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Our CME group recently launched an interesting pilot audio program for cancer patients, their loved ones, physicians, nurses and other oncology healthcare professionals dedicated to improving cancer education. We call this Phase I initiative Cancer Q&A because, well, that’s what we do...we ask questions and you hear the answers.
Like most of the series we produce for oncology professionals, the core of this patient ed series (available in both CD format and on the internet at CancerQandA.com) is the audio interview, and over the next few months, our hope is to distribute more than 18 hours of conversations about both breast and colorectal cancer. The goal is to supplement and reinforce what patients learn in the oncology office.
It’s both scary and humbling to try to figure out what might be useful to people confronting cancer, but we have to believe that one source of important and relevant information would be experts in the field. So in breast cancer, our first shot at this includes five CDs worth of educational insights provided by Kathy Miller, Joyce O’Shaughnessy, Dennis Slamon, Rowan Chlebowski, George Sledge, Bill Gradishar and Hal Burstein. Our group has very high hopes for the long-term viability of this series, but we shall see.
While Q&A is an obvious aspect of our traditional audio programs, we also really like to ask people poll questions about what they think and do. The answers to these queries may not be as straightforward, but they are always interesting and, we believe, very valuable.
Our favorite pollees in this regard are clinical researchers, and this year alone we hosted five Think Tank meetings for which we utilized premeeting surveys to gauge clinical investigator opinion on a number of controversial issues. The results were incorporated into the discussion during the meetings and were often intriguing and thought provoking, particularly because of the considerable heterogeneity in perspectives that emerged among these elite investigators. I guess that’s why they call these things controversies.
On this issue of Breast Cancer Update, we take the Q&A approach to another level and we ask Dr Bob Carlson to comment on the results of a survey generated prior to a recent breast cancer Think Tank. Dr Carlson was unfortunately not able to attend that meeting, and it was highly interesting and entertaining to watch his evidence-based, NCCN guideline-trained mind chew up controversy after controversy post hoc. I personally found it hard to disagree with anything he said and was particularly interested in his answer to a question tossed his way toward the end of the interview:
“Agree, disagree or in between? Single-agent capecitabine is generally the optimal choice of first-line systemic chemotherapy for most patients with metastatic breast cancer, including patients with no prior exposure to chemotherapy.”
Bob paused for about three seconds, looked me straight in the eye and said, “Agree.” His explanation was evidence- and quality of life-based, and I couldn’t help but feel that Bob’s patients are truly lucky to have such a fine and caring oncologist to hold their hands and lead the way.
Another Q&A function our group serves is the implementation of polls of patients. Our most recent study was of 100 people who received adjuvant chemotherapy for colon cancer in the last five years. The interesting bottom line is that both oxali-receiving and nonoxali-receiving patients generally found the experience somewhat different than what they expected, and 40 percent would go through the same therapy again for a one percent reduction in their risk of relapse.
My favorite set of oncologist Q&As was from our August 2005 survey of 145 docs demonstrating that just a couple of months after the initial ASCO presentations of the adjuvant trastuzumab trials, a profound change in clinical practice had already occurred, and more than 90 percent of oncologists were adapting treatment patterns similar to clinical investigators. I like that. It makes me feel that the onco-world has efficient communication channels.
The next question is, “When are we going to find some answers? When are we going to put ourselves out of business? When are we going to get this thing done?”
Neil Love, MD
NLove@ResearchToPractice.net
November 17, 2006
Select Publications
NCCN Clinical Practice Guidelines in Oncology™. Breast Cancer V.2.2006. nccn.org
Perez EA et al. NCCTG N9831: May 2005 update. Presentation. ASCO 2005. No abstract available
Piccart-Gebhart MJ. First results of the HERA trial. Presentation. ASCO 2005. No abstract available
Romond EH et al. Doxorubicin and cyclophosphamide followed by paclitaxel with or without trastuzumab as adjuvant therapy for patients with HER-2 positive operable breast cancer — Combined analysis of NSABP-B31/NCCTG-N9831. Presentation. ASCO 2005. No abstract available
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