Health-Care Financing Administration's proposed regulations to implement Stark II

The Health Care Financing Administration published its proposed regulations to implement the 1993 amendments to the Stark law in the Federal Register on January 9, 1998. Several provisions are of interest to oncologists: The rental of infusion pumps to patients; how "physically present in the office" is defined; discounts on drugs; and compensation in a group practice. The details are discussed in this article.

Oncology legislative update

A summary of recent and proposed legislation that may affect oncologists and their patients. The report includes information about new fraud, waste, and abuse initiatives on the part of the federal government, the outlook for research funding, Medicare reimbursement, and state negotiations and legal actions against the tobacco companies.

Oncology services: the Department of Defense perspective

The Department of Defense (DoD) military health system has responsibility for providing medical care for more than 8 million beneficiaries. This article discusses initiatives related to both the providing and purchasing of oncology services. A description of health care coverage under TRICARE, the Department's managed care program, which utilizes military treatment facilities and civilian health care providers, is provided. Participation in clinical trials by the DoD beneficiaries, oncology services in military treatment facilities, quality management programs, cancer research, and the development of new technologies to enhance early cancer detection are presented. Access to research trials and new technologies is necessary for a comprehensive approach to cancer care. Clinical trials have been the vehicle by which the oncology community developed most of its formal clinical evidence for the efficacy of various treatment approaches. The Department participates in clinical trials through cooperative group membership or affiliation. Through an interagency agreement with the National Cancer Institute, DoD beneficiaries have available the option of participating in NCI-sponsored clinical trials through the direct military care system or through civilian care with reimbursement for approved protocols nationwide. The DoD has been actively involved in breast cancer research since 1992 and prostate and ovarian cancer research since 1997. The goals of the cancer research programs are to expedite and facilitate breakthroughs in research, support innovative, and exploratory ideas with a vision to foster new directions, address neglected issues, and bring new investigators into the research arena. The program incorporates the consumer perspective by involving consumers in the decision-making process. The DoD health care system trains experts in the management of cancer patients and provides a multidisciplinary approach to care through the direct military health care system or through network providers as part of the TRICARE system. Although cost containment is key, the delivery of high quality health care that is easily accessible is a primary goal of the military health system. Provision of a comprehensive benefits package that includes a spectrum of care and employing outcomes measurements to evaluate care that is appropriate for the patient's disease is essential.

An approach to teaching ethical, legal, and psychosocial aspects of gynecologic oncology in a residency program

An approach to teaching ethical, legal, and psychosocial issues in gynecologic oncology has been integrated into an obstetrics and gynecology residency program. Team-teaching is used, involving gynecologic oncology faculty members and a medical ethicist with experience teaching in the clinical setting of obstetrics and gynecology. The teaching takes place as part of ongoing teaching rounds in the division of gynecologic oncology. Articles from clinical journals are used to inform and stimulate discussion of clinical ethical, legal, and psychosocial issues. Integrating the teaching of ethical and legal aspects of gynecologic oncology into residency education is challenging, given the competing demands on the residents' time and the need for teaching to be clinically relevant. The program described in this article illustrates that such teaching can be carried out in a manner that covers main issues and has practical value for residents.

[Methodology and legitimacy of French clinical trials in primary chemoprevention of cancers. The point of view of the National Federation of French cancer centers]

In connection with the breast cancer prevention trial (BCPT) controversy, the "Fédération nationale des centres de lutte contre le cancer" (FNCLCC) decided to clarify, with the help of various discipline experts, its position on chemoprevention trials. If in terms of inclusion, two approaches can be opposed: high relative risk versus high attributable risk, these trials share in common a considerable importance of the informed consent according to potentially prosecution. A particular attention should be given to the unambiguous definition of end-points and indicators, and to monitoring of the side effects (medical or not). Non medical actors would have to play significant interventions in the schedule, the follow-up and the evaluation of such protocols. Methodological difficulties have been pointed, for example: recruitment, observance, drop out and confounding factors. French specificity has to be taking into account for the choice of pathologies, kind of interventions and global evaluation non limited to the sole dimension of the medical efficiency.