Nov. 23, 2009--ICACTL Strengthens Patient Dose Accreditation Criteria

The Intersocietal Commission for the Accreditation of Computed Tomography Laboratories (ICACTL) announced today its revised accreditation standards, including the incorporation of guidelines to strengthen patient safety as it relates to radiation standards and Appropriate Use Criteria (AUC).

As described in a press release, laboratories that make any changes to the manufacturer's default settings that could result in an increase in patient radiation exposure are now required to maintain documentation and provide adequate justification. The rationale for protocol deviation, as well as the impact of the increased dose on image quality and on radiation dose, should be documented by the supervising physician and reviewed and approved by the medical physicist.

As part of the accreditation program's Quality Assessment component, The ICACTL Standards also now recommend that laboratories measure the appropriate use of the CT exam based on criteria published/endorsed by professional medical organizations. Accredited laboratories are encouraged to measure and document the percentage of appropriate, inappropriate and uncertain indications for testing.

In addition, a program for education and reporting is suggested, inclusive of patterns of adherence to AUC; baseline rates of adherence; goals for improvement of adherence to appropriate use criteria; measurement of improvement rate; and confidential comparison reports on patterns of adherence in aggregate by ordering physician, ordering practice and interpreting practice.

Deep venous thrombosis (DVT) is a common condition with estimates suggesting that the condition affects 600,000 patients each year with up to 100,000 deaths related to DVT.1 Approximately 30% of patients with a DVT will suffer from a recurrent episode of DVT within 10 years, with the greatest risk occurring in the first 2 years. Approximately 30% of patients with a DVT will suffer from a recurrent episode of DVT within 10 years, with the greatest risk occurring in the first 2 years.2

 Dr. Mark J. Garcia, Program Director, Vascular & Interventional Radiology Fellowship and Section Chief, Vascular & Interventional Radiology at Christiana Care Health Services (Newark, DE) said, "When the thrombus (a blood clot formed within a blood vessel and remaining attached to its place of origin) injures or destroys the deep venous valves, chronic venous insufficiency (CVI) can occur. The symptoms associated with CVI are called Post Thrombotic Syndrome (PTS) and
include the spectrum ranging from extremity heaviness or fatigue, swelling and pain, itching, cramps and paresthesia ("pins and needles,"). Signs of PTS include edema, redness, hyperpigmentation, varicose veins, dependent cyanosis, peri-malleolar telangiectasia, subcutaneous fibrosis, venous stasis ulcers, and more rarely gangrene and amputation."

 PTS is the most common complication of venous thromboembolism (VTE) and occurs in 20-50% of patients despite optimal anticoagulant therapy, with severe PTS occurring in 5-10% of VTE patients. PTS has been shown to cause a significant reduction in the quality of life and can lead to repeated hospitalizations and long-term treatments. Many individuals are unable to continue as productive members of the workforce and become an economic burden on society. Using the accepted, estimated occurrences of DVT, one can reasonably extrapolate that there are hundreds of thousands of patients suffering from some degree of PTS. The goal of therapy for lower extremity DVT has
been aimed at preventing the propagation of thrombus and occurrence of pulmonary embolism as well as the recurrence of DVT. However, there are few treatment options available for chronic VTE. Current therapies include anticoagulation, elastic compression stockings and extremity elevation, with no high quality evidence to support endovascular treatment methods as an option for chronic DVT.

 Garcia presented a series of 35 patients with chronic, hard and occlusive DVT, suffering from PTS, that were successfully treated with endovascular techniques to restore flow and reduce their symptoms related to PTS. Garcia concluded, "The EKOS ultrasound assisted thrombolysis, in addition to standard angioplasty and stenting techniques, led to successful venous recanalization and patency with improved venous outflow. Our results suggest that the ability to successfully recanalize chronically occluded venous segments in patients with PTS, benefit the patient by reducing their symptoms and allowing them to enjoy an improved quality of life."

About VEITHsymposium™: Now in its fourth decade, VEITHsymposium™ provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features over 400 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

References
1 The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. 2008 U.S. Department of Health and Human
Services. Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ, 3rd. Predictors of recurrence after deep vein thrombosis and
pulmonary embolism: a population-based cohort study. Arch Intern Med 2000;160(6):761-8. Prandoni P, Lensing A, Cogo A, Cuppini S, Villalta S,
Carta M et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125(1):1-7.Kahn SR, Shrier I, Julian JA, Ducruet
T, Arsenault L, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Lamping DL, Johri M, Ginsberg J. Determinants
and time course of the post-thrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149: 698-707.

2 Bergqvist D, Jendteg S, Johansen L, Persson U, Odegaard K. Cost of long-term complications of deep venous thrombosis of the lower extremities:
an analysis of a defined patient population in Sweden. Ann Intern Med 1997; 126: 454-7. Caprini JA, Botteman MF, Stephens JM, Nadipelli V,
Ewing MM, Brandt S, Pashos CL, Cohen AT. Economic burden of long-term complications of deep vein thrombosis after total hip replacement
surgery in the United States. Value Health 2003; 6: 59-74.

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While we recognize that there will be a number of benign biopsies, we also recognize that mammography is the optimal screening tool for the early diagnosis of breast cancer in terms of cost-effectiveness, practical use, and accuracy.  To restrict its use will mean that breast cancers will go undiagnosed for an unacceptable period of time.  This restriction of mammographic screening defeats the goals of early detection, which often allows for breast conserving surgery and avoidance of chemotherapy.

The (USPSTF) also does not make a recommendation for mammography screening for women age 75 and older.  Women in this age group are at the greatest risk for breast cancer and at the point where mammography is most sensitive. 

We believe these recommendations effectively turn back the clock to pre-mammography days by making the diagnosis of breast cancer occur only when the tumor is large enough to be felt on a physical exam.  The Society will continue to advocate for routine annual mammography screening for all women beginning at age 40.  Mammography screening reduces breast cancer mortality and saves lives.   

Society of Cardiovascular Computed Tomography (SCCT) announces a new study which finds cardiac CT scans improve survival.  Utilizing newer cardiac computed tomography (CT) machines to find plaque and blockages in the coronary arteries led to better survival among those undergoing the test.  The study was presented November 15, 2009 at the American Heart Association Meeting in Orlando Florida.

SCCT's president elect, Matthew J. Budoff, MD, is the study's lead author and a researcher at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed).  Budoff said previous studies had found assessing heart disease using CT heart scans could predict overall death risks in most American adults, but did not look at whether the knowledge gained by undergoing the test led to better outcomes.

Dr. Budoff presented a study of 4,224 patients of which 60% underwent the CT angiography (or non-invasive) angiogram test, and 40% who did not.  Both groups were followed for almost seven years, and then all-cause mortality was assessed.  Cardiac patients who did not undergo the CT angiogram were almost 4-fold more likely to die during follow-up.

 "This study indicates that cardiac CT scans can provide patients and physicians an earlier and more accurate evaluation of their coronary arteries than traditional tests," said Dr. Budoff.  "The advanced knowledge clearly allows more aggressive and better treatments to be provided.  Previous studies found cardiac CT scans encourage compliance with medications and lifestyles that are protective for coronary health, and to be more accurate than stress tests.  This new large study now shows that outcomes are improved with this knowledge."

A cardiac CT scan (non-invasive angiogram) looks directly at the arteries that provide blood flow to the heart for hardening of the arteries or plaques that can block blood vessels and cause heart attacks, strokes or death.

In total, 270 deaths were recorded over 80 months of follow-up.   The death rate was significantly lower in the group undergoing the CT angiogram (n=86) as compared to the standard of care group (n=184)(p=0.001).

"This study provides significant validation of cardiac CT scans," said Dr. Budoff. "Improved compliance with therapies, more accurate assessment of risk, and identification of coronary stenosis provide important information in assessing a patient's overall death risk.  With this information, physicians can advise patients on diet, medications, exercise and other lifestyle changes that will help them avoid the risk of heart attack, strokes and other health problems."

"This is a most important study conducted by Dr. Budoff and echoes the sentiment of the SCCT, which espouses that cardiac CT angiography is the most accurate and non-invasive diagnostic imaging test for the detection of coronary artery disease," said Dr. Jack Ziffer, PhD, MD, FSCCT Chief of Radiology at Baptist Hospital and SCCT President. 

Pooling results from 21 studies, involving 622,381 men and women, researchers at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

The risk for those with migraines is 2.3 times those without, according to calculations from the Johns Hopkins team, to be presented Nov. 16 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando. For those who experience aura, the sighting of flashing lights, zigzag lines and blurred side vision along with migraines, the risk of so-called ischemic stroke is 2.5 times higher, and in women, 2.9 times as high.

Study participants, mostly in North America and Europe, were between the ages 18 and 70, and none had suffered a stroke prior to enrollment.

Senior study investigator and cardiologist Saman Nazarian, MD, says the team's latest analysis, believed to be the largest study of its kind on the topic, reinforces the relationship between migraine and stroke while correcting some discrepancies in previous analyses. For examples, a smaller combination study in 2005 by researchers in Montreal showed a bare doubling of risk, yet mixed together different mathematical measures of risk, while the Hopkins study kept them separate, pooling together only like measures. As well, another half dozen recent and smaller studies from Harvard University yielded mixed results, some showing a link between migraines and ischemic stroke, while one did not show a tie-in.

Dr. Nazarian says that while nearly 1,800 articles have been written about the relationship between migraine and ischemic stroke, the Hopkins review was more selective, combining only studies with similar designs and similar groups of people, and more comprehensive, including analysis of unpublished data.

"Identifying people at highest risk is crucial to preventing disabling strokes," says Dr. Nazarian, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. "Based on this data, physicians should consider addressing stroke risk factors in patients with a history or signs of light flashes and blurry vision associated with severe headaches."

Prevention and treatment options for migraine, he says, range from smoking cessation and taking anti-blood pressure or blood-thinning medications, such as aspirin. In women with migraines, stopping use of oral contraceptives or hormone replacement therapy may be recommended.

Such widespread use of hormone-controlling drugs is what Nazarian says may explain why women with migraines have such high risk of ischemic stroke. Contraceptives and other estrogen therapies are both known to contribute to long-term risk factors for cardiovascular diseases and stroke, such as high blood pressure and increased reactivity by clot-forming blood platelets.

Nazarian says the researchers' next steps are to evaluate if preventive therapies, especially aspirin, offset the risk of ischemic stroke in people with migraines.

Funding support for the study, performed entirely at Hopkins, was provided by the National Institutes of Health Clinical Research Scholars Program.

Other researchers involved in this study were Susan Kahn, M.D., M.Sc.; Miranda Jones, M.P.H.; Monisha Jayakumar, M.P.H.; and Deepan Dalal, MPH, The lead study investigator was June Spector, MD, MPH, a former postdoctoral research fellow at Hopkins, now in Seattle.

 "These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women," said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.

 Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50.  In truth, there are no data to support this premise.

 "The USPSTF claims that the "harms" of mammography, including discomfort of the exam, anxiety over positive results, and possibility of overtreatment because medical science cannot distinguish which cancers will become deadly most quickly ─ outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. Without doubt, the possibility of having one's life saved through early detection far outweighs any of these concerns. Their premise is tragically incorrect and will result in many needless deaths if their recommendations are adopted by the American public." said Lee.

 "The USPSTF recommendations are a step backward and represent a significant harm to women's health. To tell women they should not get regular mammograms starting at 40 when this approach has overwhelmingly been shown to save lives is shocking. At least 40 percent of the lives saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives," said W. Phil Evans, M.D., FACR, president of the Society of Breast Imaging (SBI).

 The USPSTF is an independent panel of primary care physicians funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for additional preventive services. Recently, Congress has expressed their desire to broaden this authority and enhance the role of the USPSTF in terms of its impact on coverage for existing services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-savings measure.

 "I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer. These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions. I can't help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives," said James H. Thrall, M.D., FACR, chair of the American College of Radiology Board of Chancellors.

As many software companies work to create programs that will give uniform structure to the way radiological test results are reported, a new study by researchers at Wake Forest University School of Medicine shows that such a system does not improve, but rather decreases the completeness and accuracy of the reports.

The study, published recently in Radiology, compared the accuracy and completeness of reporting test results in a free text, narrative format versus using standardized words and phrases from a pull-down menu (structured reporting).

"This research is our attempt to evaluate a new technology that is a pretty hot topic in medicine right now and has been for a few years," said Annette J. Johnson, MD, MS, an associate professor of radiology and lead investigator on the study. "Since radiology began, we have been creating our reports in a free text, narrative format. The rationale behind efforts to change this format is that all of the reports that we create could potentially be a very useful data base for clinical care and research if they were standardized."

Standardization would mean that key content could be accessed through automated means, by computer systems, rather than requiring a human being to read the report and manually sift through narrative comments to try to find and categorize key content, Dr. Johnson said.

"This type of standardization is a very appealing idea, but we did not have data regarding what effect structured systems like this might have on individual report quality until now," she added. "It turns out that a structured reporting system actually decreases the accuracy and especially the completeness of reports, which is the opposite of what we expected."

This study provides the only known data about the proposed program's effect on the quality of radiological reports, Dr. Johnson said.

Currently, she explained, a physician might send a patient who is experiencing weakness in his arm, for example, for a head computed tomography (CT) scan to rule out concerns about a stroke. A radiologist then reads the CT scan and reports what she sees.

"I might say, 'There's no evidence of hemorrhage,' or any other variety of wording to convey that idea. I could say, 'no bleeding' or 'no hematoma' or 'no hyperdensity,' all of which mean the same thing," Dr. Johnson said. "In a structured system, I would choose from a list of standardized phrases with certain specific terms available in a dropdown menu, such as 'No presence of acute stroke.' Standardization seems simple, but it's not always easy or what we commonly do in medicine. The theory is that structured reporting would make the reports intrinsically better because we'd all be using the same ideas recorded in the same verbiage instead of using numerous different ways to say 'blood.' Right now, several people reading a scan may all agree that they see the same thing, but each individual will say it in a different way."

For the study, the researchers tested such a structured reporting system on two groups of residents. Each individual in both groups was given the same set of 25 brain magnetic resonance imaging (MRI) scans along with a video of a staff physician's interpretation of the MRI scans, and was asked to report the interpretation using the free text narrative they were familiar with using. Four months later, the same set of MRIs was given separately to each individual again. Half of the residents were asked to report their observations in the free text narrative form as they had the first time. The other half were asked to create their reports using the structured reporting software, which listed standardized sentences and phrases describing different findings to choose from.

"We thought that the structured reporting group would make better reports," Johnson said. "However, the reports created using structured reporting software were actually substantially less complete and a little less accurate compared to the reports made by the same residents in free text four months earlier and with the other group of residents who used free text both times."

The company that made the specific structured reporting software used for the study is no longer in existence, Dr. Johnson said, but there are still many more software companies very focused on creating these programs and finding ways to structure reports. These companies, and the physicians who choose to use structured reporting systems, should strongly consider how the software is going to affect the quality of real patient records, and all software should be specifically tested for quality effects before being implemented, she said.

The study was funded in part by the General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF).

The American Society of Radiologic Technologists (ASRT) is offering eight pointers to patients to ensure that they receive the best and safest imaging possible. The tips come on the eve of National Radiologic Technology Week (NRTW), Nov. 8-14, which recognizes and honors radiologic technology (RT) personnel who provide medical imaging and radiation therapy treatments. NRTW marks the anniversary of Wilhelm Roentgen's discovery of the X-ray on Nov. 8, 1895.

"As radiologic technologists, our ultimate goal is to use our knowledge, skills and education to improve health care and provide patients with outstanding care," says Sal Martino, EdD, RT(R), FASRT, CAE, ASRT CEO. "Radiologic technologists realize that they are the conduit between the patient and the procedure, so they are in a unique position to help patients before, during and after exams."

The ASRT's goal in providing its list of X-ray safety tips is to empower patients with the knowledge they need to understand what to look for during exams, which will help increase safety measures and ultimately improve patient care.

 The ASRT's patient tips include:

1.       Tell your doctor or radiologic technologist if you're pregnant. Many types of X-ray examinations can be performed safely on pregnant women, but the exam's benefits must be weighed against any risk to the developing fetus.

2.       The eyes, thyroid and reproductive organs are more sensitive to radiation than other parts of the body and should be shielded when they're in the path of the X-ray beam, unless the shielding would interfere with the examination. Ask if you think you need shielding.

3.       Remain still during the exposure, which lasts only seconds. Motion makes the images blurry and requires them to be repeated, adding to radiation exposure. For certain exams, you will be asked to hold your breath so your moving lungs won't blur the image. The easiest way to do this is to take a deep breath, exhale and then take another deep breath and hold it.

4.       Remove any metal you may be wearing that could interfere with the X-ray. For example, if you're having a skull radiograph, remove earrings, hairpins and eyeglasses. For radiographs of the hand, remove rings, bracelets and watches. You may need to wear a hospital gown if your clothing has zippers, metal buttons or snaps.

5.       Tell your technologist if you have any medical or electronic devices in your body, including heart valves, pacemakers or metal objects such as those used in orthopedic surgery. Electronic and metal orthopedic devices may interfere with certain types of exams or pose risks.

6.       Don't refuse a radiologic examination if the need for it is clear. On the other hand, don't insist on a radiograph or other type of imaging exam if your physician doesn't recommend one.

7.       If you're referred to a different physician, take all of your prior imaging exams and reports with you so the new physician doesn't reorder the same exam. And remember--the new physician may call it something different, so you may think you haven't had that exam even though you have.

8.       Finally, make sure the person taking the X-ray is a registered RT. RTs must graduate from a formal educational program and pass a national certification exam. They also must earn CE credits throughout their careers.

A pair of studies in Cancer Epidemiology, Biomarkers & Prevention have laid to rest the decades-long concern that lower total cholesterol may lead to cancer--and indicate that lower cholesterol actually may reduce the risk of high-grade prostate cancer.

Early studies suggested that low cholesterol could increase the risk of certain types of cancer, said Demetrius Albanes, MD, a senior investigator at the National Cancer Institute (NCI). "Our study affirms that lower total cholesterol may be caused by undiagnosed cancer," said Dr. Albanes. "In terms of public health message, we found that higher levels of 'good cholesterol' (HDL) seem to be protective for all cancers, which is in line with recommendations for cardiovascular health."

The researchers observed 29,093 men from the Alpha-Tocopheral, Beta-Carotene Cancer Prevention Study cohort for 18 years, making it the largest and longest study of its kind. In that follow-up period, they noted 7,545 cancer cases. Low total cholesterol blood levels were associated with an 18 percent higher risk of cancer overall, similar to increases seen in previous studies. However, this risk disappeared when researchers excluded cases that occurred in the early years after the original blood draw.

This finding suggests that the low total cholesterol levels didn't cause cancer, but rather were the result of underlying cancer, said Dr. Albanes. Higher levels of HDL cholesterol were associated with a 14 percent decreased risk of cancer even after excluding nine years of early cases.

In an accompanying study that specifically examined risk for high-grade prostate cancer, Elizabeth Platz, ScD, MPH, associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and co-director of the Cancer Prevention and Control Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, found a link between low cholesterol and decreased risk of high-grade prostate cancer among 5,586 men older than 55 years.

Specifically, if men had total cholesterol of less than 200 mg/dL, they had a 59 percent reduced risk of high-grade prostate cancer, defined as a Gleason score of eight to 10. No association was seen for prostate cancer overall or for prostate cancer with a lower Gleason score. The study supports another benefit of keeping cholesterol low among men in this age group. "High-grade prostate cancer is less common than prostate cancer overall," said Dr. Platz, "but it is a subset of prostate cancer that is more likely to progress."

Discussion of the benefits of lower cholesterol inevitably leads to the discussion of the role of statins. Researchers left open the possibility that industry leaders may seek a new indication for these cholesterol-lowering drugs. "Until there is evidence from randomized trials, men should not take statins to prevent high-grade prostate cancer," said Eric Jacobs, PhD, strategic director of pharmacoepidemiology at the American Cancer Society (ACS). The author of an accompanying editorial in the Cancer Epidemiology, Biomarkers & Prevention issue, Dr. Jacobs said a randomized trial among men without prostate cancer would need to be very large and might not be feasible. "One possibility, however, would be a randomized trial among early-stage prostate cancer patients opting for surveillance rather than immediate treatment, to see if statins could lower risk of prostate cancer progression," he said.

The American College of Radiology (ACR) recently launched a practice leaders' Web site designed to address clinical and administrative issues facing radiology and radiation oncology practice leaders by providing the most recent literature from across the medical landscape as well as an online forum to discuss these issues with peers.

With its library of articles, the site offers insight into practice-related issues regarding clinical and administrative improvement. Until now, information on these topics has been scattered in different locations. The Practice Leaders' Web site offers a one-stop shop for answers to practice leadership-related questions, comments and concerns.

The Practice Leaders' Web site is a place to find customized support. The "about" section includes an area where visitors can provide feedback on topics and articles that they would like to see posted on the site. With the ever-evolving content provided by radiologists and their peers, this tool will continue to add value to the visitor's practice.

"The group practice leaders' site is by practice leaders, for practice leaders," says Philip Cook, MD, chair of the ACR Practice Leaders Web Subcommittee. "It is designed to encourage practice leaders to take an active and informed role in the issues affecting their practices and more effectively manage the day-to-day activities of their practices."

As part of the American Recovery and Reinvestment Act of 2009, the National Cancer Institute (NIC), part of the National Institutes of Health (NIH), recently funded seven research and research infrastructure Grand Opportunities (GO) grants.

The awards were for comparative effectiveness research (CER) in genomic and personalized medicine (GPM). These awards will support two-year efforts that will advance methods for analysis, synthesis, modeling and evaluation of the clinical validity and utility of existing and emerging GPM applications in cancer control and prevention. They will accelerate GPM development by planning CER initiatives as well as enhance clinical and population data infrastructure to support CER initiatives in GPM.

A team from Michigan State University's Breslin Cancer Center is developing a clinic for breast cancer survivors, hoping to reduce mortality and improve quality of life. A $39,591 grant from the Mid-Michigan Affiliate of Susan G. Komen for the Cure will support "Changing Tomorrow's Breast Cancer Survivors," a new multidisciplinary program.

"Some breast cancer survivors don't feel like medical providers are very involved with their care when treatment ends," says Deimante Tamkus, MD, an assistant professor in MSU's Department of Medicine. "However, various areas of life are affected by cancer. We want to help survivors identify potential problems, both physical and emotional, to improve their lives and help prevent recurrence."

The multidisciplinary MSU team will consist of a medical oncologist, oncology social worker and nurse educator. Martha Trout, a nurse at the Breslin Cancer Center, and Heather Spotts, an oncology social worker, also are co-investigators on the grant. Survivors will talk to team members, focusing on healthy lifestyles and recommendations to avoid recurrence.

A treatment summary and long-term recommendation will be given to the patient and sent to the primary care doctor. Follow-up phone consultations will be conducted to help survivors achieve healthy lifestyle goals. The grant also will support three educational seminars for breast cancer survivors focusing on sexuality after breast cancer, healthy exercise and nutrition for survivors, and on how to manage side effects caused by treatment such as lymphedema, a type of tissue swelling caused by fluid retention.

"We hope to raise awareness in the medical community of the many issues that breast cancer survivors struggle with after treatment such as fatigue, cognitive problems, depression and sexuality concerns," says Spotts. "The good news is, there are so many more cancer survivors compared to years ago; now, it is imperative that we address their physical and psycho-social needs."

Susan G. Komen for the Cure is the world's largest breast cancer organization, and the mid-Michigan affiliate is one of 125 affiliates dedicated to ending breast cancer in their communities.

To improve cancer care in underserved regions of the world, the American Society of Clinical Oncology (ASCO), in partnership with Health Volunteers Overseas (HVO), recently launched the International Cancer Corps (ICC), a new humanitarian program that will enable ASCO member oncologists to volunteer their time to teach in medical facilities in developing countries.

ASCO's partnership with HVO, another international medical education organization, will give ASCO's member oncologists an opportunity to spend one to four weeks at medical care centers in developing countries, sharing their medical expertise and building long-term, supportive relationships with physicians who provide cancer care in these countries.

Medical professionals who are trained and credentialed in oncology--including physicians, laboratory professionals and nurses--will be eligible to apply for the ICC program. While ICC volunteers won't treat patients directly, they will share their clinical knowledge and skills. Upon their return to the U.S., ASCO's member volunteers will continue to share ASCO's professional resources with the hospital to help sustain and improve cancer care in the region.

The first International Cancer Corps training program with HVO will open in Tegucigalpa, the capital of Honduras. With a population of nearly 7.3 million people, Honduras has less than 20 trained medical, radiation, and surgical oncologists. Over half of the population lives below the international poverty line, and health care for urban and rural poor Hondurans is extremely limited. More than 20 percent of the population has no access to health care at all.

Each practice setting will have its own unique challenges and needs. In Honduras, the focus will be on developing a training program for adult and pediatric oncology at three centers in Tegucigalpa. ASCO volunteers, depending on individual expertise and skills, will provide teaching and training to staff, residents and students in the following areas: pathology; cancer control; medical, surgical and radiation oncology seminars and workshops; curriculum development; and student and resident education.

Each year, ASCO and HVO plan to expand the program to an additional developing country while remaining committed to multi-year volunteer and educational support of previously established sites.