Analysis of the standardization and centralization for cancer treatment in Nagasaki prefecture

In medical care systems for cancer, it is important to consider the issues of standardization and centralization. In this study, we employed the Nagasaki Cancer Registry, which has a high registry rate, to investigate standardization and centralization for five major cancers, in addition to childhood malignancies (which are often rare types). Subjects were patients diagnosed with cancer and registered in the Nagasaki Cancer Registry between 1985 and 2004. For standardization, we calculated a Preference Index and five-year survival rate, and for centralization we investigated Pareto curves and Gini coefficients as well as the annual average number of cases per hospital. Results suggested that patients migrate to medical service areas different from where they reside in order to receive treatment at facilities thought to have a better record of treatment. In addition, while the number of patients and treatment facilities for childhood cancer was decreasing due to a decline in the number of children, the centralized tendency differed for the 12 diagnoses assessed. By conducting analyses based on population-based cancer registries using the evaluation methods employed in this study, it should be possible to investigate patients' migrant patterns, as well as to develop systems for providing medical care in secondary medical service areas.

Interprofessional collaboration with service users in the development of cancer services: The Cancer Partnership Project

Patient and Public Involvement (PPI) is a cornerstone of UK National Health Service (NHS) policy. The Cancer Partnership Project (CPP) is the leading national PPI initiative in cancer care. The CPP espouses a "partnership" model, with a "Partnership Group" - collaborative service improvement groups formed of NHS staff and service users - in each of 34 cancer networks in England. These groups aim to enable service users to influence local cancer service development and thereby improve the effectiveness of services. We interviewed 59 cancer service users and NHS staff in a reflective evaluation of CPP. Groups were active and visible in 30 networks, their main activities being: providing an accessible source of consumer opinion; prolific networking and representation; patient information and communication projects; and lobbying for service improvements. The groups exhibited some significant tensions. The motivations of professional staff varied markedly, and "obligatory" involvement as part of a person's job was counter-productive when not coupled with a "personal" belief in the value of PPI. Other controversial areas were the disclosure by patients' of personal health and treatment experiences, and emotional attachment to the group. It was concluded that partnership groups represent a useful PPI model, but more attention generally should be paid to the complexities of PPI and timescales required for meaningful cultural change.

Evaluation of formative development in the neighborhood cancer care cooperative

The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) were funded by the National Cancer Institute Radiation Research Program Cancer Disparities Research Partnership program in September 2003. ROCOG/NCCC provides customized, community hospital-based initiatives intended to help close the cancer disparities gap. In our two preceding articles in this issue, we have explored contextual and organizational development, described infrastructure and component programs, and outlined early evaluation strategies. This article will conclude the series of publications describing our early development by evaluating the formative implementation phase of the project. Our first 12 months were initially evaluated through a survey designed to assess staff and key stakeholders' perception of progress. An assessment of the level of completion of key project tasks was conducted 6 months after the survey. This combination has allowed ROCOG/NCCC to determine areas of success and also illustrate those in need of improvement. Our evaluation strategy can also serve as an efficient and inexpensive model for other similar community-based start-up programs to replicate.

Creation of community-based research capabilities in the neighborhood cancer care cooperative: administrative infrastructure, program initiatives, and evaluation priorities

The Radiation Oncology Community Outreach Group (ROCOG) and the Neighborhood Cancer Care Cooperative (NCCC) were developed to address oncology-related health disparities utilizing a community-based, collaborative organizational design. Funded in 2003 by the National Cancer Institute's Cancer Disparities Research Partnership program, ROCOG/NCCC has focused on reducing barriers to care and enhancing the health care system's responsiveness to minority and indigent populations within Southwestern Pennsylvania. This article will describe the component programs that have been developed under this umbrella, as well as the evolved administrative, governance, and evaluation infrastructure that supports these initiatives.

The multidisciplinary management of osteosarcoma

Patients with suspected or confirmed osteosarcoma should be evaluated and treated at a comprehensive cancer center within a multidisciplinary sarcoma program that includes pediatric, medical and radiation oncologists, orthopedic and surgical oncologists, musculoskeletal pathologists, and radiologists. Successful treatment involves proper diagnosis, neoadjuvant and adjuvant multi-agent chemotherapy, and aggressive surgery with an emphasis toward limb-preserving procedures. Treatment of osteosarcoma should be undertaken within the framework of large cooperative group clinical trials for children, adolescents, and adults. Patients treated with osteosarcoma should be followed closely both for recurrence of disease and for development of late effects of the treatment of their cancer. The treatment of metastatic, recurrent and/or refractory disease is more controversial. Despite advances in systemic treatment, surgical technique, and supportive care, the overall outcome is still poor.

The bridge between patient and doctor: the shift from CAM to integrative medicine

Integrative medicine (IM) has become a major challenge for doctors and nurses, as well as psychologists and many other disciplines involved in the endeavor to help patients to better tolerate the burden of toxic therapies and give patients tools so they can actively participate in their "salutogenesis." IM encompasses psycho-oncology, acupuncture, and physical and mental exercises to restore vital capacities lost due to toxic therapies; furthermore, it aims to replenish nutritional and metabolic deficits during and after cancer treatment. IM gains an ever increasing importance in the face of the rapidly growing number of cancer survivors demanding more than just evidence-based diagnostic and therapeutic strategies. IM has to prove its value and justification by filling the gap between unproven methods of alternative medicine, still used by many cancer patients, and academic conventional medicine, which often does not satisfy the emotional and spiritual needs of cancer patients.

Strategic planning for the TotalCare Cancer Center at Los Alamitos Medical Center with data analysis of caseloads before and after opening

PURPOSE

To evaluate the significance of the new TotalCare Cancer Center at Los Alamitos Medical Center during its first 6 months of operation. This study evaluates the short-term impact that the center has had on patient caseload in the areas of infusion and radiation oncology.

METHODS

Two 6-month time blocks were evaluated using the cancer registry database. Cases were reviewed to determine the number of patients that received chemotherapy and radiation therapy at Los Alamitos Medical Center prior to and directly after the initiation of the TotalCare Cancer Center to determine if the initial goals laid out by the administration were met.

RESULTS

The same number of patients received chemotherapy at the hospital prior to and directly after the center was opened and few patients received radiation therapy in the first 6 months after the center was opened.

CONCLUSION

The TotalCare Cancer Center did not appear to have the desired impact on caseload as was desired by the administration within the first 6 months of operation. However, overall caseload did increase over that time period, concluding that there may be a lag in overall affect of the new center.

[Tumours of the bony face in children the treated at the Paediatric ENT Clinic in Warsaw]

INTRODUCTION

The tumours of bony face at in children are rare. Among the most commonly found are inflammatory tumours and development anomalies. In histopathology, the most frequent fund are neuroma, fibromas, osteoma, lipomas. In inflammatory tumours there are abscess and inflammatory infiltration. Malignants tumours in this area are rare in children, but are mainly sarcomata or melanoma. Developmental tumours include cyst and fistula.

OBJECTIVE

To analyse tumours of the bony face treated in Paediatric ENT Clinic in Warsaw.

MATERIAL

There were thirty cases of bony face tumours treated in Paediatric ENT Clinic in Warsaw between 2005 and 2007.

RESULTS

One cases (3%) provedto be malignant, and one (3%) locally malignant. Twenty-one cases (70%) were found to be developmental tumours, three cases (10%) of abscesses, and four cases (13%) of benign tumours.

CONCLUSIONS

The most frequently-found tumours of bony face in children are developmental tumours. All tumours must be the subject of histopatological examination. In the case of cancers tumours it has to be established if the tumour is a primary or a metastatic. In the group analysed group the rare tumour were epithelioma, ganglioma.

[The management by the processes in a cancer center, an utopian initiative?]

The process approach is a mode of quality improvement. It leans on the cartography's establishment, allows to redefine organization around patients trajectory, the measure of defects and their correction. The process pilot is a new actor in the management of the establishment. It is developed since 3 years in the Institute Claudius Regaud, regional cancer center treatment of Midi-Pyrénées.

Mammography facility characteristics associated with interpretive accuracy of screening mammography

Background

Although interpretive performance varies substantially among radiologists, such variation has not been examined among mammography facilities. Understanding sources of facility variation could become a foundation for improving interpretive performance.

Methods

In this cross-sectional study conducted between 1996 and 2002, we surveyed 53 facilities to evaluate associations between facility structure, interpretive process characteristics, and interpretive performance of screening mammography (ie, sensitivity, specificity, positive predictive value [PPV1], and the likelihood of cancer among women who were referred for biopsy [PPV2]). Measures of interpretive performance were ascertained prospectively from mammography interpretations and cancer data collected by the Breast Cancer Surveillance Consortium. Logistic regression and receiver operating characteristic (ROC) curve analyses estimated the association between facility characteristics and mammography interpretive performance or accuracy (area under the ROC curve [AUC]). All P values were two-sided.

Results

Of the 53 eligible facilities, data on 44 could be analyzed. These 44 facilities accounted for 484 463 screening mammograms performed on 237 669 women, of whom 2686 were diagnosed with breast cancer during follow-up. Among the 44 facilities, mean sensitivity was 79.6% (95% confidence interval [CI] = 74.3% to 84.9%), mean specificity was 90.2% (95% CI = 88.3% to 92.0%), mean PPV1 was 4.1% (95% CI = 3.5% to 4.7%), and mean PPV2 was 38.8% (95% CI = 32.6% to 45.0%). The facilities varied statistically significantly in specificity (P < .001), PPV1 (P < .001), and PPV2 (P = .002) but not in sensitivity (P = .99). AUC was higher among facilities that offered screening mammograms alone vs those that offered screening and diagnostic mammograms (0.943 vs 0.911, P = .006), had a breast imaging specialist interpreting mammograms vs not (0.932 vs 0.905, P = .004), did not perform double reading vs independent double reading vs consensus double reading (0.925 vs 0.915 vs 0.887, P = .034), or conducted audit reviews two or more times per year vs annually vs at an unknown frequency (0.929 vs 0.904 vs 0.900, P = .018).

Conclusion

Mammography interpretive performance varies statistically significantly by facility.

Franchise. Quantum leap

The Royal Marsden's chemotherapy unit in Kingston will not only treat its own patients who live locally, but also accept referrals from local GPs. The move is part of a trend by well-known hospitals to open franchises, led by the Moorfields Eye Hospital which has 11 satellite units, including one in Dubai. Franchising by specialist hospitals can increase services, raise income and expand their brand. It also allows specialist staff to work in a range of settings.

Oncological organizations and institutions in Poland before the second World War

During the first four decades of the 20th century many oncological organizations and institutions were established in Poland. On 6 June, 1906 the Committee for Cancer Research and Control was founded. After the year 1918 when Poland regained its independence many more cancer control organizations came into being. The organizations created at that time were: the Polish Committee for Cancer Control (Warsaw 1921), the Cancer Control Society of Lódź (Lódź 1927), the Vilnius Committee for Cancer Control (Vilnius 1931), the Polish Cancer Control Institute Association in Lviv (Lviv 1929), the Polish Cancer Control Association (Warsaw 1938). These cancer control organizations undertook multiphase activities (prophylactic, educational, organizational, scientific and research) by creating outpatient and inpatient oncological care institutions, on which base numerous scientific and research papers were produced. The effect of that work was the creation of the Radium Treatment Institute in Lódź and the Research and Therapeutic Institute for Cancer Control in Vilnius, as well as founding oncological hospital wards and clinics. The most important achievement was building and opening the very modern Radium Institute in Warsaw. The initiator of the Institute, which in 1939 had 90 beds on its disposal, was Maria Skłodowska-Curie herself. Cancer control organizations members and activists conducted many propaganda actions on malignant diseases, shared they observations and research findings during meetings, conferences and assemblies in Poland and abroad.