Posts Tagged ‘kentucky’

Breast radiation trial provides more convenience, better compliance, lowered cost and patient outcomes on par with current treatment

These interim results of the 5-year Phase II clinical trial using the experimental regimen are being presented at the Breast Cancer Symposium 2014 in San Francisco by Anthony E. Dragun, M.D., vice chair and associate professor of radiation oncology at the University of Louisville.

Dragun, a radiation oncologist with University of Louisville Physicians, launched the trial three years ago at UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health and the only site offering the experimental regimen in the United States. A second KentuckyOne Health site is being planned, he said, and is expected to begin enrolling patients this autumn.

Reviewing data from Europe — the United Kingdom in particular — Dragun found an alternative to the currently standard daily radiation treatments prescribed to patients after a lumpectomy. Physicians in the U.K. and other European countries were reporting excellent results with a regimen of radiation administered once-weekly.

“Instead of daily treatments for 25-30 days, five to six treatments administered once each week were being used,” he said. “I thought this regimen would give our patients here in Kentucky a great deal of access and choice, so we developed the trial and launched it in 2011.”

Approximately 150 female patients have been enrolled in the trial thus far, he said. Patients undergoing a lumpectomy following diagnosis of breast cancer are given a choice of the current standard of daily radiation treatments or the option to enroll in the trial and receive treatment one time per week.

The radiation dosing has been calibrated to compensate for the change in how the treatments are administered, but no adverse effects have been seen, Dragun said. “The outcomes with once-weekly treatments are absolutely in line with what we see in daily breast irradiation,” he said. “The standard of care is maintained.”

Giving women the choice of how their treatment is administered means more women complete their treatment, he said. “Finding time for daily treatments for 6 weeks or more just isn’t possible for many women,” Dragun said. “Scheduling once-weekly treatments is much easier to fit into the busy lives our patients lead.

“We also see many patients who depend on public transportation or live in rural areas that are 30 miles or more from our center, and they have told us that they would not have been able to complete a traditional course of daily radiation treatment. Their only alternative would be a mastectomy,” he said.

Because radiation treatment is reimbursed on a per-treatment basis, Dragun said the overall cost is lowered. “We have reduced the number of treatments to about one-fourth to one-third of what the current daily treatment regimen is,” he said. “Medicare reimburses radiation costs on a per-treatment basis, and most private insurers do likewise.

“This means we’ve been able to reduce the cost by 50 to 60 percent without jeopardizing the quality of care.”

Dragun plans to enroll another 50 patients at the Louisville site and 30 at the future trial site. After the completion of this trial, he intends to expand into a multi-center Phase III trial at facilities in other states.

“We believe the once-weekly regimen such as this will become a standard option in the next decade,” he said.

source : http://www.sciencedaily.com/releases/2014/09/140904121041.htm

New study examines patterns of cancer screening in Appalachian women

Published in Women & Health, the study focused on six rural counties in Appalachian Kentucky. Researchers conducted in-person interviews with 222 women to assess their adherence (or lack thereof) to cancer screening guidelines. While 33 percent of the women had recently been screened for both breast and ovarian cancers, 48 percent were rarely or had never been screened for both.

Through the interviews, the researchers determined four variables that were independently associated with significantly increased odds of never or rarely receiving screenings for breast and cervical cancer: a belief that a Pap test is embarrassing, a belief that the lack of health insurance makes it difficult to obtain a Pap test, a belief that breast cancer screening is unnecessary without symptoms, and reporting no physician recommendation of a mammogram in the prior 12 months.

These patterns of non-screening in Appalachian Kentucky are troubling. The overall cancer mortality rate in Appalachian Kentucky is 17 percent higher than the national rate. Of particular concern are the elevated incidence and mortality rates of invasive cervical cancer in this area, which are 67 percent and 33 percent higher than the national rate.

Additionally, the belief that a breast cancer screening is unnecessary without symptoms is problematic, because often by the time a woman experiences symptoms or has a lump, the cancer is in a more advanced stage. A mammogram performed every 1-2 years for women aged 40 years or older could reduce mortality rates by approximately 20-25 percent over a 10-year period.

"Our study findings reinforce the challenges to screening faced by many vulnerable and underserved women," said Nancy Schoenberg, lead author on the paper and professor of Behavioral Science at the UK College of Medicine. "Whether they experience inadequate knowledge, as shown in this research, or inadequate resources, as shown in other studies, many women find it difficult to obtain optimal preventive health care. Facilitating optimal prevention will reduce the huge toll cancer takes on women, their families and their communities."

source : http://www.sciencedaily.com/releases/2014/01/140122133430.htm

Leadership void, not lack of money, slows efforts to address cervical cancer

"We focus on cervical cancer because it is likely the ‘low-hanging fruit’ opportunity to beat a cancer in this generation," said Beth Meyerson, a health policy expert at the IU School of Public Health-Bloomington. "We have the tools of HPV vaccination, screening and treatment; but uninsured women and women of color experience huge health disparities. This is the signal that we have a health system problem."

Meyerson and her research colleagues conducted interviews with 15 professionals working in programs involving cervical cancer. These included federal and state government breast and cervical cancer programs; women’s health and cancer control; national advocacy organizations engaged in sexual health and cancer; legislative affairs; researchers working in cervical cancer intervention and evaluation; state coalitions engaged in cervical cancer efforts; and partners from industry working on diagnostics, therapeutics or vaccines.

The researchers identified numerous obstacles, including "paucity of state-level coordination exacerbated by a lack of cervical cancer inter-agency/program influence" that prevented comprehensive, streamlined systems of care.

A possible solution would establish state-level coordinated efforts across agencies, as done in Kentucky. Those involved would meet to set strategic goals that would align policies and programs. This would include agencies such as the state departments of health and state Medicaid programs. Addressing this likely would cost very little, Meyerson said, but the benefits would be substantial.

"The challenge is to help separately funded programs work together — a very tall charge and one that public health administration grapples with perennially," she said.

source : http://www.sciencedaily.com/releases/2013/11/131103140619.htm