Breast Cancer Alert: Teleconference on 12/13

Shortcomings & Patient Concerns re: New Study of Breast Brachytherapy (APBI) –

What Women Need to Know Now

Tuesday, Dec. 13, 2011

Noon EST

Call-in number:  1-480-629-9712

Please join us via teleconference to hear statements and discussion by four of the world’s leading clinical researchers in breast brachytherapy (accelerated partial breast irradiation, or APBI).

These experts will highlight their concerns about a controversial — and potentially misleading — new study on APBI presented at last week’s San Antonio Breast Cancer Symposium. They will also provide perspective on what women need to know now about breast cancer radiation therapy.

The teleconference will feature:

Robert Kuske, MD, (Phoenix) Co-Principal Investigator, NSABP B-39 study comparing five-day APBI to six-week whole breast irradiation

Peter D. Beitsch, MD, (Dallas) Co-Principal Investigator of the American Society of Breast Surgeons’ MammoSite Registry

Jayant Viadya, MD, (London, U.K.), pioneer of targeted intraoperative radiotherapy (IORT)

Rakesh Patel, MD, (Pleasanton, Ca.), Chairman, American Brachytherapy Society

This event is open to the first 50 participants, including media and other interested parties.

(Note to media: To ensure your place on the call, please contact Liz Dowling, tel. 415-388-2794; Liz@dowlingdennis.net.)

Problems with New Breast Cancer Radiation Study

There’s plenty of controversy about – and disagreement with – a new study from MD Anderson (MDA). One expert MD even said the study’s flaws were not trivial, but “huge.”

The study said women who got an older form of breast brachytherapy appear to have slightly higher rates of complications and subsequent mastectomy. Presented at this week’s San Antonio Breast Cancer Symposium, it was a “look-back” at Medicare records.

The MDA conclusions have prompted unusually strenuous objections from physicians who support and perform breast brachytherapy.

Breast brachytherapy, a form of accelerated partial breast irradiation (APBI), is increasingly popular because of its clinical efficacy for appropriate patients, and because it takes just 5 days.

By comparison, the standard course of external-beam, whole-breast irradiation (WBI) takes six or seven weeks. Many early-stage breast cancer patients increasingly express a preference for the far more convenient approach of APBI.

Follow-up radiation is recommended for women who have a lumpectomy as part of breast-conservation therapy. APBI now accounts for an estimated 13% of patients undergoing treatment in 2007, according to MDA’s Dr. Benjamin D. Smith, lead author of the study.

But are the study’s conclusions valid? And what are doctors saying to their patients about breast cancer treatment – especially given that the study data covers a period before more sophisticated APBI became available? (After all, even MD Anderson isn’t changing the way it offers APBI.)

“Criticism of the study surfaced almost immediately,” noted the respected radiology website AuntMinnie.com. “One critique was that the study is based on an analysis of Medicare billing codes rather than actual clinical outcomes.” Medicare claims data is often not a reliable measure of clinical effectiveness.

Also weighing in was the American Society of Breast Surgeons, which represents physicians who place the catheters that deliver breast brachytherapy.

ASBrS maintains a registry of 1440 patients treated by APBI with the balloon catheter device through 2004. It statement said numerous published studies have shown:

– A 5-year local cancer-recurrence rate of <5%, comparable to that of WBI;

– A low rate of other complications with APBI; and

– Good or excellent cosmetic results in approximately 90% of patients.

ASBrS noted that several randomized and nonrandomized studies using another technique of APBI — multiple interstitial catheters — have also seen rates of local cancer recurrence comparable to WBI.

For the record, Dowling & Dennis represents a company that makes one of those multiple interstitial catheters. It’s called SAVI – and it was developed to address the shortcomings of earlier brachytherapy technology, the one examined in the MDA study.

For more information on the experiences of women who’ve had SAVI treatment, see SAVI Sisters. Study data on SAVI is available here. In particular see the peer-reviewed, published results in the respected Red Journal (abstract available here.)

Other concerns about the MD Anderson study include:

– “Patients in this study received antiquated technology,” according to Robert Kuske, M.D., the principal investigator in a landmark trial comparing breast brachytherapy to traditional WBI. “Single-lumen balloons are being replaced with newer multichannel devices that allow much greater control of the radiation dose received by skin or ribs.”

– Said Dr. Frank Vicini, “All this study tells us is that when billing codes are analyzed, there appear to be differences in outcomes based upon billing-code surrogates for clinical outcomes. You can’t turn something nonclinical into clinical.”

Dr. Vicini is a Michigan radiation oncologist who publishes outcomes data comparing 199 APBI patients to 199 patients getting conventional treatment.

“Although the authors acknowledge the flaws in their study, these are not trivial,” he told AuntMinnie. “In my opinion, they are huge.”

So how should women and their families regard the controversial new study?

In urging breast cancer patients to participate in clinical studies when possible, the American Society of Breast Surgeons had this to say:

“The evidence in the MD Anderson study should be considered in pre-surgical counseling — but is not strong enough to preclude the use of APBI in properly selected patients.”

Study ID’s Potent IV Weapon To Prevent Bloodstream Infections

When one or two hospitals get good results with a new method for preventing infections, it’s “interesting.” When 12 do, it’s time to call the method “important.”

Which is the conclusion Gregory Schears, M.D. of Rochester, Minn. reached about his study of 12 diverse hospitals that trialed SwabCap®, a disinfection cap that is used to passively disinfect the top and threads of needleless IV connectors. Excelsior Medical, SwabCap’s maker, is a Dowling & Dennis client.

Speaking at the annual meeting of the Association for Vascular Access (AVA) – and in a follow-up clinical webinar Dr. Schears said that a disinfection cap should be considered as part of best practice protocols for eliminating central line-associated bloodstream infections (CLABSIs), which kill some 30,000 U.S. patients a year according to the CDC.

You can see Dr. Schears talking about the study here: disinfection cap video. There’s also a free webinar by Dr. Schears that provides more detail on his research, available under “Videos,” here.

How did Dr. Schears reach his conclusions?

Traditionally, nurses disinfect a needleless IV connector manually before accessing the catheter line to draw blood or administer medications or nutrition. The usual method involves scrubbing the connector with an alcohol wipe for 15 seconds, then waiting another 30 seconds for the alcohol to dry before entering the line.

Because the method has several steps, takes at least 45 seconds to do correctly, and often must be done many times a day, busy nurses often cut short the time or skip it entirely. Compliance with 45-second “scrub the hub” protocol is also almost impossible to monitor: What hospital can afford to have someone trail every nurse as she goes about her rounds?

The potential for slip-ups with this method is widely believed to be an obstacle to reaching zero CLABSIs.

The SwabCap disinfection cap, which dispenses alcohol when it is pushed and twisted onto the connectors’ threads, addresses the problems with manual disinfection. It goes on in a few seconds. It twists on just one way, like a lid on a jar, which eliminates variance. Its bright orange color handles the compliance issue, because when it is observed in place, compliance is verified.

It also does two things manual disinfection cannot. Because it creates a seal at the base of the threads, the connector top and threads are continually bathed in alcohol between line accesses. Also, prolonged contact with alcohol is proven to improve disinfection. Moreover, when the cap is in place, it is protecting against touch and airborne contamination.

The hospitals that trialed the disinfection cap in Dr. Schears’ study wanted to test whether it could produce lower CLABSI rates than with manual disinfection alone. The cap’s effectiveness was measured by comparing CLABSI data from the eight-month span prior to the cap’s implementation to the eight months following implementation. This retrospective overview encompassed some 92,000 catheter days – a large number for this kind of study.

The cap made a remarkable difference. The average CLABSI rate reduction at the twelve institutions was 61.6%, which is statistically significant (p<0.0020). The hospitals in the study covered the gamut, from medical to surgical to intensive care in both community hospitals and tertiary care facilities.

For years, a nationwide public-private effort has focused on diminishing CLABSIs, but progress has been spotty. The Schears study suggests that a far greater impact might be achieved if more hospitals adopted disinfection caps. Everything we’ve seen about this device – and the study is just the latest in a constant flow of strong results – points in the same direction.

You can see Dr. Schears talking about the study here: disinfection cap video.

-      END –

Video: Study on preventing IV Bloodstream Infections

Dr. Gregory Schears (Rochester, Minn.) outlines his 12-hospital research on IV disinfection cap to reduce deadly infections.

Cloud-Based Medical Info: ONC, Feds Miss the Obvious

The federal Office of the National Coordinator for Health IT (ONC) has developed a Federal IT Strategic Plan aimed at reducing IT disparities between underserved communities. ONC published a draft of the plan in an online blog and is now seeking comments and suggestions.

We have one suggestion: Promote widespread adoption of cloud-based medical information exchange.

While the plan refers to telemedicine in general as one way to improve the usage of healthcare IT, there is no evidence the ONC recognizes that this long-used term should now include cloud-based data exchange. Nor is there any recognition of the superiority of cloud-based services for meeting the plan’s other goals.

Three of those goals are:

• Achieve adoption and information exchange through meaningful use of health IT

• Improve care, improve population health and reduce healthcare costs through the use of health IT

• Inspire confidence and trust in health IT

Cloud-based medical information exchange advances these goals in many ways.

Because it is vendor-neutral, it overcomes incompatibilities between different facilities’ IT systems –not just in underserved communities but also in the common scenarios where a rural facility is transferring patients with complex conditions to better-equipped institutions outside the community. Here is an example of just such a set-up in the San Diego area, where eMix has made a big difference: http://bit.ly/g5Umvq

The modest, per-usage fee for using a service like eMix also makes it affordable and scalable for underserved communities. No software or hardware purchase is required. Nor is there a maintenance contract because maintenance is the service provider’s responsibility.

Cloud services reduce costs in other ways, too – by avoiding the substantial labor associated with virtual private networks and the labor, postage, and courier costs associated with burning and sending files on CDs.

Cloud-based medical information exchange improves care, as well, because it is a much faster way of getting medical files in the hands of the physicians who need to see them. This is especially true for emergency cases.

Finally, cloud-based exchange inspires confidence and trust in health IT because it ends the frustration that until recently characterized most efforts to exchange files between IT systems. Until recently, sharing files between systems that didn’t talk to each other was labor-intensive, expensive, and loaded with breakdown potential.

Those days are over – but only for the institutions that are taking advantage of the technology.

If the ONC is serious about its goals, then it should be promoting this simple-to-adopt, simple-to-use solution in its strategic plan.

Patient Safety and Educating IV Nurses

As nurses have more demands placed on them to ensure patient safety, effective tools for educating nurses become increasingly important.

After all, how can we expect nurses to handle sophisticated technology in the most effective way, if we don’t do a good job of teaching them and involving them in the learning process?

One new tool for that educational process, when it comes to vascular access and infusion therapy, is an infographic recently presented as a scientific poster at the annual conference of the Association of Professionals in Infection Control and Epidemiology (APIC).

You can view a brief video about the infographic — which features a disinfection cap for protecting needleless IV connectors from contamination — on the PICC Excellence website of presenter Nancy Moureau, RN, BSN, CRNI, CPUI, here.

Dr. Attai Leads the Way on Social Media for MD’s

Fully half of Americans now participate in social media — and the impact of Twitter, YouTube, Facebook and other new media is growing every day.

Given those numbers, it’s especially surprising that there are very few doctors who take part in social media.

One happy exception to that rule is Deanna Attai, M.D. a noted breast surgeon and head of the Center for Breast Care, in Burbank, Calif. She’s proof that even a very busy doctor can find time to be online.

Like many MD’s, Dr. Attai has a website (http://www.cfbci.com). But her online presence extends well beyond that.

She participates daily on Twitter (@drattai) where she has more than 750 followers. She’s on LinkedIn and has a channel on YouTube. She’s a guest blogger for the integrative medicine site www.morrisonhealth.com, where she recently blogged about a gluten-free diet.

“I like the ability social media gives me to reach a wider audience and do what I love to do, which is teach and educate,” she says. “I try to keep my online activities within the realm of things I would talk to my patients about,” she says.

But Dr. Attai’s realm is broader than that of many breast surgeons. Taking a more holistic approach, she’s just as likely to write about general health and wellness as she is to talk about specific breast cancer issues.

Dr. Attai is one of the pioneers in physician social media.

“It’s all about getting information out,” agrees Dr. Attai.

Not one to limit her activities to simple tweets, she’s been quick to expand the Twitter platform. For example, she’s a regular participant in the weekly, live Twitter chats about breast cancer and social media, which you can track on Twitter through “#BCSM.”

Like everyone who is active on social media, however, Dr. Attai notes that there are limits. She’s careful to keep her personal life out of her social media postings. And her medical office, where she spends at least 10 hours a day, is officially a “no twitter zone.”

Look for her social media profile to continue to grow. She firmly believes that one way to be an even better physician is to communicate online, adding: “It gives patients a way to see another side of me.”