Advances in Supportive Care Offer New Opportunities for Oncology Patients and Clinicians

The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 20 de mayo del 1996

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photo of supportive care panel presentation Philadelphia, PA, May 20, 1996 -- Research presented at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO) provided insight into new solutions for maximizing the quality of cancer care.
The cost of cancer care is rising at a rate that cannot be sustained. The costs of treatment have risen from $35 billion to more than $40 billion during the period of 1990 to 1994, including direct costs of cancer treatment and indirect costs of supportive treatments such as palliative care to ease pain and suffering.

Evaluation of Capsaicin Cream for The Treatment Of Postoperative Neuropathic Pain

According to a new study, capsaicin cream, the pungent ingredient in hot chili peppers, decreases postsurgical neuropathic pain. The results were reported by Charles L. Loprinzi, M.D., professor and chair, Medical Oncology, Mayo Clinic (Rochester, MN).

It is well known that individuals who eat hot chili peppers on a regular basis build up a tolerance to them. Eventually they do not feel the heat or pain others feel when they first eat the peppers. Investigators saw this as a clue that an ingredient in the peppers might be able to control pain in some people.

Dr. Loprinzi and his colleagues in the north Central Cancer Treatment Group undertook a 16-week double-blind, placebo controlled crossover trial of 99 patients who had been operated on for various cancers, including breast and lung cancers. Half of the patients involved had had a mastectomy, while one-third had had a lung-related operation. The cream was to be applied to painful areas around the incision site four times a day. half of the participants received capsaicin cream during the first 8 weeks and an identical-appearing placebo cream in the second 8 weeks; the other half received placebo cream first followed by capsaicin cream. patients completed weekly questionnaires evaluating their treatment.

Despite some side effects, patients preferred the capsaicin treatment over placebo by a 3 to 1 margin. Upon completion of the 16 week study period, 60% of patients chose capsaicin cream, 18% chose placebo and 22% chose neither. When patients were treated with capsaicin cream they reported substantially more pain relief compared to pain relief during the placebo treatment.

Side effects of capsaicin treatment included skin burning, skin redness and coughing. Treatment was stopped for patient refusal or toxicity just as often with placebo (33% refusal, 8% toxicity) as with capsaicin (30% refusal, 8% toxicity). All capsaicin-related toxicities were tolerable.

"There has been a lot of anecdotal evidence that capsaicin cream might be useful for treating severe post-surgical pain," noted Alan Lyss, M.D., director, Missouri Baptist Cancer Center (St. Louis, MO) at a press briefing today. "This study gives credence to this anecdotal evidence. What makes this particularly interesting is the capsaicin is readily available and relatively inexpensive."

Oncology Care For Rural Kansans Via Telemedicine: The Establishment Of A Tele-Oncology Practice

A status report of the first tele-oncology practice in the United States, established between Kansas University Medical Center (KUMC) and Hays Medical Center (HMC) was presented at the 32nd Annual Meeting by Gary Doolittle, M.D., assistant professor medicine, the Kansas University Medical Center.

Delivering state-of-the-art medical care to cancer patients in rural areas has long been a challenge for oncologists. KUMC, at 500+ bed tertiary care center in Kansas City, is 280 miles from HMC, a 100 bed medical center in rural northwestern Kansas. Northwestern Kansas has a population base of 150,000, with few medical specialists.

The tele-oncology practice consists of regularly scheduled "clinics" in which KUMC oncologist participated via interactive video in patient visits to HMC clients.

Each tele-oncology site was equipped with television monitors and color cameras. A specially adapted electronic stethoscope enabled transmission of breath and cardiac sounds over the telecommunications system. X-rays were also transmitted and reviewed. Outreach on-site oncology clinics by the KUMC oncologists were conducted twice monthly.

Over 100 telemedicine consultative visits were conducted from march 1995 through February 1996 for patients suffering from a variety of hematologic disorders, malignancies and solid tumors. The researchers found no discrepancies between telemedicine consultations and subsequent on-site assessments made by oncologist at KUMC.

"The tele-oncology program provides an excellent opportunity for rural oncology patients to receive first-rate medical care close to home," noted Alan Lyss, M.D., director, Missouri Baptist Cancer Center (St. Louis, MO) at a press briefing today. "Using state-of-the-art telecommunications systems, clinicians in remote rural areas can gain access to technologically advanced diagnostic assessments and treatments often found only in major cities and medical centers."

Alternatives To Inpatient Care: A Cost Comparison Of Home Versus Ambulatory Care For Chemotherapy Administration And Supportive Care Measures

Researchers at the Ochsner Cancer Institute in New Orleans presented the results of a study measuring cost of home versus ambulatory care settings at the 32nd ASCO Annual Meeting. Results of the study concluded that an efficient outpatient (ambulatory) clinic setting is associated with greater cost savings than home care, while providing a high level of patient satisfaction.

With the ever increasing demands for cost controls, patient care has shifted from traditional locales such as inpatient hospital settings to ambulatory and home care settings. In previous studies evaluating the cost of chemotherapy administration, the outpatient clinic setting was found to provide significant cost savings and greater patient and family satisfaction compared with treatment in the hospital.

The current study was designed to measure major cost elements of home and ambulatory treatment. The costs included: personnel (treating and support staff); drugs and supplies; and overhead (space and utilities.). Four chemotherapy regimens for colon, breast and lung cancer, and three supportive care measures (blood transfusion, IV hydration, and amphotericin) were evaluated.

Home care was an average of 109% more expensive compared to the ambulatory care setting. Average home care treatment costs were more than doubled compared to the average costs for ambulatory care ($982 home care, $471 ambulatory care). To account for lower drug costs found in the clinic, costs were examined independent of pharmaceutical drugs. Home care remained an average of 140% more expensive.

One hundred patients receiving chemotherapy and supportive care in an ambulatory care setting were surveyed to determine satisfaction using a visual analog scale. Overall, patients were highly satisfied with ambulatory care setting, with an average rating of 98 out of a scale of 100.

"In this study, we are able to review the actual cost differences between home care and clinic care," noted Alan Lyss, M.D., director, Missouri Baptist Cancer Center (St. Louis, MO) at a press briefing today. "Delivering cost efficient, quality oncologic care is paramount -- particularly in the changing health care delivery markets."


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