Disease Management Update
Volume V, No. 43
March 12, 2009

Dear Healthcare Intelligence Network Client,

They say everything should be done in moderation — and alcohol consumption is no exception. This week's Disease Management Update exemplifies this saying, examining how the choice and quantity of wine affects risk levels for two types of cancer.

As always, we hope you find the news articles and interviews in the Disease Management Update useful to you and your organization. In this issue, we're asking for your feedback on this newsletter so we can tailor future issues to better meet your information needs.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Drinking Wine May Reduce Risk of Esophageal Cancer
  2. Disease Management Q&A: Self-Management of Pain
  3. HealthSounds: Pain Management Part II — The Doctor-Patient Bond
  4. No Difference Between Red and White Wine for Breast-Cancer Risk
  5. Survey of the Month: Medical Homes in 2009
  6. DM: Definition, Benchmarks, Metrics

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1. Drinking Wine May Reduce Risk of Esophageal Cancer

Drinking one glass of wine a day may lower the risk of Barrett's Esophagus by 56 percent, according to a new study by the Kaiser Permanente Division of Research. Barrett's Esophagus is a precursor to esophageal cancer, the nation's fastest growing cancer with an incidence rate that's jumped 500 percent in the last 30 years.

Barrett's Esophagus affects 5 percent of the population and occurs when heartburn or acid reflux permanently damages the esophageal lining. People with Barrett's Esophagus have a 30- to 40-fold higher risk of developing esophageal adenocarcinoma (a type of esophageal cancer) because the Barrett's Esophagus cells can grow into cancer cells.

This study, the first and largest population-based study to examine the connection between alcohol consumption and risk, looked at 953 men and women in Northern California between 2002 and 2005 and found that people who drank one or more glasses of red or white wine a day had less than half the risk (or 56 percent reduced risk) of Barrett's Esophagus. There was no reduction of Barrett's Esophagus risk among people who drank beer or liquor.

"The rate of esophageal adenocarcinoma in this country is skyrocketing, yet very little is known about its precursor, Barrett's Esophagus. We are trying to figure out how to prevent changes that may lead to esophageal cancer," said Douglas A. Corley, M.D., a Kaiser Permanente gastroenterologist and the study's principal investigator.

Researchers are not certain why wine reduces the risk of Barrett's Esophagus and esophageal cancer. One theory is that the wine's antioxidants neutralize the oxidative damage caused by gastroesophageal reflux disease, a risk factor for Barrett's Esophagus. Another theory is that wine drinkers typically consume food with their wine as opposed to drinking straight liquor without food, thereby reducing the potentially damaging effect of alcohol on esophageal tissue.

To learn more about this research, please visit:

Disease Management Update Readership Survey

Please take a few minutes by April 1 to complete this short survey and be eligible to win a free copy of our newest disease management resource, Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs, a $117 value. To participate in this survey, please visit:


2. Disease Management Q&A: Self-Management of Pain

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Danielle Butin, former manager of health information and wellness at Oxford Health Plan.

Question: What kinds of programs and resources do you have available for patients dealing with chronic pain?

Response: (Danielle Butin) We have a chronic pain management program. There is so much information out there on pain management, from the use of analgesics to anesthesiology practices to pain reduction, but it is very hard for older adults to access and find courses that are specifically and solely geared towards self-management. Literally, how do you breathe? How do you reframe? I have yet to see studies that report on more than just reframing and improved health and perception and associated cost savings. We have developed a multi-week course in pain management taught by a complementary care practitioner with a background in the Alexander technique and other pain management techniques. She is a highly gifted lecturer who has written a book on living with chronic pain. Members attending this course learn how to get in and out of their beds and chairs, how to breathe and how to walk. They are given relaxation tapes and visual imagery tapes to listen to every night.

For more details on relieving the costs and consequences of chronic pain, please visit:

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3. HealthSounds Podcast: Pain Management Part II — The Doctor-Patient Bond

According to Dr. Agostino Villani, when it comes to pain management, the doctor-patient relationship far outweighs the pain treatment itself. Dr. Villani notes that while there is no consistency in treatment outcomes, patients that experience quality doctor-patient relationships are much more successful in their pain management outcomes than those who do not. In part 2 of this interview with Dr. Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of "Pain is Not a Disease," he further discusses the importance of the physician-patient relationship, measuring the outcomes of pain management and med school curricula surrounding the topic of pain management.

To listen to this complimentary HIN podcast, please visit:

4. No Difference Between Red and White Wine for Breast-Cancer Risk

Both red and white wine are equal offenders when it comes to increasing breast-cancer risk, according to a study led by researchers at Fred Hutchinson Cancer Research Center. Researchers found that women who consumed 14 or more drinks per week, regardless of the type (wine, liquor or beer), faced a 24 percent increase in breast cancer compared with non-drinkers.

For the study, the researchers interviewed 6,327 women with breast cancer and 7,558 age-matched controls about their frequency of alcohol consumption (red wine, white wine, liquor and beer) and other breast-cancer risk factors, such as age at first pregnancy, family history of breast cancer and postmenopausal hormone use. The study participants, ages 20 to 69, were from Wisconsin, Massachusetts and New Hampshire. The frequency of alcohol consumption was similar in both groups, and equal proportions of women in both groups reported consuming red and white wine.

“We were interested in teasing out red wine’s effects on breast-cancer risk. There is reason to suspect that red wine might have beneficial effects based on previous studies of heart disease and prostate cancer,” said lead author Polly Newcomb, Ph.D., M.P.H., head of the cancer prevention program in the public health sciences division at the Hutchinson Center. “The general evidence is that alcohol consumption overall increases breast-cancer risk, but the other studies made us wonder whether red wine might in fact have some positive value.”

But Newcomb and colleagues found no compelling reason to choose Chianti over Chardonnay.

“We found no difference between red or white wine in relation to breast-cancer risk. Neither appears to have any benefits,” Newcomb said. “If a woman drinks, she should do so in moderation — no more than one drink a day. And if a woman chooses red wine, she should do so because she likes the taste, not because she thinks it may reduce her risk of breast cancer,” she said.

To learn more about this research, please visit:

5. Survey of the Month: Medical Homes in 2009

In less than five years, the patient-centered medical home (PCMH) model has quickly grown from a pediatrics-based concept to a care approach embraced by thousands of healthcare organizations hoping to improve care and costs for the chronically ill. Complete HIN's third annual survey on the PCMH's role in your organization and get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. DM: Definition, Benchmarks, Metrics

Although DM is becoming a staple of many health plans, measuring actual dollar savings is still a goal not yet achieved, according to DM industry experts who spoke at an audio conference sponsored by the Managed Care Information Center (MCIC).

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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