OncologyLive® is the flagship publication of OncLive®. Each issue delivers expert insights and clinical oncology news and updates, which impact the day-to-day clinical practice of oncology professionals who work tirelessly to help improve patient outcomes.

About 40% of insured women in the United States are not undergoing screening mammography at least every 2 years in keeping with guidelines from the US Preventive Services Task Force (USPSTF). Even fewer are getting annual mammograms as recommended by the American Cancer Society (ACS).

	"This is cause for concern. All guidelines recommend mammography at a minimum of every 2 years in average-risk healthy women aged 50 to 74. Continued public education and access to mammography are of utmost importance to reaching target goals for breast cancer screening," said lead author Milayna Subar, MD, vice president and national practice leader for Medco Health Solutions in Franklin Lakes, New Jersey, who presented fi ndings from a retrospective study.

	USPSTF guidelines, updated in 2009, recommend biennial screenings for women aged 50 to 74 years and individualized decisions on when to start regular screenings for women aged <50 years. The panel does not make recommendations for women aged >75 years. The ACS recommends healthy women undergo annual mammography screenings beginning at age 40.

	"After the updated [USPSTF] guidelines were issued, there was a huge outcry, so we decided to conduct a study to determine what women are actually doing regarding mammography screening," Subar said.

	Using the Medco Health Solutions database, which contains healthcare records for more than 12 million people with employerprovided insurance or Medicare, Subar and colleagues reviewed medical claims from January 2006 to December 2009 for women aged ≥40 years. They identified >1.5 million women in that age group who had no prior history of breast cancer.

	Results were stratified into 4 groups: aged ≥40 years, aged 40 to 49 years, aged 50 to 64 years, and ≥65 years. They were also stratified by year (2006-2009).

	In examining broad utilization rates, researchers found women aged 50 to 64 years as a group had the highest rate of adherence to annual mammography screening recommendations, with 54% receiving the test in any given year during the 4-year period. By comparison, 47% of women aged 40 to 49 years and 45% of women aged ≥65 years received an annual mammogram in any given year.

			Source: Medco Research Institute. Compliance with mammographic screening guidelines from an administrative claims database. 

. Medco Health Solutions Inc clinical brief. Published December 9, 2010. Accessed January 18, 2011.

	On an individual level, however, the lack of utilization is more dramatic (

). During the 4-year period, the percentage of women undergoing at least 1 mammogram was only 21% overall, according to Medco Research Institute's clinical brief on the study. (

	"These rates are lower than expected, and they need to be addressed," Subar said.

	The study did not break down results by education or socioeconomic status, nor did it address the women's reasons for not getting mammograms. Additionally, Subar said other types of screenings, such as physical examinations, were not assessed.

	"These data on mammograms are concerning, especially because this study was based on an insured population where cost is not a barrier, and we still have this problem," said Judith Garber, MD, Dana- Farber Cancer Institute, Boston, Massachusetts, who moderated the press conference where the data were released. "Other studies have shown this as well. We've had many reminder programs, and we need to pay attention to the lack of impact of these programs," she added.

	The federal government's recently released Healthy People 2010 challenge sets a goal of biennial mammograms for 70% of women aged ≥40, noted the Medco brief. "Clearly, that's not yet been met even among women who have insurance coverage. Continued public education and access to mammography are of utmost importance to reaching these target goals for breast cancer screening," researchers said in the brief.

Articles

About 40% of insured women in the United States are not undergoing screening mammography at least every 2 years in keeping with guidelines from the USPSTF.

Insured Women Are Skipping Mammograms at High Rates

	The American Society of Clinical Oncology has posted a full article explaining clinical practice guidelines for the treatment of stage IV non-small cell lung cancer (NSCLC) using chemotherapy. After the introduction, the article begins with a section titled “Guideline Questions,” which contains a list of questions related to treatment decision-making for first-line, second-line, and third-line chemotherapy, as well as molecular analysis. The next sections discuss the methods used to determine updates to the guidelines and the results of those methods. There are the guideline update recommendations themselves and sections discussing future research directions, patient-physician communication, and health disparities.

	This Website is part of the CancerCare program, a national nonprofit organization,  and is designed to provide information and support to lung cancer patients and their loved ones. In the information section, visitors may find details on lung cancer prevention, types of the disease, symptoms, risk factors, screening and early detection, diagnosis, staging, and treatment. This section also features an FAQ page and a glossary of terms. The lungcancer.org site also has a selection of downloadable publications that cover a wide range of topics, including the disease, caregiving, coping, clinical trials, doctor/patient communication, grief and bereavement, financial/insurance information, managing side effects, prevention, treatment advances, and more. Many of these publications— as well as most of the information on the Website&mdash;also is available in Spanish. Another resource offered by lungcancer.org is its Connect Education Workshop program. Oncology experts lead the workshops, which are interactive educational programs that participants can join via the telephone or live Internet streaming. Previous workshops are available as telephone replays or as podcasts. Other resources on lungcancer.org include support groups, a hotline, financial assistance, and a monthly newsletter.

Maintenance therapy for non-small cell lung cancer

	This CME activity is based on a 2-part slideshow with audio presentation on maintenance therapy for NSCLC. It was originally presented at the 2010 National Comprehensive Cancer Network 15

Annual Conference: Clinical Practice Guidelines & Quality Cancer Care. Two experts, Mark G. Kris, MD, of the Memorial Sloan-Kettering Cancer Center, and George R.  Simon, MD, of the Fox Chase Cancer Center, discuss various approaches to maintenance therapy for NSCLC. They examine data from a number of trials in order to evaluate and compare the different treatment methods in multiple NSCLC settings. The slides contain notes and charts displaying these data and illustrating the experts’ points. After completing this activity, participants will be able to identify the treatment approaches for patients after initial therapy for advanced NSCLC. Participants also will be able to determine which patients are most likely to benefit from maintenance therapy, and describe the risks and benefits associated with maintenance therapy.

http://www.medscape.org/viewarticle/720896

Predictors and impact of second-line chemotherapy for advanced non-small cell lung cancer in the United States: real-world considerations for maintenance therapy

 Gerber DE, Rasco DW, Yan J, Dowell JE, Xie Y

 Recent studies have demonstrated that including maintenance chemotherapy in the initial treatment of advanced NSCLC has efficacy in some patients. This study was designed to determine the predictors and impact of second-line chemotherapy administration in a contemporary, diverse population of patients with NSCLC. The researchers performed a retrospective analysis of consecutive patients diagnosed with stage IV NSCLC at the University of Texas Southwestern Medical Center’s facilities from 2000 to 2007. Data on demographics, disease, treatments, and outcomes were gathered from hospital tumor registries. The researchers then used univariate analysis and multivariate logistic regression to assess the connection between these variables.

The study included 406 patients who received first-line chemotherapy.  Of these patients, 28% were women, 59% were white, and the mean age was 59 years. Second-line chemotherapy was administered to 197 patients.  In this group, 67% of patients who had no disease progression after 4 to 6 cycles of first-line chemotherapy had received second-line chemotherapy. The study found that the receipt of second-line chemotherapy was not associated with patient age, gender, race, histology, or year of diagnosis, but was strongly associated with patient insurance type, number of first-line chemotherapy cycles, and receipt of prechemotherapy palliative radiation therapy. The multivariate model confirmed these associations. In both univariate and multivariate analyses, overall survival was associated with the number of first-line chemotherapy cycles and administration of second-line chemotherapy. The authors concluded that markers of socioeconomic status, symptom burden, and response to and tolerance of first-line chemotherapy were associated with the administration of second-line chemotherapy. They also concluded that these factors might help in selecting patients most likely to benefit from maintenance chemotherapy. 

Pemetrexed disodium, gemcitabine, and bevacizumab in treating patients with stage IIIB or stage IV non-small cell lung cancer

 This study will test the efficacy of a regimen consisting of the chemotherapy drug gemcitabine, the monoclonal antibody bevacizumab, and the antineoplastic agent pemetrexed disodium in the treatment of patients with stage IIIB or stage IV NSCLC. The primary outcome measure is progression-free survival. Secondary measures include response rate, toxicity, time to treatment failure, and overall survival.

	Tarceva is a drug manufactured by OSI Pharmaceuticals, Inc that inhibits the epidermal growth factor receptor needed by cancer cells to grow and multiply. The drug has been approved as a maintenance therapy for patients with advanced NSCLC whose cancer has not progressed after initial platinum-based chemotherapy. The most common side effects of Tarceva are mild to moderate rash and diarrhea. Less common serious adverse reactions include severe skin reactions, gastrointestinal perforations, liver and kidney problems, and interstitial lung disease-like events. For further information, visit 

Useful Online Resources and Clinical Trials for Lung Cancer

Net Guides: Lung Cancer

American Society of Clinical Oncology — genitourinary cancers

	The Website of the American Society of Clinical Oncology (ASCO) features a section devoted to information related to genitourinary cancers. This section contains articles on genitourinary cancers from the 

 and abstracts from the ASCO annual meetings, which are sorted into groups based on the specific genitourinary cancer they focus on: bladder cancer, germ cell/testicular cancer, kidney cancer, and other genitourinary cancers. Other resources include news articles on the subject, clinical practice guidelines, and related manuscripts from ASCO’s 

. Another area of the genitourinary cancers page provides information on the 2011 Genitourinary Cancers Symposium, scheduled for Orlando, Florida, February 17-19.  Visitors also may view presentations from the 2010 Genitourinary Cancers Symposium and the 2010 ASCO annual meeting. A fee must be paid in order to view the videos and slides from the 2010 ASCO annual meeting, which also is available in the form of a podcast. The fee ensures exclusive access to the material for 3 years following the meeting, after which time the content will be made available to the public.

	The Prostate Cancer Foundation (PCF) is dedicated to curing prostate cancer through funding research and helping patients with prostate cancer through advocacy, support, and information. The “Understanding Prostate Cancer” area of the Website is divided into 3 sections: “About Prostate Cancer,”  “Living with Prostate Cancer,” and “Helpful Resources.”  The first of these sections has information on the risk factors, prevention, and symptoms of prostate cancer, as well as information on the prostate in general and the importance of early detection and screening. The “Living with Prostate Cancer” section has a page for the newly diagnosed and details on treatment options, side effects, recurrence, and advanced disease. The final section helps visitors find patient support, help for families and caregivers, clinical trial information, guides, newsletters, nutritional information, a glossary of terms, and more.

Long-term management of bilateral, multifocal, recurrent renal cell carcinoma

	This CME activity is designed to educate participants on the long-term treatment of patients with bilateral multifocal renal cell carcinoma (RCC) and recurrent disease. The 3 primary sections of the CME article focus on bilaterality and multifocality, management approaches, and the treatment of recurrence. After completing the activity, participants should be aware of the national incidence of RCC in the United States, as well as the frequency of multifocal and/or bilateral RCC. Participants should also be able to state the American Society of Transplantation guidelines for kidney transplantation in this setting, describe the morbidity and mortality associated with renal replacement therapy, and review intra- and postoperative complication rates associated with repeat partial nephrectomy in patients with RCC.

http://www.medscape.org/viewarticle/721350

Application of helical tomotherapy in genitourinary malignancies

 The purpose of this study was to test the use of helical tomotherapy (HT) in the treatment of genitourinary malignancies. HT is a novel method of delivering intensity-modulated radiation therapy (IMRT) that combines the imaging features of helical computed tomography with megavoltage linear accelerator treatment. Patients with primary genitourinary malignancies were recruited for this study. Descriptive statistics such as clinical trial enrollment, treatment goal, site of radiotherapy, primary disease site, patient age, dose/fractionation, and immobilization were calculated.

 The study included 57 patients with primary genitourinary malignancies who were treated with HT. The median age was 69 years (range 45 to 83 years); 56 patients (98.2%) were male. Of the group, 94.7% had prostate cancer. Ten patients (17.5%) were treated with palliative intent, 46 patients (80.7%) with radical intent, and 1 patient (1.8%) was given only adjuvant treatment due to a high risk postoperative bladder. The authors concluded that HT could be used in both radical and palliative settings for the treatment of genitourinary malignancies because of its critical structure avoidance properties and ability to deliver conformal IMRT therapy precisely.

http://www.ncbi.nlm.nih.gov/pubmed/21172110

Gemcitabine after surgery in treating patients with newly diagnosed or recurrent bladder cancer

 This study will test the efficacy of administering the chemotherapy drug gemcitabine hydrochloride directly to patients’ bladders after they undergo surgical treatment for newly diagnosed or recurrent bladder cancer. The study will compare gemcitabine with placebo. The primary measure of the study will be the efficacy of a single intravesical instillation of gemcitabine versus placebo after transurethral resection of the bladder tumor. Secondary measures will be whether gemcitabine can improve the time to progression to muscle invasive disease, the toxicity of the regimen, and whether intravesical instillation of gemcitabine immediately after surgery results in reduced long-term morbidity in patients.

	Votrient is an orally administered angiogenesis inhibitor manufactured by GlaxoSmithKline. The FDA has approved its use for the treatment of advanced RCC. A Phase III clinical trial showed that Votrient reduced the risk of disease progression or mortality by 54% compared with placebo, regardless of prior treatment. Reports of severe and fatal hepatotoxicity have been recorded in clinical studies of Votrient, so patients should have hepatic function monitored and dosing should be adjusted or discontinued as recommended by GlaxoSmithKline. The most common adverse effects in clinical studies were diarrhea, hypertension, hair color changes, nausea, anorexia, and vomiting. Patients who are pregnant, have preexisting severe hepatic impairment, or who have histories of hemoptysis, cerebral, or clinically significant gastrointestinal hemorrhage in the past 6 months should not take Votrient. For further information, visit 

Useful Online Resources and Clinical Trials for Genitourinary Cancers

Net Guides: Genitourinary Cancers

GERD: Reflux to Esophageal Adenocarcinoma

	This hardcover book is about gastroesophageal reflux disease (GERD). GERD, also known as gastric reflux or acid reflux disease, is a condition that is a relatively common side effect of various chemotherapy drugs. This book features literature that documents the entire pathogenesis of GERD and applies it to clinical treatment of the disease. It also presents reflux carditis as a new diagnostic criterion of the disease and defines the dilated end-stage esophagus as well as the earliest microscopic phase of GERD that present diagnostic criteria fail to encompass. The book also discusses the clinical features of GERD, and serves as a reference for any medical professionals involved in the treatment of the disease. Other features of the book include an outline of how GERD causes cellular changes in the esophagus and approximately 350 images to help illustrate key points.

	Chemocare.com is a Website developed by the Cleveland Clinic Foundation that provides patients with information on chemotherapy and how to live before, during, and after treatment. One page of the site focuses on gastric reflux as a side effect of chemotherapy. This page discusses what heartburn is and how chemotherapy can cause it, steps a patient can take to manage gastric reflux, as well as descriptions of H2 blockers and proton-pump inhibitors and examples of these drugs that physicians may prescribe to treat gastric reflux. This page also features a set of guidelines advising when a patient should call his or her physician when experiencing heartburn caused by chemotherapy. Chemocare.com has other useful information on managing chemotherapy side effects and chemotherapy in general that is available in both English and Spanish, so it may be worth recommending to patients regardless of whether they suffer from gastric reflux.

http://www.chemocare.com/managing/heartburn.asp

Implementing the AGA institute guidelines for GERD: strategies based on supporting evidence

	This CME activity is based on a medical position statement and technical review on the management of GERD published in 2008 by the American Gastroenterological Association Institute (AGA). This publication then underwent a literature review process and the author’s conclusions were finalized and discussed by a panel of stakeholders, including payers, patients, surgeons, internists, and community gastroenterologists. This panel used the United States Preventive Services Task Force system of grading recommendations by evaluating the strength and quality of evidence for each key point made in the article. This CME also includes those grades. After completing this activity, participants should be able to describe the GERD management issues addressed by the AGA Institute. Participants should also be able to identify the levels of evidence supporting key recommendations for GERD differential diagnosis and treatment, and be able to discuss possible changes in practice for the management of GERD, as well as the rationale behind them.

http://www.medscape.org/viewarticle/724262

Arbaclofen placarbil decreases reflux with good tolerability in patients with GERD

Journal of Neurogastroenterology and Motility

 Arbaclofen placarbil (AP), formerly known as XP19986, is a novel transported prodrug of the active R-isomer of baclofen that overcomes the limitations of racemic baclofen. Racemic baclofen is an agonist of the y-aminobutyric acid receptor and has been shown to decrease gastric reflux through the inhibition of transient lower esophageal sphincter relaxations, with which GERD is commonly associated. Unfortunately, racemic baclofen has a short half-life, requiring frequent dosing. It also causes sedation, dizziness, nausea, and fatigue. The purpose of this study was to test the efficacy and safety of AP in the treatment of patients with GERD by comparing AP with placebo.

 In all, 50 patients were enrolled into 4 escalating doses of AP: 10, 20, 40, and 60 mg. Of the group, 44 patients were included in the efficacy analysis. The study found a statistically significant (17%) decrease in reflux episodes over 12 hours after treatment with AP compared with placebo. AP was found to be most effective at the 60-mg dosing, and was well tolerated at all dose levels. The author concluded that although the study was small, AP was worth considering as an alternative for patients with GERD that is refractory to proton pump inhibitors, since up to 40% of patients fail to completely respond symptomatically to proton pump inhibitors at standard doses.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978402/?tool=pubmed

Transoral incisionless fundoplication (TIF) registry study for treatment of GERD

 This clinical trial will test a procedure known as TIF in the treatment of GERD. In the TIF procedure, a device called EsophyX is inserted through the patient’s mouth and used to construct an antireflux valve and tighten the lower esophageal sphincter, which should eliminate the GERD. The TIF procedure is noninvasive and repeatable. The primary outcome measure of the study is the elimination of all GERD symptoms. Secondary measures include the elimination of proton pump inhibitor usage, esophageal acid exposure, healing of reflux esophagitis, safety outcomes, and the long-term elimination of GERD symptoms.

http://www.endogastricsolutions.com/esophyx_overview.htm

	Prilosec is a proton pump inhibitor that prevents heartburn by reducing the amount of acid produced in the stomach. The standard course of treatment with Prilosec is 1 pill daily for 14 days, up to 3 times per year. Each pill should last for 24 hours, so no heartburn should be experienced for the duration of the 14-day course, not only relieving symptoms but also allowing erosive esophagitis time to heal. Caution should be taken when prescribing Prilosec to patients who have had heartburn with lightheadedness, sweating, or dizziness; chest or shoulder pain with shortness of breath; frequent wheezing, especially with heartburn; unexplained weight loss; nausea or vomiting; or stomach pain.

http://www.prilosecotc.com/en_US/hcp/Pages/Home.aspx

Useful Online Resources and Clinical Trials for Gastric Reflux Supportive Care

Net Guides: Gastric Reflux Supportive Care

PathologyOutlines: Central Nervous System-tumor

	PathologyOutlines.com is a Website featuring an online textbook of surgical and clinical pathology that is regularly reviewed and revised. This chapter of the textbook focuses on cysts and tumors of the central nervous system (CNS). It begins with the various types of cysts. For each type, there are usually descriptions of the cyst location, unique traits, microscopic characteristics, gross size, and treatment. The entries for each type also generally include radiologic images, images of the gross mass, microscopic images, and occasionally case reports.  If applicable, there are details on the positive and negative stains of the cyst, and differential diagnoses information. The tumor section of the chapter includes the same types of information for each type and grade of tumor, with the addition of cytology information for most tumors. This section also reports general information and statistics on tumors of the CNS as well as factors to consider when approaching diagnosis, World Health Organization (WHO) classification of CNS tumors, and WHO grading of astrocytomas.

http://www.pathologyoutlines.com/Cnstumor.html

	The American Brain Tumor Association (ABTA) provides funds to researchers, and support and information to patients with brain tumors and their families. The ABTA Website features a tumor and treatment section with information on a number of different brain tumor topics. This section includes descriptions of various tumor types, including glioblastomas, oligodendrogliomas, oligoastrocytomas, gliomas, meningiomas, and pituitary tumors. Other topics in this section include metastatic brain tumors, cysts, childhood brain tumors, symptoms, treatment, seizures, diagnosis, parts of the brain, living with a brain tumor, facts and statistics, causes and risk factors, and more. ABTA offers supportive resources, including pen pal programs, a Facebook page, survivor stories, and information on scholarships, health insurance, and financial assistance. The care and support section also has information on working with a brain tumor, reaching out for support, neuropsychology, therapeutic recreation, and other topics.

Current and emerging treatment modalities for patients with glioblastoma

	The goal of this CME activity is to educate healthcare professionals involved in the diagnosis and treatment of patients with brain tumors on current treatment strategies for newly diagnosed or recurrent glioblastoma. Topics discussed in the activity include current approaches and unmet clinical needs in the management of these patients, treatment modalities, and the latest data on new treatment approaches and therapies in this setting. This CME includes a “test-and-teach case” approach, an activity that uses case studies with quizzes to test participants’ knowledge before providing them with the correct answer and supporting evidence. 

http://www.medscape.org/viewarticle/718942

Trends in survival after surgery for breast cancer metastatic to the brain and spinal column in Medicare patients: a population-based analysis

 Metastases to the CNS are common in patients with breast cancer and are observed in as many as 30% of these patients at autopsy. The purpose of this study was to determine population-based survival times after surgical treatment for Medicare patients with breast cancer that has metastasized to the brain and spinal column. The study used the Surveillance, Epidemiology, and End Results (SEER)—Medicare database to identify female patients with metastatic breast cancer to the CNS who were undergoing neurosurgical treatment. The study also used Kaplan-Meier estimation and a Cox proportional hazards model to calculate estimates of survival.

The study involved 643 patients who underwent neurosurgical treatment of metastatic disease from 1986-2005. Of these patients, 379 underwent spinal surgery and 264 underwent cranial surgery. The study found that patient deaths during hospital treatment were down by approximately 50% in the last decade. However, the 30-day mortality rate of 9.0% has not changed. The median postoperative survival was 7.8 months after cranial surgery, 9.4 months after laminectomy, and 15.7 months for spinal fusion. Survival following spinal fusion has gone up by approximately 50% in the past decade. The study found that patients with increased survival after cranial surgery were younger, had fewer comorbidities, and longer periods between diagnosis of breast cancer and surgical treatment. Patients with increased survival after spinal surgery had lower-grade lesions and also had longer periods between diagnosis and surgery. The authors concluded that 1 year after being surgically treated for metastases to the CNS, one-third of patients who underwent cranial surgery and half of patients who underwent spinal surgery were still alive, but the overall postoperative survival rate has increased over time only for spinal fusion procedures.

http://www.ncbi.nlm.nih.gov/pubmed/21164378

Donepezil in treating patients who have undergone radiation therapy for brain tumors

 This clinical trial is testing donepezil hydrochloride against placebo in the treatment of patients who have undergone radiation therapy for brain tumors. Donepezil is a drug that is designed to improve neurocognitive symptoms of radiation therapy, such as cognitive impairment, subjective confusion, and fatigue. The clinical trial also will evaluate the effect of donepezil versus placebo on patients’ mood and quality of life.

	Xeloda is an oral chemotherapy drug that is used to treat colorectal cancer and metastatic breast cancer. Recent studies have found that Xeloda demonstrates efficacy in treating cases of breast cancer that have metastasized to the CNS. Common side effects of Xeloda include hand-and-foot syndrome, diarrhea, nausea, vomiting, stomatitis, abdominal pain, upset stomach, constipation, loss of appetite, and dehydration. Xeloda should not be taken by women who are pregnant, planning to become pregnant, or are nursing.  For information about the drug, visit 

http://meeting.ascopubs.org/cgi/content/abstract/25/18_suppl/1098

Useful Online Resources and Clinical Trials for Central Nervous System

Net Guides: Central Nervous System

	The Atlas of Genetics and Cytogenetics in Oncology and Haematology is a free, peer-reviewed online journal whose offerings include a report on the classification of B-cell non-Hodgkin lymphomas (NHLs). The page begins with a summary of the identity of B-cell NHLs as a whole before moving into the clinical characteristics and pathology of each disease. The lymphomas listed include: small lymphocytic, lymphoplasmacytic, follicle centre cell, diffuse large cell, Burkitt, Burkitt-like, mantle cell, and marginal zone B-cell lymphoma. Each disease has brief notes on its phenotype/cell stem origin, clinical traits, and cytogenetics. By clicking on the name of a disease, a more detailed entry may be viewed that includes information such as the grade of the disease, its epidemiology, pathology, treatment, prognosis, morphological and molecular cytogenetics, involved genes and proteins, images, and more.

	The Lymphoma Research Foundation (LRF) is a nonprofit organization dedicated to funding lymphoma research and supporting patients with lymphoma by providing information on the disease. The LRF’s Website has a section devoted to information on NHL. This section includes an overview of the disease and discusses its development, signs and symptoms, risk factors, treatment, and current research. These pages also describe types of NHL and offer links to other resources on NHL in general as well as resources on specific types.  The site includes downloadable booklets and fact sheets, educational programs, lymphoma news and press releases, a quarterly newsletter, Webcasts and podcasts, and various support programs. There also are sections for children and adolescents with lymphoma, young adults with lymphoma, and patients who are interested in clinical trials.

Community and expert perspectives: a 2010 update on NHL

	This CME activity is based on abstracts related to NHL from the American Society of Clinical Oncology (ASCO) and European Hematology Association (EHA) 2010 meetings. The CME activity consists of 5 slideshows with audio (which may also be downloaded as transcripts), featuring discussions between Dr James O. Armitage, MD, and other experts. Each presentation discusses a different type of NHL: diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, T-cell lymphoma, and chronic lymphocytic leukemia. In addition to these slideshows, the CME activity features 2 articles. In one, Armitage summarizes insights into the latest data from the ASCO and EHA meetings. The other features  Jack F. Jacoub, MD, offering the perspective of the community physician on these data. After completing this activity, participants should be able to describe how the research data from the 2010 ASCO and EHA meetings relates to the management of patients with NHL. Participants also should have an understanding of how these new data can be incorporated into practice in order to improve patient outcomes and how these data are relevant at the community level.

http://www.medscape.org/viewprogram/31851

Feasibility of second hematopoietic stem cell transplantation using reduced-intensity conditioning with fludarabine and melphalan after a failed autologous hematopoietic stem cell transplantation

 The purpose of this study was to evaluate whether using reduced-intensity conditioning with fludarabine and melphalan in patients with relapsed hematologic malignancies after a prior autologous hematopoietic stem cell transplantation (HSCT) would make a second HSCT a feasible treatment. In all, 12 patients were included in the study: 7 with multiple myeloma, 3 with NHL, and 2 with acute myeloid leukemia. The graft-versus-host disease prophylaxis was cyclosporine with a minidose of methotrexate.

All patients achieved a neutrophil and platelet engraftment in a median 13.5 days and 17.5 days, respectively. Two patients experienced transplant-related mortality. Grade II-IV acute graft-versus-host disease was noted in 4 patient and chronic extensive graft-versus-host disease was noted in 1 patient. During a median follow-up of 376 days, 5 patients remained alive and without evidence of disease. The estimated rates for nonrelapse mortality, overall survival rate at 1 year, and event-free survival rate at 1 year were 28.4%, 58.3%, and 41.7%, respectively. The authors concluded that allogeneic HSCT using reduced-intensity conditioning with fludarabine and melphalan was feasible for a second HSCT in patients with hematologic malignancies that have relapsed after a failed autologous HSCT.

http://www.ncbi.nlm.nih.gov/pubmed/21094846

A study of YM155 plus rituximab in subjects with NHL who have received prior treatment

	Purpose: This clinical trial will test the use of the drug YM155 in the treatment of patients with NHL who have failed prior treatment. Patients will receive YM155 and rituximab via intravenous infusion over 14-day cycles. They will then be assessed at the end of each cycle to determine whether they may undergo another cycle. The primary outcome measure of the study will be the objective response rate. Secondary measures include complete remission rate, partial remission rate, time to response, duration of response, clinical benefit rate, progression-free survival, and overall survival. The study will also be evaluating the safety of the combination of YM155 and rituximab based on reports of adverse events, physical examinations, vital signs, laboratory assessments, and electrocardiograms.

	Treanda is a drug developed by Cephalon, Inc that is approved for the treatment of chronic lymphocytic leukemia and indolent B-cell NHL that has progressed within 6 months of treatment with rituximab. It is a chemotherapy drug with some of the properties of an alkylator, allowing it to inhibit the growth of new cancer cells and damage the DNA in existing ones. In a clinical trial testing Treanda as a single agent, the overall response rate for patients who experienced disease progression within 6 months of treatment with rituximab was 74% and the median duration of response was 9.2 months. Common non-hematologic side effects of Treanda include nausea, fatigue, vomiting, diarrhea, pyrexia, constipation, anorexia, cough, headache, weight loss, dyspnea, rash, and stomatitis.

Useful Online Resources and Clinical Trials for Non-Hodgkin Lymphoma

Net Guides: Non-Hodgkin Lymphoma

	It was not so long ago that designing an optimal treatment plan for an individual cancer patient required only a confirmed histologic/morphologic diagnosis of a particular tumor type and appropriate staging, which was surgically based in most solid tumors.

	A number of additional pathologic factors such as tumor grade were recognized to be of reasonable prognostic significance, suggesting an individual patient would likely experience a relatively more or less favorable outcome, but with few exceptions (eg, estrogen receptor in breast cancer) these data were not of any real value in helping the clinician develop a successful management strategy.  That is, a patient with a localized high-grade malignancy might have a greater risk for experiencing metastatic spread at some point in the future but this knowledge was not useful in suggesting approaches to reduce that risk.

	During the past decade, however, there has been a virtual explosion in both the quantity and quality of clinically relevant data available to oncologists that can influence disease management, and it is almost certain this state of affairs will only accelerate in the future.  From the presence of overexpression of HER2 in a breast cancer to the existence of mutations in the epidermal growth factor receptor (EGFR) in a non-small cell lung cancer, specific treatments of both common and uncommon malignancies will be increasingly based on the presence of particular molecular targets.

	But wait.  What we seem to “know for certain” 

 regarding the relevance of such testing may be challenged and changed 

.  Consider, for example, the status of an evaluation of 

mutations in patients with metastatic colon cancer.  It has been well accepted that individuals whose cancers contain a 

 to a therapeutic antibody directed at the EGFR receptor.

 However, a recent report has strongly suggested that while this conclusion is accurate for most 

 mutations in colon cancer, such therapy may be quite beneficial in the presence of one specific mutation (codon 13).

	And, the list of highly specific data in unique clinical settings, knowledge of which may influence clinical decisions significantly, continues to grow rapidly. For example, a group of investigators recently reported that men with metastatic prostate cancer who had previously been castrated experienced a markedly increased clearance of docetaxel, a phenomenon that could substantially impact the activity of the agent in this population, compared with noncastrated patients.

 Routine measurement of troponin in women receiving trastuzumab has been suggested as a method of predicting the risk of cardiotoxicity associated with the agent.

 And, knowledge of specific genetic polymorphisms (pharmacogenetics) may be useful in predicting tamoxifen efficacy and irinotecan toxicity.

	What is a busy oncologist to do to keep track of these potentially highly clinically relevant associations between a particular molecular finding and specific positive or negative outcomes such as toxicity, biological activity, and survival?   It is virtually certain that both the quantity of the information required to be processed in considering such data and the complexity associated with an appropriate interpretation in individual clinical settings are only going to increase in the future.      

	In considering a rational solution to this rapidly evolving dilemma, one can easily envision an important role for a highly interactive electronic medical record to assist in providing timely reminders for laboratory tests that might be ordered, or specific settings where attention needs to be focused on a particular issue.

	For example, in a hospital/group practice pharmacy system an electronic “flag” could be placed when docetaxel is ordered for a patient with prostate cancer, reminding the physician of the association between prior castration and docetaxel clearance.  An individual institution or clinical practice may elect to include routine orders for obtaining troponin levels in all patients receiving trastuzumab, or the physician might be automatically asked if he/she wanted to obtain the test since it may be useful in this setting. 

	Organizations may prospectively decide how they want to deal with the importance of knowledge of individual pharmacogenetic profiles when administering specific antineoplastic agents, and build that paradigm into the electronic order entry process.  For example, it might be determined that it is essential to obtain an analysis of the germline variations associated with the metabolism/removal of certain drugs (eg, UGT1A1 with irinotecan or CYP2D6 with tamoxifen).  Under these circumstances, the pharmacy could mandate that these data be obtained before the order is accepted.  Alternatively, treating physicians may simply automatically be given the option (not required) to request the test when the particular anticancer agents are employed.

	Finally, this process can be used not only for its gatekeeper function as a way to ensure optimal drug utilization and safety, but also as an excellent educational tool that provides current, clear, accurate, and comprehensive explanations regarding the relevance of particular tests and the implications of specific findings.  Such information could be extremely helpful not only for members of the healthcare team but also for our patients and their families.

It was not so long ago that designing an optimal treatment plan for an individual cancer patient required only a confirmed histologic/morphologic diagnosis of a particular tumor type and appropriate staging, which was surgically based in most solid tumors.

From the Editor: Electronic Alerts Would Help Oncologists Manage Therapy

	“Development of this technology has involved many scientific disciplines beyond oncology: physics, chemistry, biophysics, cellular biology, radiobiology, molecular biology, physical chemistry, and others.”

	Radiation, used to treat more than half of all cancers, can sometimes be as toxic to the body as it is to the tumor. Advances in nanomedicine, however, may soon make it possible for radiation oncologists and technicians to deliver doses of x-rays that are strong enough to destroy the cancer without damaging healthy tissues.

	With a new device from Nanobiotixcalled NanoXray

, inert nanoparticles, between 100 and 1000 times smaller than the diameter of a human hair,are injected into the cancer and activated by a standard x-ray. These nanoparticles, called NBTXR3,absorb high levels of radiation. Once activated, these particles create electrons that, in turn, generate free radicals, which inflict irreversible damage to the cancerous cells and cause their destruction, while the surrounding cells receive a simple standard dose of radiation.

	In early 2011, Nanobiotixplans tobegin clinical trials with NanoXray at the Gustave Roussy Institute, Paris, an international center of excellence in cancer treatment. The chief executive officer of Nanobiotix, Laurent Levy, PhD, has been working with nanotechnologies for more than a decade, developing practical applications, such as NanoXray. Levy is the president of the French Technology Platform ofNanomedicine and author of 35international publications and communications. Here, Levy discusses this new technology.

	NanoXray is a technology in which crystallineand inert nanoparticles are designed to reach the tumor and then are activated by a standard x-ray. Once into the tumor, the nanoparticles accumulate in the cancer cell, and the x-ray activates the particles to release large amounts of energy in the cell.  The electrons produced after the nanoparticles absorb a high level of x-rays generate large quantities of free radicals.

	These free radicals inflict nonspecific,irreversible damage to the cancerous cell that leads to its destruction and multiplies the effects of radiation therapy. Due to their unique design and physical properties, the nanoparticles present in the cancerous tissues absorb a strong dose of x-rays, while healthy tissues receive a standard x-ray dose.

What advantages over standard radiotherapy methods will NanoXray offer?

	There are many potential benefits from this new approach to radiation therapy:First, it achieves a better local tumor control with an inert product. Secondly, it has a good safety profile demonstrated in animal models, and lastly, it delivers a higher dose to achieve total tumor control.

	The product augments efficacy of radiation therapy. Radiation has been effective against cancer for more than 50 years, and nanoparticles emitted by NanoXray have been thoroughly investigated and found to cause no harm in noncancerous cells over long periods of time.

	NanoXray could be combined with existing therapies, such as chemotherapy, surgery, and immunotherapy, and with molecularly targeted drugs. The device provides for “on/off” therapy. The inert nanoparticles  are only rendered active when exposed to radiation. One injection of the nanoparticles should last through a course of several radiation therapy sessions, and the device works with all standard radiotherapy equipment.

	Radiation oncologists and technicians can combine NanoXray with other approaches to improve radiation therapy outcomes, such as more focused imaging techniques and technologies that improve the focus of the radiation beam.

	Nanobiotixhas 3 products in the pipeline. The first (NBTXR3) will enter clinical trials in early 2011. This compound will be injected directly into the tumor.

	A second nanoparticle (NBTXR-IV), currently being investigated in nonclinical studies, may be injected intravenously to treat other cancers where an intravenous injection is the optimum delivery route.

	The third (NBTX TOPO) is being developed for use during surgery, to prepare the cancer site for follow-up radiotherapy, such as in breast cancer surgery. Based on the existing technology and preclinical results, Nanobiotix is developing other nanomedicine programs beyond NanoXray that will sustain its pipeline and expand the uses of nanoparticles in medicine.

Which cancer patients would be more likely to benefit from the NanoXray?

	Given the universal nature of the mode of action of these particles, this technology could be applied to all radiotherapy applications, that is, 50% to 60% of patients with cancer, while maintaining an optimal standard of care. The potential expands beyond this application because the mode of action of the nanoparticle product is not specific and could, in the future,open new routes for radiotherapy.

	Nanobiotix plans to address liver cancer, glioblastoma, rectal cancer, prostate cancer, non-small cell lung cancer, and breast cancer with various formulations of the product.

Describe the evidence supporting your contention that NBTXR3 not only delivers positive outcomes, but also shows superiority over standard therapies? 

	Nonclinical research indicates the treatment is safe, effective, and delivers a dose of radiation that is markedly higher than traditional radiation therapy. Nonclinical and preclinical research is completed, and this research paves the way for clinical trials to begin in Europe in early 2011. Preliminary research with the first NanoXray product (NBTXR3) in several animal models demonstrated a complete tumor regression and prolonged survival.

	Intratumoral injection of NBTXR3 nanoparticles activated via standard radiation therapy led to complete tumor regression and showed survival benefit in mice bearing human cancer cells. The preclinical study showed that an intratumoral injection of NBTXR3 nanoparticles activated via standard radiation therapy led to complete tumor regression in mice at 60 days, and showed significant survival advantages. NanoXray used in combination with radiotherapy should help it to achieve a better local control and should not compete with other products.

Are there adverse effects with NanoXray therapy and, if so, how would they be managed?

	NBTXR3 nanoparticles are designed to be safe and effective treatment for radiosensitive and radioresistant tumors. Two years ago, Nanobiotix commenced a large safety assessment program in animals to acquire knowledge about NBTXR3's biodistribution, excretion, and potential toxicology effects in healthy and tumor-bearing animals.

	Despite the intended use of NBTXR3 as a local injection directly into a tumor, NBTXR3 was tested in animals as a systemic injection into the vein in order to mimic a clinical situation of accidental and massive passage of NBTXR3 nanoparticles into the bloodstream during the procedure of intratumor injection.

	Preclinical tolerance studies in terms of animal survival, behavior, and pathological assessment indicated capture by the reticulo-endothelial system and negligible toxicity, even for dose-maximization situations in which NBTXR3 was injected by intravenous route on 5 consecutive days.

	Results suggested absence of any indolent disease characteristics in male and female animals. Excretion studies following intravenous administration showed identical data for male and female animals, with NBTXR3 very slowly eliminated by feces per plan and no presence of NBTXR3 in urine. For the systemic administrations, NBTXR3 nanoparticles underwent endocytosis mainly in the mononuclear phagocyte system. There was no evidence of blood/brain barrier rupture. Also, no presence of inflammation or degenerative change was found in toxicology study.

What trials are underway or planned? What has been identified as the primary endpoint of these trials?

	In early 2011, Nanobiotix will begin clinical trials with NBTXR3, the first NanoXray product. The trial’s first indication will be on soft tissue sarcomas, a rare form of cancer that develops in different tissues such as in fat, muscle, and others. The primary endpoints of this trial are to demonstrate feasibility and the innocuity of the treatment in humans.

What technological advances made the NanoXray possible?

	The nanoparticle used in NanoXray technology is an inactive and inert substance (not a drug), measuring 50 nanometers in diameter—up to 1000 times smaller than the diameter of a human hair.

	The nanoparticle comprises a crystalline inorganic core and a coating layer that protects the core from unintended biological interactions within the body. Development of this technology has involved many scientific disciplines beyond oncology: physics, chemistry, biophysics, cellular biology, radiobiology, molecular biology, physical chemistry, and others. The ability to design, qualify, and manufacture such nanoparticles have been key factors in the development.

Describe how those advances were used to develop this technique?

	I have worked in the nanotechnology field for 15 years as a scientist, but also as an entrepreneur. I started with my PhD in nanotechnology, where I explored the impact of scale on the physical properties of nanomaterials—in other words, how to design and reduce the size of a material to tune and exploit its new properties.

	After this step, I thought about using the unique properties of nanoparticles to kill cancer cells. I had to go to the US (University at Buffalo, The State University of New York) to find a multidisciplinary team that could explore the concept of how to combine biology, nanomaterial, chemistry, and physics to develop nanomedicine applications. At this time the concept was very new, and everything needed to be done. Later, when we created Nanobiotix, we had to expend our knowledge to take the technology to the next level and make it industrial.

What materials form the nanoparticles used in the NanoXray, and how are the nanoparticles manufactured?

	NanoXray compounds are based on crystalline HfO2 nanoparticles. A specific manufacturing process has been developed that is scalable, ensures batch-to-batch reproducibility, and allows flexible manufacturing of several products. Successive NBTXR3 batches have been successfully validated and qualified. The current process produces sufficient materials for the completion of preclinical development, clinical trials, and potentially, initial commercialization. A manufacturer with GMP [good manufacturing processes] and injectable-product capabilities handles the production.

What stage of the development cycle are you in, and when do you think this product will be ready to submit for FDA and/or EMEA approval? When will it reach the market?

	The NanoXray therapeutics, due to their physical mechanism of action, have been classified as class III medical devices by some of the regulatory authorities in EU countries. The first Nanobiotix product, NBTXR3 for intratumoral injection, is planned to launch around 2014, but of course this always depends on development orientation and timelines, which may vary depending on clinical results.

What major challenges have you and your company faced thus far in developing this technology?

	As any young innovative healthcare company, Nanobiotix went through “classical” steps combining technological development, finding the right financing, executing manufacturing, defining the regulatory pathway, finding the right people, and so on, On top of that, Nanobiotix faces major challenges, as long as it is not a classical biotech player, involved in molecule development: We still have to educate, excite, and endorse to help our target audiences to think out of the box. These are very important tasks since we want this technology to benefit to patient as soon as possible.

Radiation, used to treat more than half of all cancers, can sometimes be as toxic to the body as it is to the tumor.

Nanotechnology X-ray Method Aims to Kill Cancer But Spare Healthy Tissue

	Medical records have changed significantly in the past decade, with powerful servers and digital archives replacing rooms jammed with filing cabinets and folders stuffed with hand-scribbled notes. Although many physicians’ offices and hospitals still retain paper records, growing pressure from the federal government to convert to electronic health records (EHRs) is making speech recognition transcription software an increasingly popular tool in medical facilities.

	Will this technology simplify the transition to fully digitalized health records, including in oncology settings?  Experts say it already has revolutionized the creation of patient  records in radiology and that it will continue to spread across the healthcare spectrum. Adopting such technology, though, is more nuanced than loading software into a computer, according to healthcare industry observers and recent research. 

	David Hirschorn, MD, director of Radiology Informatics at Staten Island University Hospital, New York, New York, said the technology is a “fait accompli” in radiology. “It’s a matter of time before it happens in the rest of healthcare,” said Hirschorn, who also conducts research in the field at Massachusetts General Hospital in Boston, during an interview with 

. “There are drivers that are pushing for speech-based documentation.”

	Jan P.H. van Santen, PhD, director of the Center for Spoken Language Understanding (CSLU) at Oregon Health and Science University in Portland, said automated speech recognition (ASR) is widely used for medical dictation these days.

	“Several companies have sold very good systems.  These systems work better— none are perfect!&mdash; the smaller the vocabulary is and the more technical and longer the words are,” he said in an email.  “Radiology, including radiation oncology, has always been among the bigger users of ASR, in part for these reasons and also, of course, because it has stricter reporting requirements than, for example, psychiatry.”

	Yet Van Santen already is looking beyond the use of speech technology for straightforward dictation to exciting new applications.

	“One is where the physician talks into the system while interacting with the patient. This is much more difficult because the vocabulary will be larger and more unpredictable, and there is going to be background noise (eg, the patient talking),” he said in the email.  “But it is enormously important now that EHRs almost force the physician to be typing away while at the same time interacting with the patient— not good, in particular in oncology, where intense and empathic physician-patient communication is so important.”

	He also said CSLU is studying ways in which speech technology can be used to analyze speech patterns that signal disease. “For example, throat cancer may cause specific acoustic markers that are different from those resulting from regular hoarseness; certain physicians can hear the difference, but most can't,” he said.

	“Another example is brain metastases. Some of these may be too small to be picked up by imaging, yet by being lodged in a functionally critical area may manifest themselves behaviorally, and one of these behavioral manifestations can be speech (about 35% of brain cancer cases present with one or more of clearly audible dysphasia, aphasia, or slurred speech). I underline here ‘clearly audible,’ because we are convinced that computer analysis of speech will be capturing many cases that are not audible to the human ear.”

	Advocates of speech recognition technology say it has many advantages. It makes hands-free computing an option for clinical documentation, test result management, speech-enabled EHRs, and diagnostic reporting.  It is also helpful for fully documenting patient feedback and extemporaneous explanations since a patient is generally more comfortable speaking responses than typing them, and the information is generally easier to understand if taken from a patient’s natural speech rather than a typed response. These full-text responses can be attached to a patient’s medical report and forwarded to subsequent practitioners.

	In radiology practices, dramatic savings have been reported. At Staten Island University Hospital, the adoption of speech recognition technology cut annual reporting costs from $300,000 to $50,000, Hirschorn said during a presentation at the Society of Imaging Informatics in Medicine conference in June. He said the radiology department was able to cut 7 full-time transcription jobs.

	In addition, the turnaround time for generating reports dropped from 2 weeks to less than 10 minutes.

	The cost of traditional dictation can easily exceed $12,000 per physician per year while voice recognition software costs approximately $1000 to $1500 per physician, according to Bruce Kleaveland, president of Kleaveland Consulting, a healthcare technology management consulting firm in Seattle, Washington. 

	The ability to better analyze information is another advantage likely to become more significant for radiation oncologists, Hirschorn said in an interview. As physicians grow accustomed to using the system, their word choice tends to grow more standardized, resulting in a searchable database where therapy trends can be analyzed.  “Outcomes research is definitely rising on the horizon of importance,”  he said.

	Although the benefits might seem evident, there are human factors that influence the performance and adoption of the technology.

	Researchers at the University of North Carolina Chapel Hill recently studied the impact of the technology on 30 faculty members in the Department of Radiology. Krishnaraj et al found the average turnaround time for radiology report processing decrease from 28 to 12.7 hours with the use of speech recognition technology.

  The volume of verified reports also increased by 5%.

	At the same time, however, the researchers found that the work habits of the faculty members played a significant role in the results. They ranked the faculty members by report turnaround time before and after the technology was adopted and classified the members by work types.

	“Faculty members who had type1 work habits, that is, reviewed, revised, and finalized reportsat the time of image review, benefited the most from use ofvoice recognition,”

	the researchers said. “… Improvement in report turnaround time does not correlate with workload but does correlate with work habits, suggesting human behavior may play a role in determining the outcome of adopting a productivity-enhancing technology.

	Kleaveland observed that physicians learning such systems will have to change the way they produce records since there’s no medical transcriptionist upon whom they can rely. “It requires a bit of patience during the training phase, demands a much more controlled environment in terms of microphone placement and ambient noise compared with traditional dictation, and requires the physician to correct mistakes made by the program,” he said.

	Likewise, Hirschorn noted that communication about the benefits of speech recognition technology and training in how to use it are important factors in its acceptance and adoption among physicians. “There’s definitely a hurdle to learn how to use it and change the way you work,” he said.

	Although Alexander Graham Bell began experimenting with ways to translate sounds into images in the mid-1870s, it was not until 1952 when Bell Labs developed the first effective over-the-phone speech recognizer.  Technology that could transcribe spoken words into text did not hit commercial markets until the 1980s. Initially, the primary users were disabled people who could not use a keyboard or a mouse, according to Datamonitor, an independent market analysis firm. By the late 1990s, though, use of the technology began growing, with the healthcare industry as the primary customer.

	In a 2008 report, Datamonitor estimated that sales of speech technology services and licenses in healthcare settings would grow from $171.4 million in 2007 to $601.2 million in 2013, with radiologists and pathologists as its prime audiences. 

	Today, Nuance Communications alone reports $449.3 million in revenue for 2010 from its Dragon Medical and other speech recognition products.  The Burlington, Massachusetts-based company has become the leading provider of the software, having acquired several other companies. Officials have said the company’s healthcare products are used in more than 5,000 organizations.

	The company sees more potential in the US government’s drive for EHRs. In October, Nuance announced that it would work with IBM to develop natural language technologies as a core component of those records.

	There are 2 main types of speech transcription technology. With front-end technology, the user speaks into a microphone and the computer converts the spoken word in real time; the user makes corrections as needed, since the text appears on the workstation screen as the user speaks. With back-end technology, the user dictates into a digital recording device and the sound file is routed along with the original sound file to a transcriptionist who then makes the necessary edits and finalizes the report. This hybrid system allows the transcriptionist to perform basic editing or correction, rather than using her time entering the full body of the dictated text. [http://blog.dragonelearning.com/]

	Faster computer processing speeds and increased drive storage have supported increased vocabulary capacity and paved the way for a marked improvement in accuracy. One of the most popular speech recognition programs, Dragon NaturallySpeaking’s Medical Version 10.1, costs $1550 and includes a 30,000-word medical vocabulary and more specialized terminology. There are 15,000 general medical terms and 15,000 medical terms specific to the user’s specialty. There are currently 58 specialties available.

	According to tech reviewers Edward C. Baig and Lamont Wood, Nuance Communication’s Dragon NaturallySpeaking has come a long way since its initial release in 1997 and in the numerous updated versions since its introduction. The “training” process that familiarized the user’s computer with his or her voice took approximately 45 minutes and was accurate only 75 percent of the time. Prior to 1998, the technology required the user to pause after every spoken word.

	[http://www.usatoday.com/printedition/money/20100729/baig29_st.art.htm]

	[http://www.computerworld.com/s/article/9019220/Hands_Off_Using_Dragon_NaturallySpeaking]

	By contrast, the most recent version takes mere minutes to be trained to an individual with accuracy topping 95%. Company officials have attributed the dramatic increase in accuracy to improved algorithms and more powerful, faster computers.

	[http://www.computerworld.com/s/article/9019224/Is_speech_recognition_finally_good_enough_]

	Another example of the products now on the market is a GE Healthcare system that weaves voice recognition technology into the radiology workflow. Centricity RISi/PACS Postprocessing with SpeechMagic™ handles all functions from order entry to the image report and distribution, with a front-end voice recognition system that the company says eliminates the need for a transcriptionist.  The system is designed for use in hospitals.

Medical Transcriptionists Still in Picture

	Will the growth of speech recognition technology mean the end of the medical transcription profession?  The Association for Healthcare Documentation Integrity, a professional society for medical transcriptionists, sees a continuing need for qualified transcriptionists. 

	Likewise, the Bureau of Labor Statistics (BLS), a division of the US Department of Labor, is forecasting 11% growth in employment for the medical transcription field from 1008 through 2018. The BLS said demand will rise as the nation’s elderly population grows and consumes more medical services and as the need for electronic documentation rises.

Medical records have changed significantly in the past decade, with powerful servers and digital archives replacing rooms jammed with filing cabinets and folders stuffed with hand-scribbled notes.

January 2011 | Oncology Live®