		Visualization of a molecular network integrated with a gene profile.

	In recent years, the sequencing of the human genome and advances in supercomputer technology have helped drive hopes that a deeper understanding of the biology of cancer would yield the markers needed to truly usher in the long-awaited era of personalized medicine.

	Biomarkers offer great potential for improving management of cancer at every point from screening and detection, to diagnosis, staging, prognosis, and the assessment of treatment response. Striking advances have been made in several fields, particularly breast cancer, and fresh research suggests significant steps forward in lung cancer.

	Yet progress has been slow in the vast, ever-changing, and controversial frontier of biomarker research, with fewer than 2 dozen cancer biomarkers approved so far by the FDA among the thousands researchers have explored.

	Experts have advanced a brew of reasons for the gap between potential and performance, in a complex field that requires the coordination of a diverse team of pathologists, molecular biologists, and biostatisticians.

	Last year, the AACR-FDA-NCI Cancer Biomarkers Collaborative described a “growing imperative” to modernize the drug development process, and made 27 recommendations in 8 different areas for doing so.

	Meanwhile, the pharmaceutical industry is exploring ways to improve biomarker development, with some industry analysts seeing regulatory issues as a significant sticking point in economically feasible biomarker development (

Industry Testing New Models for Developing Biomarkers

	Sudhir Srivastava, PhD, MPH, the founding chief of the Cancer Biomarkers Research Group at the National Cancer Institute, said in an interview with 

 that one of the challenges in biomarker research is the unrealistic expectations promoted by many study investigators.

	“With almost every paper, even if there is a remote chance of success, you see a press release hyping a discovery, but later on they fail,” Srivastava said. “The public gets so excited about it that they demand we must succeed as soon as possible. But the fact of the matter is, the hype usually does not translate into clinical studies.”

	At the same time, Srivastava said, the scientific community is getting organized and gaining momentum. “The infrastructure is in place to move forward in the right direction. More breakthroughs are a matter of time,” he said.

		Adapted from Mishra A, Mukesh V. Cancer biomarkers: are we ready for the prime time? Cancers 2010; 2:190-208; doi:10.3390/cancers2010190.

	Many researchers who have reviewed the progress made on biomarkers thus far have found much to criticize.

	In 2010, Eleftherios P. Diamandis, MD, PhD, professor and head of the Division of Clinical Biochemistry, University of Toronto, Canada, and associate scientist at the Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, reviewed cancer biomarkers initially hailed as breakthroughs and their subsequent failings.

	These included nuclear magnetic resonance of serum for cancer diagnosis; lysophosphatidic acid for ovarian cancer; 4- and 6-parameter diagnostic panels for ovarian cancer; osteopontin for ovarian cancer; early prostate cancer antigen-2 (EPCA-2) for prostate cancer detection; proteomic profiling of serum by mass spectrometry for ovarian cancer diagnosis; and peptidomic patterns for cancer diagnosis.

	Diamandis found problems ranging from inappropriate statistical analysis to biases in patient and control subject selection. Problems with EPCA- 2, for example, included reporting values that were beyond the detection limit of the assay and using inappropriate agents to test EPCA-2.

	Duke University recently gained the national spotlight in one of the most widely publicized biomarker failings. A research team had devised genetic tests to assess tumor cells by looking for gene patterns that would determine which drugs would best attack a particular cancer. The tests turned out to be worthless, though they were once hailed as a breakthrough that was seen as the first fruit of the new genomics.

	The Duke research was discovered to be fl awed only because it relied on publicly available data sets and algorithms. Keith A. Baggerly, PhD, and Kevin R. Coombes, PhD, statisticians at MD Anderson Cancer Center in Houston, Texas, spent 2000 hours finding all of the errors in the research and found even simple errors, such as row or column offsets.

	And at the NCI, the Cancer Biomarkers Research Group recently did its own random review of 1000 papers detailing biomarker discoveries. “In almost 90 percent of the papers, there was a lot of hype,” Srivastava said.

	Of course, there have been successes in the cancer biomarker field, one of the more significant biomarkers being the protein HER2, which is the target of the breast-cancer drug trastuzumab (Herceptin).

	First discovered in the early 1980s, HER2 can be found on some breast tissues, and an excess of this protein is found in some forms of breast cancer. Another example is the Philadelphia chromosome, a marker for chronic myeloid leukemia, which results from the movement of DNA from one site on the human genome to another.

	At the American Society of Clinical Oncology (ASCO) conference in June, featured research included a prospective study by the 14-member Lung Cancer Mutation Consortium that identified at least 1 of 10 “driver” mutations in tumors of nearly two-thirds of patients with advanced lung cancer.

	In a phase I trial, researchers from MD Anderson demonstrated that the ability to match individual patients with targeted cancer therapies based on the molecular profile of their tumors resulted in dramatically superior clinical outcomes, a finding that may improve patient selection for clinical trials at early stages and thus help speed drug development.

	In addition, researchers at Indiana University Melvin and Bren Simon Cancer Center in Indianapolis discovered the first predictive biomarker for taxane-induced peripheral neuropathy, single nucleotide polymorphisms in the RWDD3 gene, through a genetic analysis of more than 2000 breast cancer patients.

	The Cancer Biomarkers Research Group, which operates the Early Detection Research Network (EDRN), a collaborative effort of nearly 40 institutions, has a goal of accelerating the translation of biomarker information into clinical applications and evaluating new ways of testing tumors for predictive markers.

	“But we see our role as not just to be the accelerator of biomarker findings, but also to put the brake on bad findings,” Srivastava said of the EDRN.

	Srivastava highlighted 3 key hurdles that have historically held back biomarker progress: a lack of foundational studies, a lack of sustained funding, and a lack of quality biological samples for testing.

	“The most important players in industry and the federal government are not investing enough, yet expectations are very high,” he said. “If you look at the funding level for early detection and diagnosis, it is not as high as one would like to see as you do in drugs.”

	His budget is between $20 million and $26 million a year, spread out over about 40 institutions, which boils down to about $600,000 per institution.

	“It’s not enough to do the discovery,” he said, noting that investment in biomarkers may not be as appealing to investors because it is a long-term effort, while investors want to see short-term gains.

	A lack of acceptable biological samples also has been a big obstacle, Srivastava and other scientists said. Many programs do not use quality samples, or there is not much information about the stage at which samples were collected.

	Dean E. Brenner, MD, of the University of Michigan Medical Center, tackled this question during an ASCO presentation titled “An Update on Biomarkers for the Early Detection of Cancer, Prediction of Prognosis, and as Surrogate Endpoints for Cancer Prevention.”

	“Garbage in, garbage out,” he said, noting that biosamples can be unstable and difficult to analyze. “You need good quality.”

	Martin J. van den Bent, MD, PhD, Erasmus University Medical Center, The Netherlands, in a presentation on “Molecular Biomarkers in Neuro-oncology: Ready for Clinical Practice?” at the ASCO annual meeting, stressed the need for the adequate analytical performance of biomarkers, clinical performance, and the need for independent validation.

	He cautioned that the biomarker research is still in need of development: “We need to think twice before we topple the old regime…We could be looking at something so young and immature, the ugly ducklings that need to mature over time.”

		“A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”

		—Biomarkers Definitions Working Group

		“A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called 

		" An ideal biomarker provides high positive and negative predictive values, should be easy to sample, cheap to assay, provide ease of quality control, and should be convenient for algorithmic usage."

	None of the hurdles or the comparatively slow pace of progress means it is time to give up hope, Srivastava said.

	He said the most promising areas of cancer biomarker research over the next 5 years are in prostate, ovarian, and colon cancers, and scientists are focusing more and more not just on single biomarkers, but on panels of biomarkers as successful diagnostic tools.

	ASCO and other professional organizations are developing guidelines to help clinicians sort data regarding the usefulness of biomarkers in treating patients. Timothy D. Gilligan, MD, an oncologist in the Solid Tumor Oncology department at the Cleveland Clinic in Ohio, was part of an ASCO panel that developed guidelines on the appropriate uses for serum markers of germ cell tumors (GCTs).

	The panel did an exhaustive search of published material, reviewing hundreds of papers to identify relevant studies, and developed consensus guidelines based on data from 81 reports.

	Gilligan noted that GCTs are unique in that they are largely curable, even when they are very advanced, and that biomarkers have been used for a long time to measure tumor progression, with a fair amount of evidence supporting their use.

	“In almost all cases, when the marker goes up, it is a sign of the tumors progressing, and when the marker goes down, they are responding to treatment,” he said.

	“There is a lot at stake in doing it right, though, so you don’t overtreat people,” he said.

	Like many other clinicians, Gilligan sees not only accuracy and reliability as a big challenge with biomarkers, but also raises the question of utility.

	“Just because you can measure something doesn’t mean it is helpful to measure,” he said. “There are plenty of tumor markers that are often elevated if cancer is present, but knowing whether the marker is going up or down does not necessarily mean better care for the person.”

	“If markers go up six months before a scan goes up, is it helpful to start treatment six months earlier?” he said. “In the vast majority of cases there [are] no data.”

	Markers are most useful, he said, in diagnosing cancers where effective treatments exist.

	In some cases like ovarian cancer, evidence suggests the earlier detection of a cancer antigen biomarker, CA125, does not help patients do better, Gilligan said. The flip side of the story, he said, is prostate-specific antigen (PSA), which is very sensitive. A rise in PSA does not necessarily impact wellness, or mean a man has prostate cancer, but Gilligan noted it often creates anxiety, with no consequences, and much time is spent reassuring patients.

	“There is a potential for markers to do harm,” Gilligan said.

	He added, however, that new biomarkers that are more specific could be very useful in many areas.

	“If you use a test, there should be evidence that it is useful,” he said. “We are trying to rein people in so they do not order so many tests when there is no meaningful evidence.”

	Krystal Knapp is a freelance writer living in New Jersey.	

			Rhea J, Molinaro R. Cancer Biomarkers: Surviving the journey from bench to bedside. 

			Khleif SN, Doroshow JH, Hait WN. AACR-FDA-NCI Cancer Biomarkers Collaborative consensus report: advancing the use of biomarkers in cancer drug development. 

			Diamandis EP. Cancer biomarkers: can we turn recent failures into success? 

			Baggerly K, Coombes K. Deriving chemosensitivity from cell lines: forensic bioinformatics and reproducible research in high-throughput biology. 

			Kris MG, Johnson BE, Kwiatkowski AJ, et al. Identifi cation of driver mutations in tumor specimens from 1000 patients with lung adenocarcinoma: the NCI’s Lung Cancer Mutation Consortium (LCMC). 

			Tsimberidou AM, Iskander NG, Hong DS, et al. Personalized medicine in a phase I clinical trials program: the MD Anderson Cancer Center Initiative. 

			Schneider BP, Li L, Miller K, et al. Genetic associations with taxane-induced neuropathy by a genome-wide association study (GWAS) in E5103. 

			Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology Practice Guidelines on uses of serum tumor markers in adult males with germ cell tumors. 

Articles

Biomarkers offer great potential for improving management of cancer at every point from screening and detection, to diagnosis, staging, prognosis, and the assessment of treatment response.

The Great Biomarker Chase: Promise & Pitfalls Along the Path to Personalized Care

		DNA microarray analysis depicts lymphoma cell gene expression patterns.

	As personalized medicine occupies a growing role in the pharmaceutical pipeline, major companies are changing their research and development paradigms, according to the Tufts Center for the Study of Drug Development (CSDD).

	“Early indications show that development of personalized medicines is commanding more resources,” said Christopher-Paul Milne, DVM, MPH, JD, associate director at the center in Boston, Massachusetts, and author of the November/December Tufts CSDD Impact Report last year.

	The study, based on a survey of nearly 2 dozen companies, found that 50% of clinical trials now collect DNA from participants to help find biomarkers that correlate with a drug’s effectiveness or safety issues. Some 30% of the companies said they now require all compounds in development to have a biomarker.

	Milne said significant scientific, regulatory, commercial, and practical challenges confront companies, resulting in a variety of approaches. Many drug developers are working with academic medical centers to better understand disease mechanisms and identify strata of target populations, and with diagnostics developers to augment in-house capabilities.

	The study found that although biomarkers increasingly are used to better understand patient response, companies still cannot use biomarker data to support approval until regulators’ capacity to evaluate it catches up to the science.

	The report also noted that personalized medicine might be making drug development more complicated. While some companies are interested in using biomarkers to help understand how a drug is working in the body, they are less enthusiastic about the establishment of required tests before a drug can be used.

	A lack of evidence linking diagnostic tests to health outcomes, however, has led US healthcare payers to be skeptical about the clinical usefulness of those tests and is hindering the growth of personalized medicines, according to the 

	Some payers are denying or restricting reimbursement for testing, with a minority of payers requiring documentation that a diagnostic test has been conducted prior to prescribing personalized drugs, even when the diagnostic is included on the label.

	“Scientifically, the process of biomarker discovery and validation in general, and parallel development of drugs and companion diagnostics in particular, has been slow,” Joshua P. Cohen, PhD, senior research fellow at Tufts CSDD and author of the study, said in a press release.

			Tufts Center for the Study of Drug Development. 

Personalized Medicine Is Playing a Growing Role in Development Pipelines.

 Boston, MA: Tufts University. 2010;12(6). Impact Report.

Lack of Clinically Useful Diagnostics Hinder Growth in Personalized Medicines.

 Boston, MA: Tufts University. 2011;13(4). Impact Report.

As personalized medicine occupies a growing role in the pharmaceutical pipeline, major companies are changing their research and development paradigms.

The latest cancer study. A book-signing event. A hospital mural project. These topics and more are all fodder for the Fox Chase Cancer Center’s Facebook page. And then there is the regular fl ow of comments from patients and their loved ones: “I will be starting treatment soon and I can’t wait to meet my treatment team,” “I am starting to see again that there is life after cancer,” and “Your nurses are amazing. I don’t know where I would be without this hospital.”

	Fox Chase regularly updates its popular Facebook page with events and contests, the latest research findings, big hospital news, and small items such as staff awards and snow closings.

	Two years ago, this presence for Fox Chase was nonexistent. The Philadelphia-based cancer center had a limited online social media reach that consisted of what 1 staff member described as a less-thanrobust YouTube channel where short videos were posted. But after hearing about the efforts of other hospitals to harness social media, leaders at Fox Chase embraced the idea of starting a Facebook page as a way to better engage the community and promote the hospital.

	The result: Fox Chase now has a Facebook page that is updated several times a day and is followed by 5000 fans.

	“We were very fortunate that our board members saw the value early on in having a Facebook presence,” says Lisa Bailey, Fox Chase’s director of Social Networking Communications. “The response has been amazing. The page has really helped provide people with a strong sense of community.”

	Welcome to the brave new Internet social media world for healthcare commonly called Healthcare 2.0. Like Fox Chase, more and more physicians, including oncologists and other specialists, as well as medical facilities, are jumping on the social media bandwagon in order to provide reliable medical information to the public, connect with patients, and promote their services, with many larger organizations dedicating full-time staff to managing their social media presence.

	Fox Chase is 1 of more than 900 hospitals that now have a social media presence on sites such as Facebook, Twitter, LinkedIn, Foursquare, or YouTube. Two years ago, only a little more than 200 hospitals had such a presence, according to data collected by Ed Bennett, manager of Web operations at the University of Maryland Medical Center in Baltimore. As of January, Bennett calculated that 906 hospitals had a total of 3087 social networking sites, with Facebook being the most popular.

	In the oncology sphere, the American Society of Clinical Oncology (ASCO) reached more than 2000 followers last year with its Twitter posts. The organization also uses social networking sites to connect not only with patients but also with oncologists who have distinct and specialized common interests.

	The increase during the last 2 years reflects the healthcare industry’s recognition that a growing number of people are obtaining healthcare information online from what some physicians refer to as “Dr Google.”

	A survey by the Pew Internet & American Life Project released last month found that a growing number of Americans, about 8 in 10 Internet users, or about 59% of Americans, look online for health data, with the majority of them searching for information about a specific medical problem or treatment.

	And, a recent Harris Interactive Poll found that not only are more people using the Internet to find health information, but also that the vast majority trust the advice that they find. Only 8% said they believe the information they found was unreliable.

	Doctors are spending more and more time online for professional purposes as well. In a recent Manhattan Research Survey, physicians reported spending 8 hours online for professional purposes each week in 2010 compared with 4.5 hours in 2006.

	Yet enthusiasm for an online presence also is mixed with concerns. In his 2010 presidential address, Douglas W. Blayney, MD, former ASCO president, highlighted both the benefi ts and challenges posed by the digital revolution.

	“Let’s look at how we and ASCO are planning to cope with this information revolution to make sure the right information is available at the right time to the right person, that it informs what we do each day, and that what we learn in the care of our patients is transformed into both better treatments and more consistent quality,” he said.

	“The reality is that our way of communicating is changing the way we relate,” Blayney said. “It is more important than ever to ensure that technological efficiencies in sharing information do not erode the human connections that are so critical to both our personal and our professional lives. That said, the learning health system necessarily relies on the systematic collection, reporting, and analysis of data. Efficient sharing of clinical data informs the next clinical trial, supports higher quality of care, and supports a stronger patient-physician relationship.”

	Lee Aase, the manager of syndication and social media for the Mayo Clinic, acknowledges there is still uncertainty among some doctors about using social media, but says people are overcoming that uncertainty and moving on to embrace its features.

	The Mayo Clinic, an early adopter of social media with a presence since 2006, offers blogs, a Facebook page with more than 3000 followers, and a YouTube channel with more than 1100 videos of doctors talking about illnesses, treatment, and research. A hospital video of a couple playing the piano in a clinic lobby went viral, gaining international media attention and attracting more than 7.5 million visitors.

	Aase argues that hospital and medical practice leaders should overcome their reservations about using social media, noting that even if they block employees from having access to social networking sites during working hours, employees can access the Web anyway using their cell phones. “Really, you already have all the risks, so why not be proactive and use it to your benefit and provide people with training and guidelines to use social media responsibly?” he says.

	Aase believes that the unforeseen implications of social media are more likely positive than negative, and that the best way to promote responsible use of social media is to educate employees and have written policies about ethics and usage. The Mayo Clinic has detailed policies for both employees and users of its social media sites.

	A similar point was raised in a research letter in the Journal of the American Medical Association last month that provides a snapshot—and some concerns&mdash;about the ways physicians are using Twitter.

 Investigators examined postings by 260 self-described physicians with ≥500 followers during a 1-month period last year and analyzed the content of 5156 tweets.

	The researchers characterized 144 postings (3%) as unprofessional, including 38 tweets (0.7%) that potentially violated patient privacy. Of the 27 users (10%) who posted the potential privacy violations, all but 2 (92%) could be readily identified by their full name, photo, or Web link.

	“Ethical breaches and unprofessional content were rare but observed,” the study team wrote. “Accountability for health professionals, in addition to greater education and guidelines, may be needed to maximize potential societal and professional benefit through engagement with social media.”

	Indeed, a growing number of agencies are adopting policies. The Centers for Disease Control and Prevention recently released a 60-page “toolkit” for medical professionals offering guidelines for using social media, and the FDA is expected to issue guidelines related to Internet and social media promotion of products it regulates in coming months.

	The Ohio State Medical Association also created a 10-page report called Social Networking and the Medical Practice: Guidelines for Physicians, Office Staff and Patients, and the American Medical Association adopted a policy of its own at its semiannual policymaking meeting in San Diego in November.

	The AMA policy, fewer than 400 words long, focuses on cautions and safeguards that physicians should keep in mind for their patients’ privacy and their own careers. (

	Robert Stephen Miller, MD, is a medical oncologist specializing in breast cancer and biomedical informatics at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Maryland.

	He serves on ASCO’s Electronic Health Records Workgroup, blogs frequently for ASCO, and is an avid Twitter user. He says that while the AMA guidelines are a big step for physicians, he was hoping for something more robust in terms of a policy. “The AMA policy focuses on the bad stuff, and what not to do,” he said. “An opportunity was missed to highlight the benefits of social media and the constructive ways it can strengthen engagement and enhance patient-physician communication.”

	Miller and other doctors say social media can improve the patient experience, ensure that reliable information is available for those seeking medical advice on the Web, connect professionals who share similar interests, help influence public policy, and reach a broader audience.

	He points to the Mayo Clinic’s written statement of its social media philosophy as one that articulates a positive vision. That statement reads, in part, “The Mayo Clinic believes individuals have the right and responsibility to advocate for their own health, and that it is our responsibility to help them use social media tools to get the best information, connect with providers and with each other, and inspire healthy choices.”

	Many best practices, such as not disclosing private information, are a matter of common sense, Miller said. “I don’t even include any anonymous patient information,” he said.

	Another principle is not to give individual medical advice using social media. “As a physician, I am also not practicing medicine when I use social media,” Miller said. “I may talk about a medical issue in general, but I don’t use the medium to practice medicine and give individual advice to patients. That is not appropriate.”

	The Mayo Clinic’s policy for employees, which many other institutions, including Fox Chase, used as a model, reminds employees that policies that apply to other areas of their lives also apply to social media. The policy calls on employees to use good judgment, strive for accuracy, and not use their Mayo e-mail address when expressing personal views.

	Mayo’s Code of Ethics says Mayo will acknowledge and correct mistakes promptly, reply to e-mails and comments when appropriate, link directly to online references and original source materials, and disclose conflicts of interest.

	A Mayo Web page called “Friday Faux Pas” highlights real-life mistakes made using social media. For example, a recent post discussed how nurses in Scotland posted pictures of a surgery on the Internet and were suspended.

	“We don’t just want to be fan boys for social media,” Aase said. “There are certain risks. The point is the problem is not the social media itself, but that social media is the means by which the communication happens that was already a privacy violation.”

	Bailey, who runs the Fox Chase Facebook page, said she has rarely encountered issues in terms of what outside users post to the page. She was surprised when a recent post about a state going smoke-free generated all sorts of reactions from followers.

	“I could not believe all the comments it received,” she said. “I considered taking it down. But it opened up a dialogue where people could share their thoughts. As long as people were not using nasty language, I felt it was OK to keep it up.”

	Bailey said monitoring the Fox Chase page is critical. She and other staffers check it regularly and respond to posts when necessary, providing contact information for people seeking individualized information. It is rare, but now and then she does have to ask someone to remove a post.

	“A woman posted a note saying, `I have stage 4 metastatic breast cancer. Who should I see?’ Another patient started to give advice and suggested she see a surgeon. I had to call and ask her to take the comment down. I could remove it myself, but I prefer to ask the person who posted to take it down themselves when possible.”

	Some doctors are worried about the time and costs involved in using social media. One comment reported on an ASCO blog summed up that sentiment this way: “The membership is on the edge already with time commitments and generally regard any additional time demand as toxic.”

	Miller acknowledged time is a legitimate concern. “The Web can be seductive,” he said. “It is hard to turn off mobile devices. Some people feel they need to check every minute. I try not to do that. That said, it does take time, but not as much time as you think.”

	Social media has saved him time in some respects, Miller added. In the past he used to spend time surfing the Web looking for articles and information. Now, through Twitter, he automatically receives updates on topics that interest him by following users who write about those interests. “Twitter helps me stay up to date on topics I find are important,” he said. “Not so much on clinical information, but on other topics; for example, federal policies regarding health IT incentives.”

	Bailey said the costs for social media at Fox Chase are minimal, such as a flip video camera. Sometimes, she takes photos and videos on her cell phone, and people like the less-produced appearance of such content.

	Aase encourages healthcare professionals to set goals for what they want to achieve with social media. Then, start small and gradually expand, he recommends.

	The Mayo Clinic now offers social media resources to other healthcare organizations. On February 10, Mayo celebrated the opening of its new Center for Social Media, which already has more than 3 dozen members, including ASCO.

	The network is comprised of organizations committed to discovering ways social media tools can be harnessed to improve healthcare, promote health, and fight disease. The site is a platform for idea exchange and collaboration, and offers an in-depth curriculum that covers both practical tips and professional ethics.

	“We really believe in the positives of social media and its ability to transform healthcare. That’s why we made the investment and hired 8 staff members for the center,” said Aase.

	He argues that social media should be promoted not just because it is inevitable. “It’s the right thing to do,” he said. “Because it is in the best interest of patients.”

Bennett E. US hospitals that use social networking tools. Found In Cache. http://ebennett.org/hsnl/. Published October 19, 2010. Updated January 23, 2011. Accessed February 22, 2011.

Fox S; Pew Research Center. Health Internet & American Life Project: health topics. http://pewinternet.org/Reports/2011/ HealthTopics.aspx. Published February 1, 2011. Accessed February 23, 2011.

“Cyberchondriacs” on the rise? [news release]. New York, NY: Harris Interactive; August 4, 2010. www.harrisinteractive.com/ NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/448/ctl/ReadCustom%20Default/Default.aspx. Accessed February 15, 2011.

How many hours per week do online physicians spend on the Internet for professional purposes? iHealthbeat. www.ihealthbeat. org/data-points/2010/how-many-hours-per-week-do-online-physicians-spend-on-the-internet-for-professional-purposes. aspx#ixzz1E8v7xzj6. Published April 22, 2010. Accessed February 20, 2011.

Blayney DW. Enhancing quality through innovation: American Society of Clinical Oncology presidential address 2010. J Clin Oncol. 2010;28:4283-4288.

Chretien KC, Azar J, Kind T. Physicians on Twitter [research letter]. JAMA. 2011;305(6):566-568.

Krystal Knapp is a freelance writer living in Princeton, New Jersey

The latest cancer study. A book-signing event. A hospital mural project. These topics and more are all fodder for the Fox Chase Cancer Center's Facebook page

Krystal Knapp

Articles

The Great Biomarker Chase: Promise & Pitfalls Along the Path to Personalized Care

Industry Testing New Models for Developing Biomarkers

Socializing Medicine: Oncology Joins Facebook Era