The Daily Briefing ran this piece today and I wanted to bring it to your attention as there's been so much discussion around the clincial efficacy of prostate cancer treatement.
"Many men screened for prostate cancer who fell below the current standard for biopsy received overly aggressive treatment, according to a study by the Cancer Institute of New Jersey published in Archives of Internal Medicine.
In a study of 123,934 men, 15.2% with prostate-specific antigen readings of four nanograms--which is considered normal--or below were diagnosed with prostate cancer. Of those patients, 44% had their prostates removed and 33% underwent radiation. According to researchers, the findings suggest that current attempts to lower the threshold for abnormal prostate cancer test results would significantly increase the number of men overtreated for condition (Shao et al., Archives of Internal Medicine, 7/26 [subscription required]; Steenhuysen, Reuters, 7/26)."
One of the questions we get asked about most frequently is trends in medical oncologist alignment - because of cuts to chemotherapy payment, are we seeing more employment of medical oncologists, practice consolidation etc. Our response the past few years has consistently been "yes," but the only data we've had to support that was survey data from our membership. The Community Oncology Alliance has just released a report, the Community Oncology Cancer Care Practice Impact Report, that quantifies this trend in greater detail.
The report is put together using a combination of public and private data sources and indicates that across the last three years, 242 medical oncology practices have been acquired by hospitals, 102 have merged or been acquired by another entity and an additional 323 are struggling financially. It's hard to know exactly how comprehensive this report it, but it does provide support of trends we've been hearing anecdotally for years.
For those seeking resources for evaluating their physician alignment strategy, check out this webconference, Partnering with Medical Oncologists, and this publication, Toward True Shared Governance (specifically the chapter on physician alignment options).
In this week's issue of The New Yorker, Atul Gawande explores the multitude of challenges surrounding care for patients with terminal illness. Drawing on his own experiences as a surgeon at Brigham and Women's Hospital and Dana Farber, he illustrates why patients and families - and even their physicians - are frequently unprepared for the final stage of life.
Gawande notes that public debate has tended to focus on the question of who should have the power to make decisions about end of life care - payers, patients or physicians. But, he argues that this focus is misplaced. Rather "the failure of our system of medical care for people facing the end of their life" stems from larger societal attitudes about dying. Overwhelmingly, patients, families and physicians alike are reluctant to speak frankly about death.
Atul Gawande Examines the Challenges Surrounding End of Life Care