European Society for Medical Oncology
Receiving a cancer diagnosis is a devastating experience. Still under the shock of the bad news, patients must make many choices including who to turn to for advice and treatment, with the possibility to choose among a comprehensive cancer center, a university hospital or a community oncology hospital.
“When my oncologist informed me about my blood results, and told me the diagnosis (Plasmocytoma), I was disoriented. As a patient I was looking for detailed answers to my many questions and I wanted time,” explains Inge from Germany. “My doctor at the community oncology center explained everything to me: type of cancer, life expectancy, different treatments available and so on. To make it short, he helped me to understand what was going on with me. I was given a phone number to call at any time. The constant support of the whole team was essential to my recovery.”
The European Society for Medical Oncology (ESMO) recently created a new working group dedicated to Community Oncologists. The group aims to represent professionals working outside academic institutions or comprehensive cancer centers, who treat patients with a wide range of tumors and whose practice needs and access to resources are very specific.
Dr Robert Eckert from Internistische Gemeinschaftspraxis und Onkologische Schwerpunktpraxis in Wendlingen, Germany, who chairs the ESMO Community Oncology Working Group, explains that the first step will be to conduct surveys in as many European countries as possible in order to identify the special needs of Community Oncologists. “This will be a challenging task because the situation varies greatly across Europe. So far, we have been able to show for a number of countries that Community Oncologists are interested in practice-oriented tools, primarily in guidelines and score calculators. They need to be able to access reliable, up-to-date information quickly at the point of care in their practice, which reflects their challenge of treating a wide spectrum of malignant diseases.”
Once common needs are established, the Working Group will collaborate closely with the ESMO Leadership to develop educational activities and products, in order to meet Community Oncologists’ needs.
Dr Michalis Karamouzis, from St Savvas, Anticancer Oncologic Hospital in Athens, Greece and also a member of the new working group, explains some of the challenges of a young community oncologist: “According to my experience in Greece, Community Oncologists are doing very challenging work as they see most of the patients, not only those involved in clinical trials, but patients with all sorts of tumors, frequently with difficult tumors, patients with bad performance status, all sorts of complicated cases, including those who need supportive or palliative care.”
The way in which the treatment of cancer patients is organized –and patients’ preferences– also varies largely among European countries.
In Italy, Dr Sergio Crispino, Chair of the Italian Association of Hospital Oncology Chiefs (Collegio Italiano dei Primari Oncologi Medici Ospedalieri – CIPOMO) explains that “Many patients are treated in non-academic units. At present, in Italy, general hospitals contribute substantially to clinical research and have very advanced standards and treatments.”
In Italy the patient’s choice between a university hospital or a community setting would also depend on the region the patient lives in and the kind of cancer he has. “We cannot generalize. Patients are usually guided in their choice by family doctors,” explains Dr Crispino. “In the future, my personal view is that community oncology will grow because we are standardizing treatments so the quality of care will be similar in all centers. The development of oral drugs and gentler treatments will also contribute to this growth.”
The challenge today is to be able to provide quality care for patients from diagnosis until the end of treatment, be it in hospitals, hospices or at home. This can be done by adhering strictly to guidelines be they national, regional or international, ensuring efficiency and appropriateness of treatment.
“Also important for a community oncology center is to be able to work connected to a regional system and to participate in research, noted Dr Ulrich Stein from Hamburg, who has worked both in France and Germany.
“The important thing is that community oncologists should not work alone. They should be part of a network and participate in a common reflection and also work with others in clinical research. In France, community oncologists work closely with university hospitals or big cancer centers and are in contact with larger teams. National and international guidelines are followed and ensure that patients receive quality treatment.”
“Nowadays patients have access to a lot of information about cancer and about the quality of hospitals and clinics, thanks to the Internet. They will find out where the best centers are for their type of cancer. In France, for example, a patient may go to a big university hospital for surgery by a professor who specializes on a specific kind of tumor, then decide to go to a community oncology center for chemo and radiotherapy. Proximity may be an issue in some regions: some patients may want a community center closer to home, while others are willing to travel 80 km to be treated at a university center,” explains Dr Stein.
Dr Stein believes that ESMO’s new working group can help by making sure community oncologists are kept up to date with the latest treatments and by offering expert opinion on recent research. “By informing about what is going on in oncology, ESMO can help professionals learn from each other’s experiences in Europe and beyond.”
Dr Eckert also highlights the need for a real cross-border healthcare for Europe’s increasingly mobile population. “I have had to follow patients coming from other countries. In some cases the cooperation with cancer centers abroad was very easy, but in other places it was extremely difficult to access patients’ records.”
Dr Eckert concludes: “Our challenge is to form an enthusiastic group of doctors. We need to establish what the situation is in our countries and then work to answer the specific needs of our professionals. At the end of the day, the objective of the ESMO Community Oncology Working Group is to strive to ensure the best standard of care for all cancer patients, everywhere in Europe, inside and outside dedicated cancer centers.”
“It is essential that there’s a link between university hospitals and community oncology settings, between research and practice,” notes Rolf Stahel, Chair of the ESMO Educational Committee, ‘forefather’ of the Community Oncology working group. “This is the only way we can guarantee that the important results of research are brought as quickly as possible to cancer patients, which is the ultimate goal of all who work in the oncology community.”
Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice
Hopkins Children’s study suggests antibiotics may not always be best therapy
When it comes to curing skin infected with the antibiotic-resistant bacterium MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic, according to a new Johns Hopkins Children’s Center study. The work is published in the March issue of Pediatrics.
Researchers originally set out to compare the efficacy of two antibiotics commonly used to treat staph skin infections, randomly giving 191 children either cephalexin, a classic anti-staph antibiotic known to work against the most common strains of the bacterium but not MRSA, or clindamycin, known to work better against the resistant strains. Much to the researchers’ surprise, they said, drug choice didn’t matter: 95 percent of the children in the study recovered completely within a week, regardless of which antibiotic they got.
The finding led the research team to conclude that proper wound care, not antibiotics, may have been the key to healing.
“The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week,” says study lead investigator Aaron Chen, M.D., an emergency physician at Hopkins Children’s. “The better news might be that good low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference between rapid healing and persistent infection.”
Chen says that proper wound care has always been the cornerstone of skin infection treatment but, the researchers say, in recent years more physicians have started prescribing antibiotics preemptively.
Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit — if any — of drug therapy versus proper wound care. The best study, they say, would compare patients receiving placebo with those on antibiotics, along with proper wound cleaning, draining and dressing.
Antibiotics can have serious side effects, fuel drug resistance and raise the cost of care significantly, the researchers say.
“Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case,” says senior investigator George Siberry, M.D., M.P.H., a Hopkins Children’s pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development. “We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them.”
The 191 children in the study, ages 6 months to 18 years, were treated for skin infections at Hopkins Children’s from 2006 to 2009. Of these, 133 were infected with community-acquired MRSA, and the remainder had simple staph infections with non-resistant strains of the bacterium. Community-acquired (CA-MRSA) is a virulent subset of the bacterium that’s not susceptible to most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in those who are sick or have weakened immune systems, it can lead to invasive, sometimes fatal, infections.
At 48-hour to 72-hour follow-ups, children treated with both antibiotics showed similar rates of improvement — 94 percent in the cephalexin group improved and 97 percent in the clindamycin group improved. By one week, the infections were gone in 97 percent of patients receiving cephalexin and in 94 percent of those on clindamycin. Those younger than 1 year of age and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.
Co-authors on the study included Karen Carroll, M.D., Marie Diener-West, Ph.D., Tracy Ross, M.S., Joyce Ordun, M.S., C.R.N.P., Mitchell Goldstein, M.D., Gaurav Kulkarni, M.D., and J.B. Cantey, M.D., all of Hopkins.
The research was funded by a grant from the Thrasher Research Foundation and the General Clinical Research Center at Johns Hopkins.
Knowledge Gaps, Fears Common Among Parents of Children with Drug-Resistant Bacteria http://www.hopkinschildrens.org/Fears-Common-Among-Parents-of-Children-with-Drug-Resistant-Bacteria.aspx
Community-Acquired MRSA Becoming More Common in Pediatric ICU Patients http://www.hopkinschildrens.org/Community-Acquired-MRSA-Becoming-More-Common-in-Pediatric-ICU-Patients.aspx
Healthy Roads Media and other sources of quality health information in many languages and multiple formats
From a recent posting to Medlib-L (a medical librarian listserv)
“I direct a multilingual web-based health information project called Healthy Roads Media (www.healthyroadsmedia.org).
It is an effort to explore, develop and evaluate the use of various information technology strategies to provide health information access to hard to reach populations. Of special focus are low-literacy and non-English speaking groups.
Our materials are in multiple formats – handouts, audio, multimedia, web-video, and iPod video. We have had the content migrate off of the computer platform to iPods, televisions (via cabled iPod), radio and simple MP3 players (a solder in Iraq). Audio is our most accessed format (even more than handouts).
Some of the languages we work with are new or come from mainly an oral tradition so formats other than written are especially important. I am just beginning to explore mobile phone strategies as this technology has penetrated into every group and is easier for many to access that computers/internet. The one thing we have not explored (due to lack of funding and staff) are social media strategies.”
Current Topics include abuse, AIDS/HIV, asthma, cancer, dental health, diseases/conditions,food/nutrition, housing, immunization, mental health,pregnancy, sexual health, smoking, and TB.
The Links page includes
- New Routes: Using local media made by immigrants and refugees to improve the health of immigrants and refugees.
- Multicultural Health Communication Service
- Immunization Action Coalition
- Minnesota Dept. of Health – Refugee Health
- Multilingual & Multicultural Information Sites
- The 24 Languages Project
- The Center for Cross-Cultural Health
- The San Jose Plane Tree Health Library
- EthnoMed: Ethnic medicine information from Harborview Medical Center
- Virginia Department of Health, Division of Disease Prevention, Tuberculosis Control
- Hmong Health Website
- American Academy of Physicians, FamilyDoctor.org
- Health Information Translations
- California Health Literacy Initiative
- Multi-Cultural Educational Resources
- MedlinePlus Interactive Health Tutorials
Some additional resources
- Health Information in Multiple Languages (MedlinePlus)
- Consumer Health Information in Many Languages Resources (National Network of Libraries of Medicine) As of Dec 2010 languages included American Sign Language, Arabic, Cambodian/Khmer, Chinese, French, German, Hmong, Korean, Laotian, Russian, Spanish, Thai, and Vietnamese
- Multilingual Health Information (Stanford) As of Dec 2010 the site included nearly 50 languages)
- Health Materials in Languages other than English
- (Health) Materials in Asian Languages
- Health Information Translations -Quality Translations in Multiple Languages (via Mount Carmel Health Sciences Library)
- Locate easy-to-read health information in different languages.
- Print outs are in English and in a foreign language (dual language information).
Sources (with additional links)
Multicultural and Multilingual Health Information (University of Colorado Denver Health Sciences Library)
Health Websites in Other Languages (Binghampton University Libraries)