Ace Allen

Practising oncology via telemedicine

Although there are increasing numbers of telemedicine programmes in the USA, few have offered teleoncology services, so that the role of telemedicine in the practice of clinical oncology has yet to be fully defined. Telemedicine has been used successfully for direct patient care in Kansas. It is also a method of providing supportive care for the cancer patient, including assessments of pain and nutrition. In addition, televised tumour conferences and nursing education courses can help smaller communities develop a level of expertise that allows patients to be treated locally. Telemedicine may well be used in future for access to national and international cancer experts, and for participation in new cancer treatment protocols through cooperative group trials. When practising oncology via telemedicine, there are unique problems, including issues regarding technology interactive video and radiograph review and practice patient oncologist preferences and doctor-patient communication . Very little has been published in the area of tele-oncology so far, and studies concerning its efficacy, cost-effectiveness and the best organizational structure are still in progress. However, telemedicine appears to be a useful technique in the practice of oncology.

A pilot study of the physician acceptance of tele-oncology.

During the winter of 1993, medical oncologists from an urban, university-based hospital provided oncology care to rural patients using interactive video clinics (tele-oncology). In order to assess physician satisfaction with this form of outreach, surveys were performed after the video encounters, as well as after a limited number of subsequent clinical encounters on site. Various aspects of satisfaction were evaluated. Although the sample was small (a total of 41 clinical encounters and 3 oncologists), the results suggested that there was a reasonable level of physician satisfaction with, and confidence in, the use of video to replace some on-site oncology consultations. A definitive study of tele-oncology for providing care to rural cancer patients therefore appears to be warranted.

Cisplatin and novobiocin in the treatment of non-small cell lung cancer. A southwest oncology group study

Novobiocin, a commercially available oral antibiotic, inhibits DNA topoisomerase II in a manner shown in cell culture to enhance the cytotoxicity of alkylating agents and cisplatin. Thirty‐six patients were entered on a Phase II trial using high‐dose cisplatin (100 mg/m2 on days 1 and 8 for four cycles) after steady‐state dosing with novobiocin (1000 mg or four 250‐mg capsules every 12 hours for six doses, four of which were administered before each dose of cisplatin). One patient remains on study and cannot be evaluated for response. No complete responses were seen. Three patients (8%) had partial responses and an additional patient had an unconfirmed partial response. The median survival time of all patients was just less than 7 months. These results are comparable with those of other concurrent Southwest Oncology Group (SWOG) Phase II and III trials of high‐dose cisplatin in non‐small cell lung cancer (NSCLC). Novobiocin plasma levels were obtained for three patients and were approximately 50% of the optimal concentration as reported in cell culture for potentiation of cytotoxicity. It was concluded that an optimum test of novobiocin as a modulator of cytotoxicity may require the availability of an intravenous preparation.

Potential Role of Platelet-Derived Growth Factor Receptor Inhibition Using Imatinib in Combination with Docetaxel in the Treatment of Recurrent Non-small Cell Lung Cancer

Introduction: Platelet-derived growth factor receptor (PDGFR) is expressed in lung cancer and is involved in angiogenesis. Preclinical models demonstrated that imatinib (Im) regulates angiogenesis through PDGFR inhibition and enhances efficacy of chemotherapy. Hypothesis: We hypothesized that Im plus docetaxel (D) would have a synergistic effect detectable by an increase in response rate in patients with recurrent non-small cell lung cancer (NSCLC). Methods: A phase II trial to evaluate Im in combination with D in patients with recurrent NSCLC was conducted. The primary end point was response rate, using a Simon two-stage design. Eligible patients had measurable disease and no more than two chemotherapy regimens. D was given at 30 mg/m2/wk intravenously ×3 every 4 weeks and oral Im at 600 mg daily for four cycles. Patients required two cycles to be evaluable for response. Nonprogressors after four cycles continued with Im maintenance until progression or for a total of 12 months. Results: Twenty-three patients were enrolled in the first stage. Toxicity was mainly nonhematologic. We observed one partial response (5.5%), four stable disease (22.2%), and 13 progressed (72.2%). Median time to progression was 1.9 months, and median overall survival was 6.1 months. Two patients who went on Im maintenance had time to progression of 7.78 months and 15.8 months. Conclusion: Im in combination with D did not achieve its primary objective of improving response rate in patients with recurrent NSCLC. An increased understanding of the complex PDGFR pathway in lung cancer and alternative strategies to inhibit it are needed.

Malignant myositis ossificans. A case report.

A patient presented with an ossifying thigh mass suggestive of myositis ossificans. He had no antecedent trauma to the area. The mass was found to be an ossifying soft tissue metastasis from an occult gastric adenocarcinoma primary. Malignancy, and especially metastatic malignancy, is rarely considered in the differential diagnosis of a radiographic presentation of myositis ossificans.

Phase II evaluation of piroxantrone in renal cell carcinoma - A Southwest Oncology Group Study

SummaryThe Southwest Oncology Group (SWOG) studied the response rate and toxicity of piroxantrone (150 mg/m2 q 21 days) in patients with advanced metastatic renal cell carcinoma. Among 32 eligible patients, there were no partial nor complete responses. There were two mixed responses. Significant white cell toxicity, anemia, nausea, and vomiting were observed. Mild or moderate degrees of fever, malaise, and stomatitis occurred. No significant cardiac toxicity was noted. Piroxantrone does not have significant activity as a single agent in advanced renal cell carcinoma.

Smoking-related disease in a VA hospital.

An inpatient population was studied to assess the contribution of smoking to the cause of their hospitalization. We established a new methodology to assess a patient population for smoking-related disease, and found that, during a 24-hr period, 32% of all medical and surgical patients studied were hospitalized with smoking-related disease. Moreover, 17% of all medical and surgical patients were hospitalized for diseases that were very highly related to smoking (with risk-ratios greater than 5). On certain services these percentages were much higher. Smoking-related diseases account for a significant proportion of the hospitalizations at the Kansas City Veterans Administration Hospital.

From acute leukaemia to multiple myeloma: clarification of a diagnosis using tele-oncology.

A consultation was requested from rural Hays, Kansas, to the University of Kansas Medical Center (KUMC), some 280 miles (450 km) to the east, for a patient suffering from thrombocytopenia. Because of the very low platelet count (less than 20,0001Ill) the patient was scheduled for a semi-emergency consultation, instead of waiting for the next scheduled tele-haematology clinic. Before the teleconsultation, the referring physician had made a working diagnosis of immune-mediated thrombocytopenia, and had prescribed the patient steroids. After administration of platelets, a bone marrow sample had been obtained, and the result was pending at the time the consultation was requested. Before the teleconsultation, laboratory records were sent to KUMC by fax. The telemedicine equipment at the referring and consulting sites included high-resolution three-chip (CCD) colour video cameras and twin 35 inch (89 cm) monitors incorporated into a teleconferencing system (Rembrandt Gallery) with a codec (II/VP, Compression Labs Inc, San Jose, California) (Fig 1). Data were transmitted at 384 kbit/s. Cardiac and breath sounds were auscultated using an electronic stethoscope (SimulScope, Cardionics Inc, Houston, Texas). Radiographs were sent using a document camera (Elmo EV-386, Elmo Manufacturing Co, New York).