Head and neck surgery workforce in the year 2014

The head and neck surgery workforce in the United States over the next 20 years is of significant interest to physicians, patients, and others. Using election to fellowship in the American Society for Head and Neck Surgery or the Society of Head and Neck Surgeons, or both, as the criteria for designation as a head and neck surgeon, a mathematical model was designed to project the growth of the head and neck surgery workforce through the year 2014. The current combined active membership of the two societies was analyzed to determine the impact of age distribution on this model. The paradigm assumes 30 new head and neck surgeons each year and includes the appropriate mortality rate for each cohort. Based on this model, the total number of head and neck surgeons should decrease slightly from 1109 in the year 1994 to 1028 in the year 2014. A steady-state supply of head and neck surgeons is therefore predicted.

A comparison of delays in the treatment of cancer with radiation in Canada and the United States

PURPOSE

Waiting lists for medical care in Canada have been used as an argument against the single-payer option for health care reform in the United States, but there have been no direct comparisons of access to care in these two health care systems. The objective of this study was to compare how long cancer patients wait for radiotherapy in Canada and the USA.

METHODS AND MATERIALS

Heads of radiation oncology at all cancer centers listed by the International Union Against Cancer (UICC) in Canada and the United States were sent a questionnaire that asked how long their patients waited for radiotherapy, and how long they though it was acceptable for patients to wait, in six clinical situations.

RESULTS

Ninety-two of 97 eligible centers responded (95%). Median waiting times to start of radiotherapy were as follows: carcinoma of the larynx (T2,N0,M0), 29 days in Canada, 10 days in the USA; carcinoma of the lung (Stage IIIb, squamous), 34 days in Canada, 9 days in the USA; carcinoma of the prostate (Stage B2), 40 days in Canada, 11 days in the USA; carcinoma of the breast (T2,N0,M0) referred 1 month after lumpectomy, 43 days in Canada, 10 days in the USA; carcinoma of the prostate with painful bone metastases, 17 days in Canada, 5 days in the USA; carcinoma of the prostate with spinal cord compression, < 1 day in Canada, < 1 day in the USA. The differences in waiting times between Canada and the USA were all statistically significant (p < 0.0001), except in the case of emergency treatment for cord compression. The majority of radiation oncologists in both Canada and the USA regarded the delays reported by Canadian departments as medically unacceptable.

CONCLUSIONS

Patients almost everywhere in Canada wait longer for radiotherapy than they do almost anywhere in the United States.

Heterogeneity of cancer surveillance practices among medical oncologists in Washington and Oregon

BACKGROUND

Medical oncologists provide long term care for patients who have been treated for cancer and are in remission. However, little is known about how physicians use routine laboratory and imaging tests for detecting cancer recurrence in their patients.

METHODS

To assess type and level of their surveillance testing of patients with cancer who are in remission, a cross-sectional survey of medical oncologists was performed. Seventy-three members of the American Society of Clinical Oncology residing in Washington and Oregon participated (70% response rate). Standardized questionnaires were mailed to medical oncologists using a multiple-mailing technique. Three scenarios, each describing a patient with cancer of the breast, colon, or prostate, were included. Participants were asked to indicate the frequency at which they would order seven different diagnostic tests in the routine follow-up of such patients.

RESULTS

Virtually all respondents would practice some level of follow-up testing of their patients. Although testing practices did not vary significantly according to physician age, year of graduation, practice type, or state of residence, there was considerable variability from physician to physician.

CONCLUSIONS

These results suggest that optimal cancer-surveillance testing programs for patients with cancer of the breast, colon, or prostate have not yet been satisfactorily defined.

Evaluating the message: the relationship between compliance rate and the subject of a practice guideline

To explore the relationship between providers' compliance and some key aspects of the clinical messages in practice guidelines, studies published in the English language medical literature between 1980 and 1991 were retrieved through MEDLINE and through relevant review articles in the field. All published studies providing compliance rates with practice guidelines and endorsed by official organizations were eligible for the study. The clinical content and the reported compliance rate were gathered for each recommendation in the 23 studies selected. The medical and surgical procedures addressed by 143 recommendations were identified according to specialty area, type of procedure (diagnostic, surgical, etc.) and were independently classified by the authors as being high or low on characteristics thought to influence diffusion:complexity, trialability and observability. The mean compliance rate with the 143 clinical recommendations was 54.5% (95% CI: 50.2%-58.9%), with those in the specialty areas of cardiology and oncology showing the highest compliance (mean 63.6% and 62.2%, respectively). Recommendations concerning procedures with high complexity had lower compliance rates than those low on complexity (41.9% vs. 55.9%; P = 0.05), and those judged to be high on trialability had higher compliance rates than those low on trialability (55.6% vs 36.8%; P = 0.03). Overall, all the characteristics of the clinical recommendations considered in the practice guidelines could account for no more than 47% of the observed variability in compliance rates. The target area of practice and the complexity and trialability of the recommended procedure appear to be useful, if partial, predictors of the level of compliance with a practice guideline.

Future manpower needs in caring for an older cancer-patient population

The Minnesota Cancer Surveillance System provides data for almost all cancers newly diagnosed in residents of Minnesota. A statistical method, Population Cancer Risk (PCR), estimates the total number of cancers that will occur in the lifetimes of 1,000 people, based on the Minnesota cancer incidence and life expectancy rates from 1988-1990. The overall PCR is 459 cancers per 1,000 lifetimes of persons born today. By year 2020 the Minnesota population will have increased 12% since 1990, but the total cancer incidence will have increased 60%. As a result, there will be an increased demand for medical oncologists, radiotherapists, and surgical subspecialists. Primary care physicians will play an increasing role in cancer prevention, early detection, therapies, and long-term follow-up. Physician's assistants and skilled nurses will add further to patient cancer management. Cancer patients will be older, on average. The future will include changes in the methods of care of the older cancer patients and in economic, social, and bioethical issues involving older persons.

The practice patterns of adult oncologists' care of pediatric oncology patients

The role of the adult oncologists in the area of pediatric cancer treatment previously has been unmeasured. A questionnaire bearing regarding the practice of 447 adult oncologists was administered in June 1991. The membership list of the Association of Community Cancer Centers was used to identify contact oncologists. One hundred thirty-one questionnaires (29.3%) were returned for analysis. The data reveal that 204 patients younger than 21 years of age were treated during the last year in 63 adult oncology practices. Most of these patients were more than 15 years of age. Only a minority (53) were treated in rural practices. In addition, only a minority (27%) of these patients are reported to be enrolled in clinical trials. In addition, adult oncologists appear to regard physiologically mature adolescents (age 16-21 years) as adults. They do not seem to make a distinction between patients 16-21 years old and those older than 21 years.

Physician use among patients receiving cancer chemotherapy

BACKGROUND

Little research has examined the volume and pattern of physician use or the scope of multiple physician use in patients with cancer.

METHODS

The authors studied a sample of 259 patients with advanced cancer who received outpatient chemotherapy at two hospital clinics and eight private oncology practices.

RESULTS

These patients reported regularly seeing an average of three different physicians an average of 15 times in 3 months. The number of physicians seen was strongly correlated with the number of reported visits (r = 0.65). Demographic and disease characteristics were associated only moderately with visit volume. Patients without a regular physician had a less concentrated pattern of visits to many doctors than did those with a regular doctor.

CONCLUSIONS

This pattern of physician use among active treatment patients has not been described before and has implications for continuity of care.

The availability of psychosocial interventions to children with cancer and their families

Awareness of the need for and efficacy of psychosocial services for pediatric oncology patients and their families has increased greatly in the last decade. However, it is currently unknown to what extent these services are available. Therefore, a national survey of pediatric oncologists was conducted to determine the availability of the following services: psychological/psychiatric and social work consultation, support groups for patients and family members, nonpharmacological pain and anxiety management, and nonpharmacological treatment of anticipatory emesis. Results suggest that most centers offer social work consultation and support groups to parents. Fewer support groups are offered to patients and even fewer nonpharmacological services to assist patients in coping with anticipatory nausea and pain are offered. Results are discussed in terms of the pattern of service delivery and cost-effectiveness.

Reimbursement policies constrain the practice of oncology

OBJECTIVE

To determine the prevalence of off-label anticancer drug use (ie, using drugs to treat conditions other than those listed on the Food and Drug Administration's approved drug label), the extent of reimbursement denials for these uses, and the effect of denials on the treatment of cancer patients.

DESIGN, SETTING, AND PARTICIPANTS

A three-part questionnaire was sent to a randomized sample of oncologists taken from the 1990 membership of the American Society of Clinical Oncology in March 1990. A response rate of 56% yielded information from 681 oncologists on the drugs they prescribed to 2018 new cancer patients and on those they frequently use in treating 11 specific types of cancer.

MAIN OUTCOME MEASURES

The labeled uses of the drugs prescribed and frequently used in chemotherapies were checked against the indications treated to determine whether they were prescribed for off-label uses. Three drug compendia were used as cited sources of off-label drug uses. The extent of reimbursement denials over the last 12 months and their effects on treatments were based on respondent opinions.

MAIN RESULTS

Off-label drug use is prevalent and dominates the chemotherapy regimens of cancers that are more difficult to treat and for which there are no cures or agreements on standardized treatment. Most oncologists reported frustration with shifting reimbursement policies in general and with an increasing rate of denials for some off-label drug uses. Indeed, a surprising number of oncologists claimed that these policies caused them to alter preferred treatments and site of care.

CONCLUSION

These findings suggest the need for public discussion of off-label drug use issues so that appropriate policies can be developed.

Multivariate statistics in oncology: a review

In recent years multivariate analysis has been applied to the study of prognosis, diagnosis, and treatment in cancer patients. This form of analysis has provided investigators with a method to interpret increasingly complex data sets. In the current review, multivariate procedures such as the Cox proportional hazards model, logistic regression, and stepwise regression analysis are examined and compared with emphasis on the advantages and disadvantages of each procedure. Guidelines for the proper usage and interpretation of results are presented.

Patterns of utilization of mammography comparison by physician specialties in 6,000 consecutive mammograms

Mammography is regarded as the most important screening test for breast cancer. The combination of physical examination of the breast by a physician and mammography can result in reduced breast cancer mortality. Evidence is mounting that mammography alone can produce similar results. Despite these facts, mammography is underutilized in the United States. In an attempt to define the utilization of mammography in the Ochsner Medical Institutions, New Orleans, Louisiana, the records of 6,000 consecutive patients who underwent mammography were reviewed with respect to the specialty of the physician ordering the test. The ratio of the number of mammograms ordered by each service to the number of eligible patients (women over age 50) visiting that service provided insight into the patterns of utilization of mammography in the Ochsner Clinic. This information will allow for efficient utilization of time and resources in planning continuing education programs geared toward mammographic screening.

[Clinical characteristics of patients with malignant neoplasms of the pancreas in case control studies in the Opole district]

Clinical data on 110 well-diagnosed cases of the pancreatic cancer collected in the study region between 1985 and 1987 by means of population case-control study are described. Out of 43.6% of the histologically diagnosed cases, 61.7% hand biopsy of the primary organ and 31.0% hand biopsy beyond the primary organ. There were 47.8% adenocarcinoma. Surgical findings (90% of the cases) included mainly isolated tumor of the head of pancreas (55.5%) or tumour of the head and other site of the organ (32.7%). 87.3% of the cancers was unifocal. Average diameter of tumour was 8 cm. Many metastases in gastrointestinal tract were found.

[Risk of malignant neoplasms among Polish population in 1986]

An analysis of the mortality for malignant tumors in Poland in 1986 is provided. The most frequent neoplasms noted in Poland were in 1986: in men cancer of the lungs (33.5% of all malignancies), cancer of the stomach (13.4%), prostate (4.8%), and pancreas (4.2%). In women the most frequent were: breast cancer (13.1%), cancer of the stomach (9.6%), lungs (7.8%), and cervix (6.7%). In 1986, significant difference in mortality rate was seen between men and women (prevalence of death in men) and between urban and rural areas (prevalence in urban areas). Moreover, persisting higher mortality rate for malignancies was noted in the western and central regions in comparison to eastern Poland. Mortality rate for malignancies in both men and women is higher in Poland than the average mortality rate in Europe.