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In a unique partnership, the Stanford University School of Medicine and the Palo Alto Medical Foundation will collaborate on a research project that aims to improve outcomes for breast cancer patients.

The project is the brainchild of Richard Levy, PhD, a longtime community philanthropist and business leader, who said he saw an opportunity for the two medical centers to share expertise on a subject that is of great interest to him - improving cancer survival. He and his wife, Susan, will provide a gift of $2.1 million for the three-year study, which will focus on both the medical and psychosocial factors that contribute to cancer treatment and survival.

“From the point of view of patients, what makes for good health is good technology and good environmental factors, such as the doctor/patient relationship, nutrition, exercise and lifestyle factors,” said Levy, a resident of Portola Valley, Calif. “Patients need both. Here we have two world-class institutions in both areas. It’s a natural partnership.”

Although scientists at the two medical centers have worked together over the years on many projects, this is the first time the two institutions have officially partnered with the intent of building a long-term collaborative relationship in research.

Levy is the former president and CEO of Varian Medical Systems in Palo Alto, where he has spent the last 40 years. He has longstanding ties to both Stanford and PAMF. He has served on the board of PAMF for the past 10 years and its parent, Sutter Health, for the last three. A nuclear chemist by training, he and his colleagues at Varian worked closely over the years with Stanford scientists in the Department of Radiation Oncology to pioneer linear accelerators for cancer treatment. Levy retired as CEO in 2006 but remains the company’s chairman of the board. He is also active in initiatives involving philanthropy and health-care reform.

Levy said he hopes the study will not only lead to improvements in cancer care but also point to ways of reducing medical-care costs nationally.

“If Palo Alto and Stanford can find a way to provide better care at lower cost, that will set an example for other communities,” he said.

In the study, physicians and scientists at both organizations will follow the journey of hundreds of patients throughout the course of their treatment with an eye to understanding the role of cancer biology and different patterns of care in outcomes and quality. The researchers will document every aspect of the patients’ treatment, including all tests, drug infusions, surgeries and radiation treatments, as well as nonmedical support they receive, such as yoga, alternative therapies or group therapy.

“By harmonizing data from the two institutions, we will have a deep data source that will enrich the understanding of the clinical course and outcome of the disease,” said Ralph Horwitz, MD, professor and chair of the Department of Medicine at Stanford. “We can look comprehensively at the biological, clinical, social and environmental factors that influence outcomes.”

The researchers chose to study breast cancer because it is a common disease in which there are basic protocols, though there are many variations in how patients and their doctors choose to pursue them, said Hal Luft, PhD, executive director of the Research Institute at the Palo Alto Medical Foundation. For instance, women may choose breast-conserving surgery or full mastectomy, he noted, or they may opt for different chemotherapy plans with different toxicities and frequencies.

“So there is a decision-making process for women - how do they choose among these options?” Luft said. “We will try to capture this information and analyze how women’s preferences and best clinical practices can be combined with other factors to achieve optimal treatment.”

The researchers also will aim to capture information on the women’s experiences - their anxieties, concerns and satisfaction with the process - through interviews and patient journals.

“There is a kind of road map that physicians and patients follow. But they may deviate from that road,” said Amar Das, MD, PhD, principal investigator at Stanford and assistant professor of medicine and of psychiatry and behavioral sciences. “The question is by how much? And does it matter? Are patients more satisfied going down one path over another, and what impact does that have on survival?”

All the data from the study will be collected in a new secure electronic database known as OncoShare, in which patients and their treating doctors will remain anonymous. The researchers said OncoShare will be the first large-scale research database to incorporate comprehensive information on breast cancer characteristics, practice variation and treatment effectiveness that can help answer pressing questions on how biomarkers, cancer genetics, patient choices and patterns of care all interact and relate to outcomes. Patients will have to provide consent to be included in the study.

While the focus of the study is on breast cancer, Levy said ultimately he would like to see the approach applied in other diseases as well, such as heart disease, diabetes and other types of cancer.

“There are plenty of other common diseases where the quality of health is related to both technology and lifestyle,” he said.

The Stanford University School of Medicine consistently ranks among the nation’s top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Source
The Palo Alto Medical Foundation for Health Care

TORONTO, June 5 — A frameless stereotactic needle biopsy of brain tissue is as safe in regions of the brain that involve language and other functions as it is in less vital areas, researchers said.

In a retrospective analysis of 284 consecutive cases where the technique was used, the overall rate of neurological adverse events was 6.7%, according to Christopher McPherson, M.D., of the University of Cincinnati, and colleagues.

When so-called “eloquent” regions were biopsied, the complication rate was 5.6%, compared with 8.1% for non-eloquent areas, Dr. McPherson and colleagues said in the May issue of the Journal of Neurosurgery.

Since the difference was not statistically significant, the researchers said, “our study demonstrates the safety and efficacy of frameless stereotactic biopsy of lesions in eloquent brain regions.”

• Explain to interested patients that this study found that a widely used method of sampling brain tissue for diagnostic purposes is safe regardless of where in the brain it takes place.

“Needle biopsies in eloquent areas have generally been acknowledged to be safe, because the needle causes only a small amount of disruption to the brain,” Dr. McPherson said in a statement. “But until now,” he said, “researchers had not actually documented that biopsies in eloquent areas were as safe as those in non-eloquent areas.”

The frameless method, in which scanning equipment and high-speed computers keep track of the position of the head and brain using a set of marks on the patient’s skin, is an alternative to the use of a rigid head frame.

The first neurological procedures using the technique were performed in the 1980s.

In this study, “eloquent” areas included the brainstem, basal ganglia, corpus callosum, motor cortex, thalamus, and visual cortex, the researcher said. Complications were defined as any worsening of existing neurological deficits, seizures, brain hemorrhage, and death.

Of the 19 patients with complications, Dr. McPherson and colleagues found the following:

• Three developed hematomas that required operative evacuation, and in one of those, malignant edema of the tumor developed and the lesion was resected within 24 hours of biopsy.
• Eleven patients significantly improved or returned to baseline status, while two others improved minimally.
• The remaining six had neurological decline and their families decided against additional treatment. Those cases accounted for the 30-day mortality rate of 2%. Only two of the six patients had a hemorrhage associated with the biopsy.

A higher number of needle passes was associated with a greater risk of hemorrhage in eloquent areas, and not elsewhere, but there was no significant effect on the risk of a change in neurological status, the researchers found.

Limitations of the study included its retrospective design, use of operative records and imaging to determine location of the lesion, and use of lesion location rather than the trajectory of the biopsy for determining the region involved.

“Diagnosing and treating brain tumors always carries risk,” Dr. McPherson said. “Within that context, the results of this large sampling of biopsies are encouraging overall and reinforce our belief that stereotactic biopsy is a valuable diagnostic tool.”

The study had support from the University of Cincinnati Neuroscience Institute. The researchers said they had no disclosures.

Primary source: Journal of Neurosurgery

Source reference:

Air EL et al. “Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases” J Neurosurg 2009; DOI: 10.3171/2009.3.JNS081695.

Cervical Cancer Awareness Week 8-14 June 2009 is a key time to remind women that it is of huge importance that they attend their screening appointment when asked. The Improvement Foundation (IF) aim to help tackle the decline in screening uptake by addressing levels of complacency among clinicians and the public through their national Cervical Screening Improvement Programme.

With the uptake of cervical screening dropping across all age groups, the biggest fall being in the 25-34s, IF is working with frontline staff, at sites across the country, to support improvements in the cervical screening service in general practice and primary care trusts and achieve large scale change.

This is done by improving the systems and processes already in place, addressing the barriers to screening and raising awareness amongst staff and patients. IF believes that it is necessary to tackle all these aspects to achieve lasting change, and to address some of the reasons why younger women in particular are not responding to the offer of tests.

The work being carried out by IF is part of a fifteen month structured programme, commissioned by the Department of Health, to introduce lasting changes which will improve women’s experience of the way cervical screening is offered.

The IF Cervical Screening Improvement Programme brings together people involved across the cervical screening pathway from GPs to reception staff, and practice managers to public health specialists. For some, this is the first time the team has come together, allowing them to share and understand the barriers faced by their local communities and identify effective local resources to raise knowledge and awareness of the importance of cervical screening with the target age group.

Cervical screening saves lives, the lives of young women, many of them mothers of young children. IF is committed to making a difference in the numbers of 25-34 year olds who are screened.

For more information about the Cervical Screening Improvement Programme please visit http://www.improvementfoundation.org/cervicalscreening

Source
The Improvement Foundation