With cancer rates soaring - an estimated 1.5 million Americans were diagnosed with cancer in 2010, according to the National Cancer Institute - there's an increasing need for better cancer treatments. But fewer than 1% of cancer patients join clinical trials.
In an article just published in the Annals of Surgery, Waddah B. Al-Refaie, MD and colleagues found that just 0.64% of patients with solid tumors enrolled in clinical trials. They analyzed data on 244,528 cancer patients from the California Cancer Registry from 2001-2008 ("Cancer Trials Versus the Real World in the United States").
The authors point out that the few patients who do join trials do not represent the wide range of U.S. cancer patients. Patients who do enroll in clinical trials tend to be white, younger than 65 years old, and have late-stage cancer, the authors state. This lack of diversity makes it hard to assess how well a new drug might work on other types of patients.
There are many reasons why cancer patients don't join clinical trials. Some of the barriers are financial: doctors don't always tell patients about clinical trials for fear of losing patient revenue to the trial, and insurers don't always cover the cost of clinical trials for patients (although that should change with reform in 2014), explains Betsy de Parry on Candid Cancer ("Low enrollment in clinical trials is hampering progress"). Some barriers are more complex: patients might not live near clinical trial sites, and minority patients might distrust medical authorities, particularly around clinical trials, points out the National Cancer Institute, in a web page on trial participation that is older but still relevant.
The bottom line is that trial participation is inadequate to develop better, potentially life-saving treatments that so many cancer patients need. Information about joining cancer clinical trials is available online at the National Cancer Institute's website.
Monday, August 29, 2011
Friday, August 19, 2011
Leaving for Private Practice
Recently, several doctors that my family uses told me that they are leaving the hospital where they practice to become independent. I was surprised to hear this, because I had read that the the opposite is true: doctors are leaving private practice for the safety of a steady hospital salary.
Our doctors' frustrations, however, were legion. They disagreed with the hospital's billing practices, and were disappointed with the poor upkeep of the buildings. They suspected that political wranglings would block planned renovations to the hospital.
I had to agree with them on all these counts. As exhausted new parents, we tangled with the hospital's aggressive billing department just a few weeks after my oldest child was born. One of the hospital's parking garages has no elevators, which is fine unless you are pregnant, injured, nauseous, or disabled. Once, we had to carry a seriously ill child through a long, dark, underground tunnel in the belly of the hospital to hand-deliver a specimen for testing.
While sending us and our insurer bills regularly, the hospital also periodically asks for donations to its charities and building campaign. I decided long ago that we had given enough.
Despite the hassles, though, we have received excellent care from the doctors affiliated with the hospital, which kept us coming back. It's been nice to have most of our providers all in one place. Now we will need to drive all over town for doctor's visits, as our trusted community of doctors slowly disperses.
Our doctors' frustrations, however, were legion. They disagreed with the hospital's billing practices, and were disappointed with the poor upkeep of the buildings. They suspected that political wranglings would block planned renovations to the hospital.
I had to agree with them on all these counts. As exhausted new parents, we tangled with the hospital's aggressive billing department just a few weeks after my oldest child was born. One of the hospital's parking garages has no elevators, which is fine unless you are pregnant, injured, nauseous, or disabled. Once, we had to carry a seriously ill child through a long, dark, underground tunnel in the belly of the hospital to hand-deliver a specimen for testing.
While sending us and our insurer bills regularly, the hospital also periodically asks for donations to its charities and building campaign. I decided long ago that we had given enough.
Despite the hassles, though, we have received excellent care from the doctors affiliated with the hospital, which kept us coming back. It's been nice to have most of our providers all in one place. Now we will need to drive all over town for doctor's visits, as our trusted community of doctors slowly disperses.
Sunday, August 14, 2011
New Gun Law Restricts Health Care Providers
Florida recently passed a law making it illegal for doctors to ask patients whether there is a gun in their house during a routine health care visit. The law, CS/CS/ HB155, which became effective in early June, makes some exceptions for EMTs and paramedics, who frequently treat people injured by gun violence.
But the law's wording makes it clear that Florida firearm owners are primarily concerned about their own privacy. The law prohibits recording firearm ownership in a patient's medical record, prohibits "harassment of patient regarding firearm ownership during examination," and prohibits "discrimination by insurance companies" against firearm owners.
Asking about, or counseling against, gun ownership is not an idle issue. As physician Erin N. Marcus points out in a New York Times essay on this topic:
Asking patients questions about their sexual habits, alcohol consumption, gun ownership, and other "off-limit" topics is part of a doctor's job in providing good health care to a patient. This information is used privately by the doctor to ensure better care, not reported to local authorities. Questions from health care providers about illegal activities, such as illegal drug use or texting while driving (illegal in some states) don't provoke public outrage. Questions about legal gun possession do.
But the law's wording makes it clear that Florida firearm owners are primarily concerned about their own privacy. The law prohibits recording firearm ownership in a patient's medical record, prohibits "harassment of patient regarding firearm ownership during examination," and prohibits "discrimination by insurance companies" against firearm owners.
Asking about, or counseling against, gun ownership is not an idle issue. As physician Erin N. Marcus points out in a New York Times essay on this topic:
As a general internist in South Florida, I often see the effects of gun violence. Many of my patients have been injured or disabled by a gunshot, or had a family member shot and killed. Shortly after the new law went into effect, local television stations broadcast a story about a 4-year-old in Miami who was accidentally shot by his 17-year-old half brother, who was playing with a .22-caliber rifle.
Asking patients questions about their sexual habits, alcohol consumption, gun ownership, and other "off-limit" topics is part of a doctor's job in providing good health care to a patient. This information is used privately by the doctor to ensure better care, not reported to local authorities. Questions from health care providers about illegal activities, such as illegal drug use or texting while driving (illegal in some states) don't provoke public outrage. Questions about legal gun possession do.
Sunday, August 7, 2011
Recruiting Providers Who Trained Abroad
With a shortage of health care providers looming, the U.S. is trying to tap foreign-trained professionals to fill the gap. There are two tactics to achieve this, as several recent articles in Fierce Healthcare point out: giving temporary visas to nurses currently living and working abroad, and creating on-ramps for foreign-trained health care professionals living in the U.S. to practice medicine again.
As Fierce Healthcare points out, these policies would not just increase the number of people practicing medicine in the U.S., they would also add more diversity and language/cultural competency skills to the current health care workforce.
A bill approved by the House of Representatives, H.R. 1933, would double the length of time that foreign-trained nurses could work in U.S. hospitals from three years to six years, although the bill allows fewer of these visas than were granted in the past. These nurses would work in areas with nursing shortages that also serve Medicare and Medicaid patients, the Fierce Healthcare article explains.
Fierce Healthcare points out that, despite a crushing shortage of tens of thousands of health care professionals nationwide, this bill only grants 300 visas and serves about a dozen hospitals. Many of these hospitals are located in the bill sponsor's home state of Texas.
Meanwhile, the Welcome Back Initiative seeks to recruit underemployed foreign-trained U.S. residents back into medicine. The initiative funds free resource centers that provide information on getting appropriate credentials to practice in the U.S., educational programs, and job opportunities. The initiative currently serves only nine areas of the country, however, virtually ignoring the Midwest and the South.
These recruitment tools, if limited (and, I suspect, politically fraught), are at least a step in the right direction toward solving a serious provider shortage in health care.
As Fierce Healthcare points out, these policies would not just increase the number of people practicing medicine in the U.S., they would also add more diversity and language/cultural competency skills to the current health care workforce.
A bill approved by the House of Representatives, H.R. 1933, would double the length of time that foreign-trained nurses could work in U.S. hospitals from three years to six years, although the bill allows fewer of these visas than were granted in the past. These nurses would work in areas with nursing shortages that also serve Medicare and Medicaid patients, the Fierce Healthcare article explains.
Fierce Healthcare points out that, despite a crushing shortage of tens of thousands of health care professionals nationwide, this bill only grants 300 visas and serves about a dozen hospitals. Many of these hospitals are located in the bill sponsor's home state of Texas.
Meanwhile, the Welcome Back Initiative seeks to recruit underemployed foreign-trained U.S. residents back into medicine. The initiative funds free resource centers that provide information on getting appropriate credentials to practice in the U.S., educational programs, and job opportunities. The initiative currently serves only nine areas of the country, however, virtually ignoring the Midwest and the South.
These recruitment tools, if limited (and, I suspect, politically fraught), are at least a step in the right direction toward solving a serious provider shortage in health care.
Subscribe to:
Posts (Atom)
