9th Annual Conference: "Clinical Practice Guidelines"


9th Annual Conference: “Clinical Practice Guidelines & Outcomes Data in Oncology” sponsored by the National Comprehensive Cancer Network (NCCN).

This year’s meeting was held in Ft. Lauderdale and the primary audience was oncologists. NCCN has an ongoing program of developing (by consensus) comprehensive guidelines for diagnosis, treatment, supportive care, and recommendations on managing symptoms experienced by cancer patients.

Some of the information offered by this organization is available to patients at its website, www.nccn.org.

One of the presentations was an overview of the ongoing problems in containing nausea and vomiting (Antiemesis).

The most ‘distressing’ ‘side’** effects to patients are vomiting, nausea and loss of hair. Ranked in that order from a study prior to the availability of 5-HT3 Antagonists, it is now nausea, loss of hair, vomiting.

The presenter Mark G. Kris, MD pointed out that despite the use of ondansetron and dexamethasone, 76% of patients still developed nausea and 73% had delayed nausea (days 2-5). Cycle 2 was similar. 11% vomited on day 1, 19% on day 2-5, and 6% day 1-5.

His conclusion: “despite prophylaxis with ondansetron and dexamethasone, the majority of patients experienced nausea”.

Dr. Kris stated that the goals of antiemetic treatment in chemotherapy patients, is to prevent nausea and vomiting rather than treat it. He suggested that cost should NOT be a barrier to use, that patients need protection throughout at least a 4 day period, the lowest efficacious dose should be used with consideration for the toxicity of the specific meds chosen.

It is currently believed that oral or IV meds have equivalent results.

There are other problems that may cause emesis in people with cancer:

Partial or complete bowel obstruction

Vestibular dysfunction

Brain metastasis

Electrolyte imbalance (hypercalcemia, hyperglycemia, hyponatremia)

Concomitant drug treatments including opiates

Gastoparesis (slowed digestion in the stomach), tumor or chemotherapy (vincristine, etc) induced

Psychophysiologic – i.e. anxiety or anticipatory nausea and vomiting

The Annie Appleseed Project suggests that people having trouble with the medications offered, should consider the use of acupuncture and Chinese herbs, ginger root, yoga, and relaxation techniques in general, and perhaps wrist bands.

For more information on non-toxic approaches, go to http://annieappleseedproject.org/nausrelban.html There was a Roundtable discussion on Access to High Quality Cancer Care, which included several patient, advocates.

NCCN also has an “Oncology Outcomes Project” which collects data to measure the way clinicians use their guidelines, evaluates quality of cancer care, and reports on issues like socio-demographics, diagnostic procedures, response to treatment, long-term survival, etc.

An example of information presented: “Of 2,326 patients undergoing mastectomy, 45% received reconstruction. Of the reconstructions, 42% were implants, 21% rotational TRAM flaps, 31% free TRAM flaps, and 6% other.

From the Senior Adult Panel Report: benefits of adjuvant chemotherapy in women age 70 is 13%, age 75 is 21%, age 80 is 30%. All patients age 70+ should undergo some form of geriatric assessment, performed by an oncologist or referring physician.

Stephen M. Prescott, MD of the Huntsman Cancer Institute at the University of Utah gave a presentation on “Predictive Medicine: Implications for Your Practice”. Unfortunately there were no pre-submitted slides. He did state that he had nothing to disclose.

The majority of attendees are 3rd year fellows.

**I no longer use the term ‘side’ effects as I consider that a marketing term. Most of the effects we do not want are as real as the ones we do. So I call them unwanted.

Ann Fonfa is the founder and president of The Annie Appleseed Project, a web-based provider of information, education, advocacy and awareness for people with cancer, family and friends from the patient perspective. Special emphasis is placed on complementary, alternative (CAM), natural therapies.

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