OBR Daily Commentary

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Prostate Cancer and Value in Cancer Care

(ASCO Connection Blog) May 8, 2011 - Two articles in the most recent New England Journal of Medicine should get you thinking about where we are as a profession. Both have to do with prostate cancer, and while unrelated in their subject matter they both require us to address the same issue: whom do we treat?

Thomas Marsland, MD (Posted: May 11, 2011)

quotesAgain, kudos to Dr. Sledge and his very insightful reading of the two articles. The discussion of "value" is always a difficult one. I'm sure the additional 4 months of life would have been very "valuable" to his dad but would that have been valuable to society in general. My hope and prayers are that these types of value decisions are best left to the patients and their doctors, discussed in an open and transparent manner not contaminated by third- party administrative rules and regulations. One can only hope that as additional research unfolds that the mantra of "right drug for the right patient" truly helps in choosing what really is the value for the patient and the society both.quotes

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The IPAB: How Will It Change Medicare?

(Kaiser Health News) May 8, 2011 - It sounds like a new Apple product, but IPAB is actually a controversial board at the heart of a highly charged battle over Medicare, the federal health program for the elderly and disabled.

Thomas Marsland, MD (Posted: May 11, 2011)

quotesOf all the things in the health care reform bill the IPAB is perhaps the most scary. It puts in place a group of "appointed" individuals who are not responsible to anyone. They have unlimited authority and, taken to the worst case scenario, could result in total price controls. The IPAB is really not subject to any of the other checks and balances other areas of government are. Their potential to impact health care delivery could truly be catastrophic. quotes

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New Study Suggests Breast Cancer Treatments Lose Effectiveness Over Time

(CTRC/UT Health Science Center) May 9, 2011 - Some breast cancer treatments designed to reduce the risk of a recurrence may lose their effectiveness once the patient survives the first three-year danger zone, suggests a new study published online today in the Journal of Clinical Oncology.

(Posted: May 11, 2011)

quotesThis interesting comment outlines what we now know about differences in recurrence patterns based on tumor biology - with a relatively striking time based variation. The authors suggest that this implies that therapies delivered in the adjuvant setting, specifically chemotherapy, lose effectiveness over time. Indeed we need to understand the natural history of specific cancers, and even more importantly, appropriately individualize therapy to biology. However, patients with early stage breast cancer are living longer now than ever before, and patients with the most aggressive form of cancer are generally free of relapse if they survive without recurrence for 5 years. In contrast, patients with indolent, hormone receptor positive disease experience at least 50% of their relapse risk after 5 years. So, in fact, adjuvant therapy does not 'lose' its effectiveness. Instead, chemotherapy has its greatest impact on cancers likely to recur early. The later relapses may be better controlled by longer duration hormone therapy, perhaps given in sequence or intermittently to reduce development of resistance. Current clinical trial design must take this biologic heterogeneity into account.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...