Greg Frieherr

On Feb. 28 President Obama was screened for colorectal cancer using CT colonography. The results from this exam, also called virtual colonoscopy, along with those from the rest of the president’s annual physical, which was done at the National Naval Medical Center in Bethesda, described the president as “fit for duty.”

It’s a kind of man bites dog story: unusual, remarkable, yet oddly plausible. The Centers for Medicare and Medicaid Services has told its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March.

African Americans have a higher mortality rate from lung cancer than whites, a fact first discovered in the early 1980s. For decades, researchers have looked for differences in access to care, rates of surgery, and patient preferences to explain the disparity. Now it seems the answer may relate at least partly to the way African Americans think about lung cancer, according to a survey conducted by the Dana-Farber Cancer Institute.

Experts from health systems, government, and the insurance industry offer insights into how quality is defined and measured in medicine today.

Concerned that erythropoiesis-stimulating agents may actually undo what chemotherapy has done, promoting tumor progression or recurrence and shortening overall survival, the FDA is clamping down on these products, marketed by Amgen as Aranesp (darbepoetin alfa) and Epogen (epoetin alfa), and by Centocor Ortho Biotech Products as Procrit (epoetin alfa).

Cancer patients sometimes develop neurologic complications directly caused by their cancers. Sometimes, however, these disorders are due not to the growth of a cancer tumor but to cancer-fighting antibodies that mistakenly attack cells in the nervous system. PET/CT may help physicians tell the difference.

Magnets have been thought for centuries to have healing power. Scientists at Georgia Institute of Technology and the Ovarian Cancer Institute hope to take this possibility a quantum leap further. They are grooming magnetic nanoparticles as the mainstay of a technique aimed at filtering out free-circulating ovarian cancer cells from the body. Their goal is to slow or stop the metastatic spread of cancer.

Some believed the unraveling of the human genome would lead overnight to the genetic tweaking of errant cells and the tailoring of treatments to patients. That dream’s time has not yet come, even a decade after the human genome was first sequenced. But the scientific community has made enormous progress in developing tools to examine the genome and their application. And those efforts may soon lead to practical results for mainstream oncology.

The standard for delivering the best quality of care to breast cancer patients calls for surgeons to consult with other specialists and to provide resources and education to help patients decide their course of treatment. That doesn't mean they do it.

As many as one in four cancer patients develop metastatic cancers of the brain. Existing therapies seldom do more than slow the disease. Adding to the urgency to find a way to prevent brain metastasis is the increasing number of such cases.

Precise and noninvasive, stereotactic radiosurgery is proving a godsend to some noncancer patients: Its use for applications outside oncology-such as the treatment of movement disorders, arteriovenous malformations, and neuralgia-have been around almost since the commercial introduction of this technology. The noninvasive destruction of brain tumors dominates the use of this equipment, but alternate uses are picking up steam, according to Iris C. Gibbs, MD, an assistant professor of radiation oncology at the Stanford Cancer Center in California and codirector of the CyberKnife Radiosurgery Program at the Stanford Hospital and Clinics, where the CyberKnife was invented. “The results of studies with large numbers of patients help us get a sense of the factors that contribute to either the success or failure of these techniques,” Dr. Gibbs said.

Oncology specialists heaved a sigh of relief in November, after analysts from ASCO and ASTRO concluded that the worst had, in fact, not happened. A 6% cut proposed last summer by the Centers for Medicare & Medicaid Services to affect medical oncology practice in 2010 under Medicare’s final physician fee schedule would instead be only 1%, according to an October announcement made by CMS.

Ultrasound elastography may be the link bridging the gap between suspicion and definitive proof, a noninvasive means to distinguish between benign and malignant tissue. The technology for doing so appeared some years ago at the annual meeting of the Radiological Society of North America as an experimental curiosity. It’s been evolving since then until it appears now to have reached a clinical tipping point.

The oncology community is happy about next year’s cut in Medicare reimbursement. Well, maybe not so much happy as relieved.

Precise and noninvasive, stereotactic radiosurgery is proving a godsend to some noncancer patients. Its use for applications outside oncology, such as the treatment of movement disorders, arteriovenous malformations, and neuralgia, have been around almost since the commercial introduction of this technology.

The incidence of later-stage breast cancer has not kept pace with a substantial increase in diagnosed breast cancers, an increase achieved largely by the use of better imaging equipment and a nearly 70% screening rate among women 40 years and older. This fact, underscored in a special communication in the Journal of the American Medical Association, pokes holes in the widely held public belief that early diagnosis will prevent the majority of breast cancer deaths.

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one delivery method to another. Yet receiving more treatments and spending extra on more sophisticated technology may do little good, at least when it comes to pain relief.

PET/CT is gaining recognition both medically and politically when it comes to sizing up cancer. And the timing for oncologists couldn’t be better.

Oncology is gaining ground on several fronts, thanks in large part to increased sophistication in the technology of cancer therapeutics, but also in how those technologies are applied.

A new class of cancer alpha-pharmaceuticals is approaching the marketplace, one built around the basis of radiotherapy itself. An isotope of radium, the element discovered more than a century ago by Pierre and Marie Curie, is the cornerstone of this new class of radiopharmaceuticals.

Dr. Otis W. Brawley took a courageous stand late last week, one he has taken many times before, but which had until then gone all but unnoticed. Responding to a Journal of the American Medical Association article detailing the scientific and medical limitations of breast and prostate screening, the chief medical officer of the American Cancer Society acknowledged that “in the case of some screening for some cancers, modern medicine has overpromised.”

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one delivery method to another. Yet receiving more treatments and spending extra on more sophisticated technology may do little good, at least when it comes to pain relief.

Subtle clues to the better management of cancer patients may lie hidden in images otherwise used exclusively for diagnosis. German researchers at ECCO/ESMO 2009 have found that ultrasound images of lymph nodes may contain clues to whether and to what extent melanoma has begun to spread. The discovery raises the possibility that ultrasound might help oncologists predict a patient’s probable survival without the need for sentinel node biopsy (abstract O9303).

Comparative uptake of two radiotracers allows characterization of tumor.

Clues to radiosensitivity promise personalized radiation therapy

Pattern analyses reveal clues to better patient management

More than a decade has passed since the FDA approved the first pill to fight cancer. Designed to battle metastatic colorectal cancer, capecitabine (Xeloda) marked a significant change in chemotherapy, untethering some cancer patients from office-based intravenous drug infusions. Other such drugs have since been commercially released, including temozolomide (Temodar) and imatinib (Gleevec), but the reimbursement system in this country has failed to keep up.

Megadollar centers give way to smaller, cheaper machines

Researchers suggest routine screening of breast cancer patients for disruptions.

Freestanding and community-based cancer centers will be leading with their chins if the Centers for Medicare and Medicaid Services revises its reimbursement rules on equipment utilization.