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In Treatment, Practice Makes (More) Perfect


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In Treatment, Practice Makes (More) Perfect

Women with breast cancer are much better off when they are seen at hospitals that do brisk business in such treatment. Patients at hospitals treating fewer than 25 breast cancer patients per year had a 20% lower survival rate after five years than patients at hospitals handling larger numbers of breast-cancer patients, researchers said.

Dr. Monica Morrow, an oncologist at Northwestern University Medical School in Chicago, analyzed data from 1,304 institutions on 175,879 women with breast cancer. She found that 509 of the hospitals, or about 39%, treated fewer than 25 breast-cancer patients a year, while 12% treated more than 100 patients a year. Patients at the high-volume hospitals were clearly doing better.

"What the study does not say is that physicians in large hospitals are better than physicians in small hospitals," Morrow said. The difference, she believes, is in the entire "system of care" at bigger hospitals: Better mammography may catch tumors earlier, the pathologists' analysis of tumors might be more thorough, and care is more likely to be provided by a team representing multiple specialties. The study follows earlier reports that busy hospitals have better outcomes with high-risk cancer surgery and chemotherapy.

Next, Morrow hopes to determine exactly which of these factors account for the survival differences. Meanwhile, she says, the 20% differential is important enough that patients at low-volume hospitals should seek a second opinion at a busier hospital.By Paul RaeburnReturn to top

These Pills Help Chill Out Hot Flashes

An antidepressant drug can reduce hot flashes in women--and in men with prostate cancer. Hot flashes are common during menopause but can also be triggered by breast-cancer drugs such as Tamoxifen. Many women tolerate the flashes for fear that estrogen therapy might stimulate growth of their cancer.

Now there's another option, reported Dr. Charles L. Loprinzi, an oncologist at the Mayo Clinic Cancer Center in Rochester, Minn. His study of 229 patients found that Effexor, when given at doses lower than normal for treating depression, reduced the severity of hot flashes by 61%. The drug was so effective it might also be considered for menopausal women without cancer who would rather not take estrogen, he said. Men with prostate cancer who must undergo castration might also benefit. After surgery, such men often suffer from hot flashes.By Paul RaeburnReturn to top

Locking the Barn Door Works After All

Early cancer treatment usually focuses on trying to prevent its spread to other organs without being too brutal to the patient. But once a tumor has spread to other parts of the body, treatment directed at the original source is often ineffective--or so it was thought. But a new study of kidney cancer has found that treating the source can help even after the cancer has spread.

Doctors at Loyola University Chicago's Stritch School of Medicine in Maywood, Ill., investigated a seemingly paradoxical strategy in patients with advanced kidney cancer. They decided to remove the kidneys of patients even though the cancer had already spread beyond that organ. They then gave the patients a form of the immune-system booster interferon. The treatment increased the patients' survival time by some 50%, from an average of 8 months to 12.5 months, according to Loyola's Robert C. Flanigan.

The cost of surgery to add four months to patients' lives is $10,000 to $15,000. But Flanigan said that newer drugs--the one he used is now a decade old--could boost the survival time and be more cost-effective.By Paul RaeburnReturn to top


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