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Strict evidence-based criteria should be used when prescribing erythropoiesis-stimulating agents (ESAs) for cancer, as ESAs appear to activate signaling pathways that are important in altering tumor behavior and treatment response, experts said.

The extent to which patients should have access to experimental therapies is a hotly contested issue, and courts and regulatory agencies have wrestled with the problems involved when an individual is willing to be treated with unapproved drugs at the potential expense of causing harm not only to the individual but to the clinical trial process itself.

Drug-drug and disease-drug interactions in elderly patients with cancer are significant; 33% of elderly patients who are taking 3 or more medications are rehospitalized within 6 months of a hospital discharge. "A better index of predicting tolerance to chemotherapy in the elderly is crucial," said Mihaela Popa, MD, Moffitt Cancer Center, Tampa, Florida. Tolerance to chemotherapy among older patients with cancer may be affected by multiple chronic conditions requiring multiple medications and aging-related alterations that induce changes in drug distribution, she said.

Patients with metastatic colorectal cancer are more likely to respond to initial treatment that includes cetuximab if they have nonmutated, wild-type KRAS gene status, reported Eric Van Cutsem, MD, University Hospital Gasthuisberg, Leuven, Belgium. "For the first time in colorectal cancer, we are able to predict which patients are likely to be helped by the new biologics," he said. "KRAS is the first molecular marker for the selection of a targeted therapy in combination with a standard chemotherapy regimen in first-line metastatic colorectal cancer. KRAS testing should be routinely conducted in all colorectal cancer patients immediately after diagnosis to ensure the best treatment strategies for the individual patient."

Drugs in development for the treatment of bipolar disorder and psychosis

Today's hospitals now compete with something far more engaging and intoxicating than the hospital down the street - consumer expectations.

The majority of program development or improvement plans fail to meet their projected performance. What can a healthcare executive leadership team do to change this outcome for their organization?

Most healthcare players agree that ICD-10 implementation will be expensive and resource-intensive. Yet opportunities abound to enable proactive organizations to become industry leaders with the new system.

Dental benefit consultants are important allies for insurers as the dental profession transitions to an evidence-based dentistry (EBD) perspective.

National Reports-Providing useful information is key to increasing satisfaction among health plan members, say industry experts.

Washington, D.C. - The Bush administration has proposed additional curbs on certain sales practices by insurers likely to confuse and deceive seniors enrolling in Medicare Advantage and prescription drug plans. Insurers applauded the marketing policy, partly in hopes of heading off legislation that would give states a larger role in policing Medicare marketing activities.

Employers are more than just concerned about the rising costs of prescription drugs-they're ready to stem the tide, according to industry experts.

How is it that well-informed people can look at the same data and come up with dramatically different conclusions and action implications? It turns on whether the analysis is done by biostatisticians looking at utilization data in an academically rigorous way, or by actuaries and benefits consultants looking at overall financial trends in a pre-post manner.

The use of technology to automate simple tasks has been widely adopted. E-mails broadcast information in a fraction of the time it would take a manual process. More complex tasks, however, require a human driver, and those tasks are in higher demand today.

The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions.

The intensive care unit (ICU) is, in many ways, the most significant section of a hospital, because it is where life-threatening issues occur almost daily. The ICU is the one area where most hospitals don't employ specialists-board-certified intensivists with expertise and training in critical care medicine.

The U.S. healthcare system continues to struggle with costs. As costs have climbed, data needs among employers are changing swiftly. Some employers are asking their health plan providers for deeper, more telling employee health information, only to find that they aren't able to obtain it because of HIPAA and similar laws.

Geisinger Health System and Geisinger Health Plan have attracted attention from key industry players ever since introducing a bundled-pricing program called ProvenCare in 2006. Richard Gilfillan, MD, president and CEO of Geisinger Health Plan, played a critical role in the launch of the new payment structure.

When companies interact with governmental bodies, issues related to the Public Information Act frequently arise. It is imperative for those companies to understand the Public Information Act as well as the internal procedures that may be developed to handle open records issues.

I had the honor of joining 40 executive delegates for a week to observe the Irish healthcare system. While spending in the Irish healthcare system is just 7.2% of GDP, the public hospitals are filled to the gills.

Commonwealth Fund State Performance Ranking (2007): 2

Adding zoledronic acid to anastrozole or tamoxifen therapy decreased recurrence by 35% and increased disease free survival by 36% in premenopausal breast cancer patients, according to results of the Austrian Breast and Colorectal Cancer Study Group Trial 12 (ABCSG-12). The multicenter, Phase III trial is the first large trial to demonstrate the significant antitumor benefit of zoledronic acid, said Michael Gnant, MD, Medical University of Vienna. "Adjuvant treatment with zoledronic acid should be considered in order to improve the standard of care in premenopausal breast cancer patients," he said.

Modafinil appears to reduce the severity of chemotherapy-induced severe fatigue, reported Gary R. Morrow, PhD, MS.

Vaginal brachytherapy is as effective as external beam radiation therapy in preventing the recurrence of higher-risk endometrial cancer but with fewer side effects and results in superior quality of life, according to a Phase 3 study presented by Remi A. Nout, MD.

Adherence to a four-point Individualized Sleep Promotion Plan (ISPP) intervention consisting of stimulus control, sleep restriction, relaxation therapy, and sleep-hygiene practices significantly lowered fatigue and increased sleep quality for patients undergoing adjuvant chemotherapy. Fatigue and sleep disturbances are the most frequently reported symptoms during adjuvant chemotherapy for breast cancer. One-third of breast cancer patients report persistent fatigue and abnormal sleep/wake cycles, said Ann M Berger, PhD, RN, professor, College of Nursing, University of Nebraska Medical Center, Omaha.

Routine cardiac monitoring is suggested for patients receiving sunitinib, as cardiotoxicity, particularly left ventricular (LV) dysfunction, is common, said Melinda Telli, MD.

Everolimus, an experimental oral agent that targets the mTOR protein, may represent an effective second-line option for patients with metastatic renal-cell carcinoma whose disease has progressed despite treatment with a tyrosine kinase inhibitor.

Phase 3 trial results show that adding bevacizumab to docetaxel as first-line therapy for newly diagnosed HER2-negative, locally recurrent, or metastatic breast cancer resulted in significantly less disease progression. "This shows that the antiangiogenic approach to treating breast cancer is effective, regardless of which taxane drug it is combined with," said lead author David Miles, MD, professor, Mount Vernon Cancer Center, Middlesex, UK. Previous studies have shown that the combination of bevacizumab to paclitaxel doubled progression-free survival among patients with metastatic breast cancer.