 2009, has attempted to control the progression of his disease with the most powerful available treatment regimens, including bortezomib-based regimens, for both induction and consolidation therapy followed by autologous stem-cell transplants. Subsequently, because the patient was deemed treatment refractory, treatment with the newly approved carfilzomib was initiated. Coincidentally, the patient developed acute kidney injury, evidenced by tenfold rise in his creatinine levels, 2 weeks after the initiation of carfilzomib. The etiology of his acute kidney injury was unclear; although initially thought to be secondary to volume depletion, this new chemotherapeutic drug could not be excluded as the causative agent given the correlation with the timing of onset. In addition, because carfilzomib was newly approved, there was little documentation on its toxicities, but nephrotoxicity has been noted as a rare side effect. Nevertheless, multiple myeloma is known to damage kidneys, and this patient had light chain disease, kappa type, the form of multiple myeloma that has been shown to most commonly involve the kidneys. An invasive biopsy was indicated to determine the etiology of the patient’s renal failure, as the myeloma could not be excluded, and though the former 2 causes may be reversible, aggressive interventions would be required should the latter have cause his acute kidney injury. Renal failure in multiple myeloma can be attributed to a number of causes, and it is often unclear on presentation what the precipitating factor is, which makes treatment, and thus recovery of renal function a difficult task. The following case details the patient’s clinical presentation and the subsequent investigations and management of his condition, along with a brief discussion of how one can approach and manage renal failure in this patient population.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"359-363"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and response criteria are the new challenges","authors":"J. D. Lartigue","doi":"10.12788/J.CMONC.0079","DOIUrl":"https://doi.org/10.12788/J.CMONC.0079","url":null,"abstract":"The immune system and cancer The immune system functions by recognizing signals (antigens) on the surface of invading organisms as “nonself” and mounting a response that ultimately leads to the death of these organisms. Because tumors are made up of our own cells they often don’t display these signals and are therefore more or less tolerated by the body. When tumors do display unusual proteins on their surface that could be recognized as nonself, they are able to actively subvert the subsequent immune response. Indeed, the property of immune evasion has now been added to the list of cancer hallmarks – the key features defined by Weinberg and Hanahan that allow a cell to become malignant. It has become clear that there are several ways in which tumors achieve a state of immune tolerance. Several of these mechanisms have been targeted for novel therapies and have resulted in the establishment of durable antitumor immune responses that are known as immunotherapies.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"371-376"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging therapies for melanoma","authors":"S. Legha","doi":"10.12788/j.cmonc.0081","DOIUrl":"https://doi.org/10.12788/j.cmonc.0081","url":null,"abstract":"Metastatic melanoma is a highly challenging cancer to treat. Like other solid tumors, it is a very heterogeneous disease both clinically and biologically. Consequently, the first decision point in its management is to assess the severity of an individual patient’s disease. This can be done based on the patient’s symptoms and how they have evolved over the preceding 1-2 months, performance status, the extent of disease as determined by physical examination, and staging workup, which should include either computed tomography scans of the body or a positron emission tomography/CT study as well as a brain magnetic resonance imaging scan. Patients with brain metastases as a subset (which is sizable – 20%-25% have brain metastases) require special attention because they may not respond to systemic therapies and will thus have to be managed with brain-targeted treatment options. Tumor testing for BRAF mutations is necessary in all patients with metastatic melanoma because the BRAF inhibitors (vemurafenib or dabrafenib) are a preferred choice of targeted therapy for this subset of patients, which constitutes about 50% of all melanoma patients. Immunotherapy plays an important role in nearly all patients with metastatic melanoma including those who have progressed after anti-BRAF therapy. Chemotherapy still has a significant (yet diminishing) role for patients who are no longer suitable for immunotherapy. Targeted therapy is the preferred choice of therapy provided the tumor has presence of BRAF mutations. The first targeted therapy agent shown to have a high level of activity was the BRAF inhibitor vemurafenib, which was approved by the Food and Drug Administration in 2011. This drug has produced objective responses in more than 50% of BRAF-mutated melanoma cases and the onset of response is rapid, especially in patients who have large loads of metastatic tumor. However, the responses are not durable and typically last about 6 months before the tumor begins to progress again. The second BRAF inhibitor, dabrafenib, was approved by the FDA in May 2013 on the basis of its single-agent activity, which was similar to that of vemurafenib. MEK inhibitors are also active in advanced melanoma although the response rates are lower (22%). One such drug, trametinib, also received FDA approval in May 2013 for single-agent use in BRAF-positive melanomas. Because of their short duration of response, targeted agents are now being tested in combination with other agents. The first such attempt used a combination of dabrafenib and trametinib and the results of the phase 1-2 study showed response rates of nearly 70% and a response duration that was more than 9 months longer compared with the individual single agents (5.8 months). Immune stimulation as a form of anticancer therapy has played a more important role in managing melanoma than in any other cancer. Responses were observed in a minority of patients yet the responses were frequently quite durable and the responders","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"340-341"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key issues in the management of gastrointestinal immune-related adverse events associated with ipilimumab administration","authors":"M. Sznol, M. Callahan, Jianda Yuan, J. Wolchok","doi":"10.12788/J.CMONC.0055","DOIUrl":"https://doi.org/10.12788/J.CMONC.0055","url":null,"abstract":"Ipilimumab is an anticytotoxic T lymphocyte antigen-4 (CTLA-4) monoclonal antibody that attenuates negative signaling from CTLA-4 and potentiates T-cell activation and proliferation. Two phase 3 randomized trials in advanced melanoma demonstrated a significant improvement in overall survival, the first of which led to regulatory approval in the United States and Europe for treatment of unresectable or metastatic melanoma. Ipilimumab administration is associated with immune-related adverse events (irAEs). Gastrointestinal (GI) irAEs are among the most common and although they are typically mild to moderate in severity, if they are left unrecognized or untreated, they can become life-threatening. These toxicities can be managed effectively in almost all patients by using established guidelines that stress vigilance and the use of corticosteroids and other immunosuppressive agents when necessary. The goal of this review is to educate physicians on the recognition and challenges associated with management of GI irAEs.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"69 1","pages":"351-358"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology and quality and cost of care","authors":"D. Patt","doi":"10.12788/j.cmonc.0077","DOIUrl":"https://doi.org/10.12788/j.cmonc.0077","url":null,"abstract":"As I write this editorial, we who practice medicine face many challenges. Our internal and external environments are changing, and we are asked to do more with less, but we have better tools to perform that work. We have health care reform, which has been met with such opposition that our government temporarily shutdown in October and faced potential default on the national debt. Although it is uncertain to what degree health care reform will succeed at its primary objectives – the provision of services to the underserved and cost control – it is clear that there are changes ahead that will have an impact on our care delivery. Because many states did not embrace Medicaid, it remains unclear how meaningful care will be provided. The technical challenges in registering for the health care exchanges partnered with the very small penalty for not enrolling are likely to precipitate lower-than-anticipated use of the exchanges, which could result in adverse selection of a sicker patient population, and increase proportional costs for patients enrolled in the health care exchanges. How will we manage this change better? As a country, we spend 18% of our gross domestic product on health care, which is far more than any other country. Although we strive to improve patient access to care and cost containment, we aspire to these outcomes being born out of value-based care delivery, but lack meaningful supply-side controls that could foster value-based decisions. The boundary aversion in cost containment is pervasive from the way in which the Food and Drug Administration considers drug approvals – focusing on the drug’s efficacy and toxicity, but not its cost – to the way in which we approach patient-centered outcomes research with specific prohibitions from the Patient Centered Outcomes Research Institute to evaluate costs of care. Despite being in a time of change, challenges, and a great deal of disagreement, we have our sights focused on a better future. We talk about our goals of care delivery – high-quality, patient-centered, collaborative, cost-effective, value-based, efficient – and we are optimistic. Given our tremendous technologic advances, it is easy to see how we can use health technology to meet these goals more efficiently and effectively. We see that in this month’s issue of COMMUNITY ONCOLOGY, and it can offer us hope. There are many examples of ways in which we can leverage technology to foster collaboration, improve communication, and efficiently improve patient care in a cost-effective manner. On page 316, Schenken et al evaluate inexpensive solutions to enhance remote care in hospitals that deal with the critical issue of using technology to improve care in areas that do not have easy access to care. Ricci et al discuss planning evaluation programs for assessing telecommunications applications in community radiation oncology programs (p. 325), and Bold et al demonstrate an effective model for collaborative virtual tumor boards incorporati","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"309-309"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}