News News
Dr. James S. Goodwin
Clearly, psychological factors operating in the physician, the patient, or the family can significantly influence treatment decisions. But many physicians and others believe economic forces play an even more powerful role. According to Goodwin, "There are clear economic forces which lead to overtreatment of older people."
Financial Incentives And Eisenberg, citing several studies, stated, "there is reasonable evidence that doctors do adjust the services they provide in response to economic incentives." He noted that fee-for-service medicine offers physicians financial incentives for overprovision of services, and that studies indicate doctors prescribe fewer services when they work for a fixed salary. Economics and treatment decisions are related in another way as well. Total resources are always limited, and these limitations are becoming more apparent as our society confronts escalating medical costs on the one hand and increasing alternative needs on the other. Vol. 84, No. 18, September 16, 1992
Solutions Although a problem as complex as that of medical decisionmaking can have no simple solution, there is strong agreement that both undertreatment and overtreatment can be significantly decreased by making certain that patients and their families are as fully informed as possible and have ample opportunity to discuss treatment with the physicians. . "Sometimes people get whisked into the (health) system so quickly that they haven't been given enough information and then enough time to think it all the way through," Foos said. "Patients need to have enough information, and they need to have enough time." Wisconsin's Goodwin stressed that doctors also need more information with which to make appropriate decisions. "Our best treatment information relates to cancer, because there are population-based registries. So we can get good information about the real world. Outcomes must be measured, and these must include quality of life." —Elaine Blume
Older Americans Are Priority in Cancer Research The National Cancer Institute has made cancer in older adults one of its top priorities, initiating a wide range of research studies on prevention, early detection, and treatment for older adults. In June 1990, NCI convened a workshop on the underlying molecular, cellular, and immunological factors in age-related cancers. It focused on colorectal, breast, and prostate cancer — the cancers of highest incidence and mortality among populations over age 65. Researchers will follow 350,000 members of the American Association of Retired Persons for 5 years to study relationships betwen diet and cancer. A clinical trial begins this fall to determine the effectiveness of the drug finasteride (trade name Proscar), in preventing prostate cancer. The Division of Cancer Etiology is conducting a follow-up study of 60,000 women who previously participated in the Breast Cancer Detection and Demonstration Project in the 1980s. "Many of the women included in the study are now over 65 years old," said Louise Brinton, Ph.D., chief of NCI's environmental studies section. "We are looking at menstrual and reproductive factors, hormone use, diet, and breast cancer. We should have results coming out in a year." NCI is testing and comparing the effectiveness of interventions to increase early detection and follow-up care of breast cancer in women ages 65 and older. As part of research on early detection patterns and health care seeking behaviors by older people, NCI is NEWS
1397
Downloaded from http://jnci.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 16, 2015
Though the term "medical rationing" is a hot button, observers point out that such rationing already occurs in many guises, including discouragingly long waits at public clinics and hospitals, rejection of uninsured patients by private hospitals, as well as avoidance of medical care and failure to fill prescriptions by patients deterred by expense. Medical ethicist Daniel Callahan, Ph.D., director of The Hastings Center, Hastings-on-Hudson, N.Y., believes certain large expenditures for treatment of the elderly might more wisely and ethically be used for other purposes. His position is lent force by indications, such as those outlined above, that some medical care for the elderly is clearly damaging to the patient.
News News
Dr. Louise Brinton
analyzing SEER data to determine if age is related to stage of diagnosis. NCI has removed age restrictions from clinical trials to include older cancer patients. "If you have a 75year-old patient, you need to have a clinical trial that includes that age group," said Edward Sondik, Ph.D., deputy director of NCI's Division of Cancer Prevention and Control. Major treatment trials that involve older patients include breast, ovarian, and prostate cancer protocols. Other NCI research targeting older people includes basic cancer research on brain, prostate, and colorectal cancers. In addition to research, NCI has begun a nationwide cancer education program for older Americans. Its goal is to educate health professionals and the public on the importance of cancer prevention, early detection, and proper treatment of people 65 and older. It involves working with newspapers, magazines, radio, TV — as well as organizations such as the American Association of Retired Persons. — John Burklow 1398
A non-toxic drug commonly used to treat children with inherited metabolic disorders may also be beneficial in treating some cancers and inherited blood diseases, according to researchers from the National Cancer Institute and The Johns Hopkins University Medical School in Baltimore. Acting via several different mechanisms, phenylacetate may be useful for these diverse diseases. "While focusing on phenylacetate as a potential anti-cancer drug, it became apparent that this non-toxic, natural compound can promote the differentiation of both cancer and non-cancer cells," explained Dvorit Samid, Ph.D., acting head of the Differentiation Control Section of NCI's Clinical Pharmacology Branch. Differentiation therapy causes cancer cells to mature, making them less aggressive, cease dividing, and eventually die. "Differentiation inducers provide an important alternative treatment for cancers that do not respond to conventional therapies. Such drugs also have therapeutic potential in several other diseases, including inherited anemias," she said. Two cancer drugs, hydroxyurea and 5-azacytidine, have already proven useful in treating anemias, but have toxicities that limit their use.
"It would appear that there are reasonably good grounds for attempting to inhibit the growth of human cancers by the application of the relatively nontoxic compound phenylacetic acid and its esters," Neish wrote. Because glutamine is also an important carrier of ammonia to the kidney for excretion, phenylacetate (as sodium phenylbutyrate) is already given to children who have inherited diseases in which an excess of ammonia is created. The drug binds to the glutamine/ammonia complex and eliminates it.
Different Mechanism Phenylacetate not only reduces circulating levels of glutamine, but also alters the expression of several cellular genes, including a reduction in the myc oncogene, according to laboratory research by Samid with colleagues at the
Original Research Because cancer cells need more glutamine than normal cells, researchers postulated that a drug that decreased the availability of glutamine, a non-essential amino acid, would be a good anti-cancer agent. In a 1970 article in the journal Experientia, WJP. Neish of the University of Sheffield, United Kingdom, wrote about a simple method for depleting glutamine, based on the fact that humans use glutamine to detoxify phenylacetic acid.
Dr. Dvorit Samid
Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 16, 2015
Non-toxic Drug Being Tested To Treat Cancer and Anemias
Dr. James S. Goodwin
Clearly, psychological factors operating in the physician, the patient, or the family can significantly influence treatment decisions. But many physicians and others believe economic forces play an even more powerful role. According to Goodwin, "There are clear economic forces which lead to overtreatment of older people."
Financial Incentives And Eisenberg, citing several studies, stated, "there is reasonable evidence that doctors do adjust the services they provide in response to economic incentives." He noted that fee-for-service medicine offers physicians financial incentives for overprovision of services, and that studies indicate doctors prescribe fewer services when they work for a fixed salary. Economics and treatment decisions are related in another way as well. Total resources are always limited, and these limitations are becoming more apparent as our society confronts escalating medical costs on the one hand and increasing alternative needs on the other. Vol. 84, No. 18, September 16, 1992
Solutions Although a problem as complex as that of medical decisionmaking can have no simple solution, there is strong agreement that both undertreatment and overtreatment can be significantly decreased by making certain that patients and their families are as fully informed as possible and have ample opportunity to discuss treatment with the physicians. . "Sometimes people get whisked into the (health) system so quickly that they haven't been given enough information and then enough time to think it all the way through," Foos said. "Patients need to have enough information, and they need to have enough time." Wisconsin's Goodwin stressed that doctors also need more information with which to make appropriate decisions. "Our best treatment information relates to cancer, because there are population-based registries. So we can get good information about the real world. Outcomes must be measured, and these must include quality of life." —Elaine Blume
Older Americans Are Priority in Cancer Research The National Cancer Institute has made cancer in older adults one of its top priorities, initiating a wide range of research studies on prevention, early detection, and treatment for older adults. In June 1990, NCI convened a workshop on the underlying molecular, cellular, and immunological factors in age-related cancers. It focused on colorectal, breast, and prostate cancer — the cancers of highest incidence and mortality among populations over age 65. Researchers will follow 350,000 members of the American Association of Retired Persons for 5 years to study relationships betwen diet and cancer. A clinical trial begins this fall to determine the effectiveness of the drug finasteride (trade name Proscar), in preventing prostate cancer. The Division of Cancer Etiology is conducting a follow-up study of 60,000 women who previously participated in the Breast Cancer Detection and Demonstration Project in the 1980s. "Many of the women included in the study are now over 65 years old," said Louise Brinton, Ph.D., chief of NCI's environmental studies section. "We are looking at menstrual and reproductive factors, hormone use, diet, and breast cancer. We should have results coming out in a year." NCI is testing and comparing the effectiveness of interventions to increase early detection and follow-up care of breast cancer in women ages 65 and older. As part of research on early detection patterns and health care seeking behaviors by older people, NCI is NEWS
1397
Downloaded from http://jnci.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 16, 2015
Though the term "medical rationing" is a hot button, observers point out that such rationing already occurs in many guises, including discouragingly long waits at public clinics and hospitals, rejection of uninsured patients by private hospitals, as well as avoidance of medical care and failure to fill prescriptions by patients deterred by expense. Medical ethicist Daniel Callahan, Ph.D., director of The Hastings Center, Hastings-on-Hudson, N.Y., believes certain large expenditures for treatment of the elderly might more wisely and ethically be used for other purposes. His position is lent force by indications, such as those outlined above, that some medical care for the elderly is clearly damaging to the patient.
News News
Dr. Louise Brinton
analyzing SEER data to determine if age is related to stage of diagnosis. NCI has removed age restrictions from clinical trials to include older cancer patients. "If you have a 75year-old patient, you need to have a clinical trial that includes that age group," said Edward Sondik, Ph.D., deputy director of NCI's Division of Cancer Prevention and Control. Major treatment trials that involve older patients include breast, ovarian, and prostate cancer protocols. Other NCI research targeting older people includes basic cancer research on brain, prostate, and colorectal cancers. In addition to research, NCI has begun a nationwide cancer education program for older Americans. Its goal is to educate health professionals and the public on the importance of cancer prevention, early detection, and proper treatment of people 65 and older. It involves working with newspapers, magazines, radio, TV — as well as organizations such as the American Association of Retired Persons. — John Burklow 1398
A non-toxic drug commonly used to treat children with inherited metabolic disorders may also be beneficial in treating some cancers and inherited blood diseases, according to researchers from the National Cancer Institute and The Johns Hopkins University Medical School in Baltimore. Acting via several different mechanisms, phenylacetate may be useful for these diverse diseases. "While focusing on phenylacetate as a potential anti-cancer drug, it became apparent that this non-toxic, natural compound can promote the differentiation of both cancer and non-cancer cells," explained Dvorit Samid, Ph.D., acting head of the Differentiation Control Section of NCI's Clinical Pharmacology Branch. Differentiation therapy causes cancer cells to mature, making them less aggressive, cease dividing, and eventually die. "Differentiation inducers provide an important alternative treatment for cancers that do not respond to conventional therapies. Such drugs also have therapeutic potential in several other diseases, including inherited anemias," she said. Two cancer drugs, hydroxyurea and 5-azacytidine, have already proven useful in treating anemias, but have toxicities that limit their use.
"It would appear that there are reasonably good grounds for attempting to inhibit the growth of human cancers by the application of the relatively nontoxic compound phenylacetic acid and its esters," Neish wrote. Because glutamine is also an important carrier of ammonia to the kidney for excretion, phenylacetate (as sodium phenylbutyrate) is already given to children who have inherited diseases in which an excess of ammonia is created. The drug binds to the glutamine/ammonia complex and eliminates it.
Different Mechanism Phenylacetate not only reduces circulating levels of glutamine, but also alters the expression of several cellular genes, including a reduction in the myc oncogene, according to laboratory research by Samid with colleagues at the
Original Research Because cancer cells need more glutamine than normal cells, researchers postulated that a drug that decreased the availability of glutamine, a non-essential amino acid, would be a good anti-cancer agent. In a 1970 article in the journal Experientia, WJP. Neish of the University of Sheffield, United Kingdom, wrote about a simple method for depleting glutamine, based on the fact that humans use glutamine to detoxify phenylacetic acid.
Dr. Dvorit Samid
Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 16, 2015
Non-toxic Drug Being Tested To Treat Cancer and Anemias
