ASCO 2011 3, 6, 10, 13, 14
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FDA update 18, 19, 26, 27
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Suicide risk in patients with cancer 31
AUGUST 15, 2011 ASCOPost.com
Editor-in-Chief, James O. Armitage, MD
Expert’s Corner
VOLUME 2, ISSUE 12
Acting on Fear
A Landmark Lung Screening Trial: What Does It Mean for Clinicians and Their Patients? By Ronald Piana
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he NCI-funded NaNational Lung Screening Trial tional Lung Screening Trial (NLST), pub■■ The NLST reported 20% fewer lung cancer deaths in those screened with lished recently in The New low-dose helical CT compared with chest x-rays. England Journal of Medi1 ■ ■ NLST participants included 53,454 individuals between 55 and 74 years at cine, was heralded as a randomization with a history of at least 30 pack-years of cigarette smoking; landmark study in lung if former smokers, participants had quit within the previous 15 years. cancer detection. This ■■ All-cause mortality (deaths due to any factor, including lung cancer) in study is the first comprethe NLST was 7% lower in those screened with low-dose helical CT. hensive clinical trial to find that screening highCT in lung cancer screening has been vigorously chalrisk individuals with lowlenged. What was your general sense of the issue going dose CT reduces lung cancer deaths by 20% cominto the trial? pared with chest x-ray. One of the trial’s co-leaders, My history with this study dates back to the Christine Berg, MD, spoke with The ASCO Post fall of 1998, when I learned of the discussion at about how the data answer critics the Varese Conference for lung cancer screening of the study. addressing the potential of low-dose helical CT Early Thoughts on Lung for early detection. The preliminary information Cancer Screening indicated that low-dose helical CT screening had SEE PAGE 45 The value of low-dose helical continued on page 4 Perspective
Rising Costs of Cancer Care: It’s More Than Drugs By Ronald Piana
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ll parties—the government, payers, and consumers—agree that, left unchecked, rising health-care costs will eventually hamstring vital portions of our delivery system. For example, Medicare, which covers more than 50% of the nation’s patients with cancer, is marching headlong toward insolvency. Largely due to sticker-shock prices of some newer therapeutics, oncology is in the spotlight of the health-care spending debate. In an occasional series of articles, The ASCO Post will look at oncology costs and how to reduce spending without hampering the quality of care.
Costs and Value Put simply, health-care spending is calculated as units of care multiplied by their respective costs. While numerous studies indicate that more services do not necessarily result in better outcomes, determining the true clinical value of health services—especially in a complex disease like cancer—is where much of today’s debate begins and ends. While it is true that oncology costs are rising
at an unsustainable rate, it is important to weigh costs against outcomes. For instance, a study led by Aman Buzdar, MD, FACP, Professor of Breast Medical Oncology, The University of Texas MD Anderson Cancer Aman Buzdar, MD, FACP Center, Houston, looked at survival data for nearly 57,000 patients with breast cancer from 1944 to 2004 and calculated 10-year survival rates. Dramatic improvements were seen in local, regional, and metastatic disease. Among women with regional disease from 1944 to 1954, only 16.2% of women were still alive 10 years later, compared with 74% in the most recent decade analyzed, from 1995 to 2004. Naturally, improvements over the past decades in breast cancer survival are due to a number of factors,
By Deb Stewart, BSN, RN, CBCN, BPNC-IC As told to Jo Cavallo
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hen I was first diagnosed with breast cancer in 1979 there was no global movement to raise awareness of the disease, there were no pink ribbon pins to show support, and there was no Internet with which to search for information. My doctor gave me the news on a Friday night, and the following Monday I had a mastectomy on my left breast. Everything was urgent. I had this cancer and it had to be treated right away. I was just 25 and I didn’t understand a lot of what was going on, even though I was a nurse. I didn’t have anything about my diagnosis in writing, and I couldn’t find anyone my age to talk to about having breast cancer. I just acted on fear. continued on page 2
Ms. Stewart is a nurse and breast health educator at the Johns Hopkins Avon Foundation Breast Center in Baltimore.
MORE IN THIS ISSUE Oncology Meetings Coverage 2011 ASCO Annual Meeting Breast Cancer ���������������������������������������������� 3 Multiple Myeloma ��������������������������������������� 6 Ovarian Cancer ��������������������������������������� 10 Prostate Cancer ��������������������������������������� 13 Hepatocellular Carcinoma ���������������������� 14 Direct from ASCO ��������������������������������������� 20 Psychosocial Oncology ������������������������������� 31 Integrative Oncology ���������������������������������� 39 TAP Caucus �������������������������������������������������� 42
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