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Douglas W. Blayney, MD

Clinical practice guidelines are the focus of this issue, those for surveillance after curative therapy for colorectal cancer and for surveillance on deployment of sentinel lymph node (SLN) biopsy as part of the curative therapy for breast cancer. Both topics are the subject of guidelines recently developed by ASCO's Health Services Committee and published in the Journal of Clinical Oncology. The colorectal cancer guidelines contain a major change regarding the use of computed tomography (CT) for surveillance. Patients who are at high risk of recurrence, and who could be candidates for curative-intent surgery at recurrence, should undergo annual CT of the chest and abdomen for 3 years after primary therapy. A pelvic CT scan should be considered for surveillance after rectal cancer therapy, especially for patients who have not been treated with radiotherapy. In regard to curative treatment of breast cancer, the guideline panel supports use of the SLN biopsy. A surgeon who is trained in the procedure should perform the SLN biopsy. Of importance to the medical oncologist and for leaders of cancer programs, is the surgeon's participation in a quality control program.

As one of the portfolio of ASCO journals, the Journal of Oncology Practice is publishing the executive summary of the guidelines, a comment piece by a leading surgeon involved in teaching the SLN procedure, and some tools to assist in implementation. We include tear sheets for inclusion in patient charts. These can be photocopied freely. For practices using paper charts, the photocopies can be placed either onto or into the chart in a prominent place as a reminder and a monitor. Those practices that are contemplating purchase of, or that have influence over creators of, electronic patient records might embed these follow-up guideline tools in their electronic record.

Our report of the July 2005 ASCO Legislative Conference provides a first peek at the data derived from the Centers for Medicare & Medicaid Services Oncology Demonstration Project. The project is collecting data on patients' pain, fatigue, and nausea and vomiting. To the extent that these self-reported early data are reliable, the report indicates that we as oncologists are doing a good job of controlling nausea and vomiting—2% of Medicare patients were reported as having substantial ("quite a bit" or "very much") nausea and vomiting. On pain, we could do better—8% had substantial pain. Fatigue was not well managed. Twenty-six percent of patients had substantial fatigue. This vast amount of data awaits further analysis, particularly in regard to its validity, its completeness, and its correlation with other data.

Also discussed at the ASCO Legislative Conference was the program of National Cancer Institute (NCI) Director and acting Food and Drug Administration Commissioner Andrew von Eschenbach, MD, to improve the NCI-sponsored clinical trials program. The Clinical Trials Working Group is a subject of an in-depth interview in our Washington Consult column. The lead of this initiative, James H. Doroshow, MD, forecasts that in 2006, implementation that will facilitate community oncologists' involvement will begin, including efforts to increase community oncologist involvement in clinical trial design, establishing the network of scientific steering committees, and establishing the information technology infrastructure, including the clinical trials database and standard reporting forms. Clinical trials are a labor of love for many of us. Please read our report, and the supporting materials on the NCI Web site.

Your patients may be asking you about participating in the Medicare Part D prescription drug plan. This is the largest expansion of the federal Medicare program since the program's inception in 1965. We attempt to offer you some guidance to give to your patients. As our article explains, our patients are likely to turn to us for an explanation of the Part D benefit. The complexities of the program make it impossible to offer blanket advice. You should consider the patient's illness, the potential treatment options they have now, and options that may be important in the future. Some drugs will have less expense to the patient when administered under Part A (in the hospital outpatient department) or Part B (in the office setting). As our article explains, your patient's existing drug coverage should also be considered; if they have a drug coverage plan from their former or current employer, their current plan may be more advantageous than the government-sponsored Part D plan. As a practical matter, we cannot make treatment decisions on the basis of the economics of the situation. Although the law prohibits us from recommending one plan over another, if our patients have a variety of equally good treatment options, it's in all of our best interests to advise them on their treatment, payment, and insurance options.

The report from ASCO Clinical Practice Committee Chair John V. Cox, DO, FACP, should remind us of two things. Firstly, although ASCO's disaster relief efforts after Hurricane Katrina were particularly noteworthy, we need better planning. Ad hoc arrangements got our patients through this time; the toll on the affected oncology practices is being counted. Cox raises important questions that the Journal will focus on in the coming year. Secondly, let us give thanks and remember our blessings as we gather with our families and friends during this holiday time. In the upper Midwest, we will not see the earth outside until spring. We wish our readers and families a happy time with their own friends and families.

This Article Extract Full Text (PDF) Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Blayney, D. W. Search for Related Content PubMed Articles by Blayney, D. W.