Independent News on Advances in Hematology/Oncology CLINICALONCOLOGY.COM • November 2013 • Vol. 8, No. 11
INSIDE CURRENT PRACTICE Introducing Massachusetts General Hospital Cancer Center: Expert commentaries on recent studies ..................... 11 Clinical Conundrums ....... 15
by the
numbers
End-of-life care A study of Medicare cancer patients by the Dartmouth Atlas Project has shown that while hospice care is generally being better utilized by physicians, patients are still being overtreated at the end of life.
20032007
2010
Admitted to an ICU during the last month of life
23.7%
28.8%
Hospice initiated during the last three days of life
8.3%
Sees 10 or more 46.2% physicians within the last six months of life
10.9%
58.5%
Source: Dartmouth Atlas Project. T Trends in Cancer Care Near the End of Life. http://www.dartmouthatlas.org/downloads/reports/Cancer_brief_090413.pdf. Published Septemberr 4, 2013.
IMAGES in ONCOLOGY
ASCO 2013
Patients Care About Cost, Even When Not Paying Chicago—Two studies, although posing slightly different questions, indicate that a substantial proportion of patients with cancer want their physicians to include the costs of care in their discussion of treatment options. In one study, the figure was about 50%; in the other, it was about 70%. Both studies, presented at the 2013 annual meeting of the American Society of Clinical Oncology (ASCO), indicate that only a minority of clinicians include any information about costs now. One study was designed to evaluate see PATIENT COST, T page 10
“Untitled (Tiny Bubbles),” a dreamscape of poikilocytes. For more information see page 2.
How I Manage...
Vogl, NY...
Follicular Lymphoma—Part I
Tamoxifen or Prophylactic Mastectomy for BRCA1/2 2 Carriers?
F
ollicular lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL) in the United States, accounting for almost one-fourth of cases, and Bruce Cheson, MD the most frequently diagnosed indolent NHL. Its etiology is unknown, with no known risk factors. The median age at diagnosis is 60 years. FL is divided into three histologic grades based on the number of large cells (centroblasts) per high power field. Grades 1 to 3a, as defined by the 2008 World Health Organization (WHO) classification, have relatively comparable outcomes and generally are see FOLLICULAR LYMPHOMA, page 14
Larger cohort study confirms tamoxifen activity
K
elly-Ann Phillips, MBBS, of the Peter MacCallum Cancer Centre in Melbourne, Australia, and 35 co-authors published a paper in the September 1, 2013, issue of the Journal of Clinical Oncology (JCO ( ) demonstrating for the third time that tamoxifen use is associated with a reduced incidence of contralateral breast cancers in BRCA1 and BRCA2 mutation carriers.1 The paper reports on contralateral breast cancers in mutation carriers who already had one breast cancer both before and Steven Vogl, MD after they entered one of three international observational cohorts. Although these women were the subjects of the analysis, the point of the paper is that tamoxifen prevents new breast cancers in these women, and that tamoxifen should be considered as an option for breast cancer prevention in mutation carriers see CHEMOPREVENTION, N page 3
RE VIE WS & COMMENTAR IES
Expert Insights From Massachusetts General Hospital Cancer Center Low-Dose Aspirin Reduces Extent of Colorectal, Lung Tumors ....................... 12 Andrew T. Chan, MD
No Advantage To Screen Asymptomatic Women for Ovarian Cancer ..................... 13 Marcela del Carmen, MD, MPH