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Cancer cachexia may be an immunologic phenomenon related to increased cytokine production that occurs in response to the tumor itself or to the stress of surgery, John M. Daly, MD, said at the Society of Surgical Oncology's Annual Cancer Symposium. As such, the routine administration of preoperative total parenteral nutrition (TPN) may not be a useful strategy for all types of cancer.

The National Coalition for Cancer Survivorship (NCCS) recently surveyed health providers, government officials, professional and advocacy organizations, scientists, and others regarding a critical issue facing this nation's 8 million cancer survivors: quality cancer care. The responses were illuminating as they portrayed a system in flux. The United States is moving away from a health care system where fee for service insurance plans predominate to one where market-based alternatives are quickly gaining favor among employers, consumers, and other purchasers of health care coverage. What this fundamental transition will mean for survivors and individuals with other serious or life-threatening diseases and the people who care for them is an open question with important public policy implications

Multiple endocrine neoplasia type 2 (MEN-2) is known to be associated with missense mutations in the RET proto-oncogene, and specific RET mutations have been detected in families. This disease can be deadly since more than half of patients who harbor the genetic susceptibility present with metastatic medullary thyroid carcinoma. About 50% of patients affected with MEN-2 will develop pheochromocytoma (often bilateral), and 10% to 20% will develop functioning parathyroid adenomas.

Drs. Lerman and Croyle provide a quite thorough review of an area in need of continuing research-ie, patients' behavioral and emotional responses to genetic testing for cancer susceptibility. The authors present current information on what we do and don't know about the psychological characteristics of individuals likely to undergo testing, possible adverse reactions, issues specific to the genetic counseling process, family coping and adaptation, and possible ways of managing psychological sequelae of genetic testing. Admirably, the authors note that much of their discussion should be considered speculative until more empirical data specific to genetic testing is available. Given this "state of the science," I will raise some additional questions based on some of the statements made by Drs. Lerman and Croyle.

Increased knowledge about inherited susceptibility for cancer and the identification of genes associated with cancer risk has increased the need for individuals with training in genetics to work closely with oncology professionals in the familial cancer arena. Genetic counselors can provide a variety of useful services: They may function as clinical coordinators of a family cancer risk counseling (FCRC) program and serve as study coordinators on research teams.

NEW YORK--Dr. David W. Golde has been appointed Physician-in-Chief of Memorial Hospital, Dr. Paul Marks, president of Memorial Sloan-Kettering Cancer Center, announced. Dr. Golde succeeds Joseph V. Simone, MD, who is to become clinical director for the Huntsman Cancer Institute, Salt Lake City.

PALM SPRINGS, Calif--Women with HIV represent the fastest growing segment of the epidemic and are among the most vulnerable for the undermanage-ment of both pain and psychological distress, Robert Boland, MD, and Margaret McDonald, CSW, said at the Academy of Psychosomatic Medicine meeting.

At the 1995 American Society of Hematology meeting in Seattle, Washington, researchers from UCLA School of Medicine presented results from a 21-month, phase III clinical study showing that long-term pamidronate disodium (Aredia) therapy reduces skeletal-related episodes in patients with stage III multiple myeloma and also improves survival in those on salvage therapy. Pamidronate disodium is the first medical therapy proven to reduce pathologic fractures and other skeletal complications in patients with multiple myeloma.

PITTSBURGH--The Health Care Financing Administration's current re-evaluation of reimbursements for physician work and practice expenses could have "a major impact" on chemotherapy administration cost codes, Joseph S. Bailes, MD, said at the Association of Community Cancer Center's 1995 Oncology Symposium.

I would like to call your attention to a misleading statement that appeared in the Industry Watch section of the October, 1995, issue of Oncology News International under the title "Casodex Approved for Prostatic Cancer" (page 23).

OAK BROOK, Ill--Young physicians seeking careers in radiation on-cology may have severely limited employment opportunities in the foreseeable future, according to the American College of Radiation Oncology (ACRO). The College forecasts that up to 1,000 radiation oncologists will be either underemployed or unemployed shortly after the year 2000.

WASHINGTON--The new director of the National Cancer Institute envisions the NCI as an institute focused on science, but with a responsibility toward the community to disseminate information and be involved in larger issues.

The following recommendations have been developed to provide guidance to healthcare workers when educating women

In Los Angeles, the future seems to arrive a little sooner than in the rest of the country. The defense-based economy has crashed and burned, shifting hundreds of thousands of employees into managed care plans, mostly HMOs.

PHILADELPHIA--The clinical practice guidelines developed by the National Comprehensive Cancer Network (NCCN), to be presented at the coalition's first conference in March, represent the first step toward a larger goal--developing a database of how those guidelines are used throughout the network.

BETHESDA, Md--At its most recent meeting, the National Cancer Advisory Board heard a report on the Division of Cancer Treatment, Diagnosis, and Centers and its efforts to promote third-party payer support for clinical trials.

BETHESDA, Md--The American Urologic Association has named Judd W. Moul, MD, Prostate Educator of the Year. Dr. Moul is director, Center for Prostate Disease Research, Uniformed Services University of the Health Sciences.

WASHINGTON--The original 'war on cancer' was declared by the President of the United States in 1971, and a cure was promised within 10 years. In that same year, Texas Instruments was developing the first pocket calculator and Intel had just introduced the microchip, said financier Michael R. Milken at the National Cancer Summit. The meeting was sponsored by the Association for the Cure of Cancer of the Prostate (CaP CURE, see box on page 20), which Mr. Milken founded, and by other leading cancer organizations.

Acquired susceptibility mutation--A mutation in a gene that occurs after birth from a carcinogenic insult. Allele--One of several mutational forms of a specific gene.

MIAMI BEACH--Early-stage prostate cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT) at the University of Michigan Medical Center had excellent survival rates with few complications, Howard Sandler, MD, reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.

WASHINGTON--The George Washington University Medical Center will soon be providing mobile mammog-raphy services in Washington, DC. Allan B. Weingold, MD, vice president for medical affairs, announced the project at the Fifth Annual Jo Oberstar Memorial Lecture, delivered by Tipper Gore, wife of Vice President Al Gore (see box below).

WASHINGTON--In 1990, General H. Norman Schwarzkopf commanded the imagination of the American people during his service as Commander of Operations Desert Shield and Desert Storm. At the First National Congress on Cancer Survivorship, he stormed the stage of the Washington Court Hotel to describe his role as a prostate cancer survivor and patient advocate. The message was simple and personal. "I am here," the general said, "because I won a battle."

PITTSBURGH--Physicians in Pennsylvania play a "very heavy" role in medical policy decisions for the Health Care Financing Administration (HCFA) and Pennsylvania Blue Shield, Brent O'Connell, MD, said at the Association of Community Cancer Center's 1995 On-cology Symposium.

The 1995 Cancer Treatment edited by Dr. Charles Haskell is the fourth edition of his original textbook published in 1980. Cancer Treatment has kept pace with advances in oncology over these 15 years, and the fourth edition includes new

BALTIMORE--"Clinical practice guidelines link science and the bedside, helping the doctor and patient to make the best possible decisions," said Mary L. Grady, a technical writer-editor with the Agency for Health Care Policy and Research (AHCPR).

NUTLEY, NJ--Vesanoid (treti-noin, all-trans-retinoic acid) has become the first retinoid to receive a cancer treatment indication from the US Food and Drug Administration. The new agent, from Hoffmann-La Roche, is indicated for induction of remission in patients with acute promyelocytic leukemia (APL) who are refractory to or have relapsed from anthracycline chemotherapy, or for whom anthracy-cline chemotherapy is contraindicated.

Potent immune cells that have been pretreated with peptides taken from the surface of tumor cells are effective in curing established cancers and in preventing cancers from developing in mice, according to research published in the December 1995 issue of Nature Medicine. Clinical trials of this therapeutic approach will begin soon, according to study investigators.

A malfunctioning "traffic cop" gene apparently plays an important role in the formation of liver cancer, according to researchers from the Duke University Comprehensive Cancer Center and Zeneca Pharmaceuticals of Chesire, United Kingdom.

SEATTLE--DNA from the recently discovered Kaposi's sarcoma-associated herpesvirus (KSHV) has been isolated in KS lesions as well as some AIDS-related lymphomas, and the new research suggests that foscarnet (Foscavir) may effectively inhibit the virus. Enrique. A. Mesri, PhD, of the Department of Medicine, Cornell University Medical College, reported the findings at the American Society of Hematology (ASH) meeting.

Corticosteroids have not been approved by the FDA for use as antiemetic agents. However, the efficacy of these agents (primarily dexamethasone) when used as single agents for control of emesis has been extensively documented. In addition,