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May 21, 2009 Volume VI, No. 1

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

The CDC's National Center for Health Statistics ranks cancer as the second most common cause of death in the United States, with 559,312 deaths a year, or 22.8 percent of all deaths.
This week's Disease Management Update looks at various cancer therapies as well as laws that some states are implementing to combat smoking-related cancers.

Your colleague in the business of healthcare,
Laura Greene, Editor

This week's industry news:

Table of Contents

  1. Two Therapies Are Better Than One
  2. Low-Income Patients Skipping Hormonal Therapy
  3. Medical Home IT
  4. Tools for Web 2.0 Implementation
  5. Healthcare Trends & Studies
  6. Smokefree Workplaces
  7. Uninsured & Underinsured

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Sponsored by: CosmoCom

Could the simple telephone be the disease management breakthrough of 2009? Learn what to expect from device-free disease management via telephone. Resolve requests efficiently, enhance quality & availability, inform & activate patients, improve patient experience & loyalty. Join CosmoCom & Datamonitor for a complimentary “New Horizons in Telehealth” webinar on June 3.

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Two Targeted Therapies Better Than One Aggressive Lymphoma

When combined with a cocktail of chemotherapy drugs, two monoclonal antibodies, instead of one, appear to offer superior results in patients with diffuse large B-cell lymphoma, according to Mayo Clinic researchers working with the North Central Cancer Treatment Group (NCCTG). Researchers say that adding the targeted therapy epratuzumab to a regimen known as R-CHOP resulted in an overall 12-month survival of 88 percent in 78 patients. While they call that a very good outcome, the researchers were especially encouraged because the survival rate was 85 percent in patients with high-risk disease.

"These results are very good and very promising, and hopefully will be an important advance over treatment now being offered to patients with this cancer," says the study's lead author, Ivana Micallef, M.D., a Mayo Clinic hematologist. "But we cannot yet say that is so, since the two different regimens haven't been tested head to head. Still, we are eager to do a randomized, phase III study because when we compare our results to some other studies of R-CHOP, our findings do look better."

The NCCTG multi-institutional research network is planning a clinical trial that will randomize patients with high-risk diffuse large B-cell lymphoma to either this regimen, known as ER-CHOP, or to R-CHOP, the standard treatment. R-CHOP includes a combination of chemotherapy drugs (cyclophosphamide, doxorubicin and vincristine), the steroid drug prednisone and rituximab, a monoclonal antibody.

In addition to the results on overall survival, the researchers found an 82 percent progression-free survival (PFS) in the group. The 39 high-risk patients had a 77 percent PFS, and, for the 39 low-risk patients, PFS was 88 percent. Patients are deemed high risk if they have three or more poor prognostic factors, such as age (60 years or older), elevated LDH (a blood test), advanced disease stage, disease outside of lymph nodes and poor physical performance status.

To learn more about this research, please visit: http://www.mayoclinic.org/news2009-rst/5271.html

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Low-Income Breast Cancer Patients Skip Therapy, Increase Risks

Many low-income women are failing to take the hormonal therapy prescribed as part of their breast cancer treatment, possibly lowering their survival rates, according to a study led by a researcher in the Duke Comprehensive Cancer Center. The researchers looked at a sample of Medicaid-insured women with hormone receptor-positive breast cancer and evaluated their prescription records to see whether they'd picked up the drugs.

"Low-income women with breast cancer have a higher mortality rate than other women with cancer, and we wanted to see what might be causing this," said Gretchen Kimmick, M.D., an oncologist at Duke University Medical Center and lead investigator on the study. "What we found is that many low-income women in North Carolina who might benefit from hormonal therapy are not getting it or are not taking it as prescribed. Even though these women had continuous health insurance with low prescription co-pays, we found that only 64 percent of them were filling any prescriptions for hormonal therapy within 12 months after being diagnosed," Dr. Kimmick said.

The pills block hormone formation and action, helping to prevent the hormone receptor-positive breast cancers from growing. This treatment can keep the cancer from returning and has proven beneficial in reducing recurrence and death from breast cancer, Kimmick said. The findings point out that these low-income women are not consistently getting and using hormonal therapy. Therefore, they are actually receiving less than standard care.

"From this study, there is no way to know why the women were not taking medication as prescribed," Kimmick said. "From previous studies, reasons have included side effects, such as hot flashes, aches and pains, cost of the medication, and lack of understanding about how important it is," she said.

"Our study also shows, that in the year following the initial prescription fill, 40 percent of the women were not regularly taking their hormonal therapy," Dr. Kimmick said. "Of the women actually taking the pills, 20 percent stopped taking the prescription before the end of the first year. This is alarming since women are even more likely to discontinue use over subsequent years."

To learn more about this research, please visit:

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Enhancing Care & Communication Through Health IT

Health IT is can improve a medical home's communication and prevention strategies, says Ewa Matuszewski, CEO of Medical Network One. In this podcast, Matuszewski also comments on how health IT supports the joint principles of the PCMH and describes how her health IT tool of choice can be a stepping stone to further implement IT within a medical home.

To listen to this complimentary HIN podcast, please visit: http://www.hin.com/podcasts/podcast.htm#87

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Tools for Web 2.0 Implementation

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is John Sharp, Cleveland Clinic project manager for IT Web services.

Question: For healthcare companies just starting to create a more dynamic Web site, what are the top three tools that should be implemented first to attract more people to the site?

Response: Podcasting and video are number one because the technology’s readily available to do it. It’s certainly popular on the Web and makes a lot of sense — whether you post them on YouTube or on your Web site, it’s a place to start. Blogging could be appropriate; you just have to find a place to start. It could be just one blog, or it could be kind of a “day in the life” viewpoint — for instance, for nurse recruitment or for someone dealing with a chronic disease. Have a featured patient write a blog that would receive assistance from marketing for that particular medical clinic in producing their blog. It’s their story, but it’s sponsored by the healthcare organization. The third one would be social networking, which might be more effective in a partnership with some existing social networks. We haven’t launched into that area, other than physicians’ social networks, but for patient sites it might be a useful tool in giving a viewpoint of, “This is what it’s really like to live with this illness, and this is how we as an organization can help you cope with this illness,” through the interaction and a moderated social network. That’s a lot of if, ands or buts, but we’re all adding our caution to it while at the same time being excited about the technology.

For more details on Web 2.0 implementation, please visit: http://store.hin.com/product.asp?itemid=3818

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Medication Adherence Intervention

The story is in the statistics: 65 percent of all prescriptions show non-compliance; 33 percent of all prescriptions are not even filled; medication-related hospital admissions cost $100 billion every year. Yet, studies show that education interventions can be effective in improving adherence. Learn how medication adherence interventions can improve outcomes while lowering costs.

To download this complimentary white paper, please visit:

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Nation Halfway to Smoke-Free Workplace Laws

Wisconsin is now the 25th state in the nation — and the second in 2009 — to pass a comprehensive smoke-free workplace law protecting virtually everyone from secondhand smoke in public places and workplaces. According to the U.S. Surgeon General, nearly 50,000 Americans die each year from secondhand smoke exposure. It is also the cause of a host of other diseases and ailments, including lung cancer and heart disease.

“Wisconsin is a critical turning point in our fight to make our nation smoke-free,” said Charles D. Connor, president and CEO of the American Lung Association. “Thanks to the leadership shown by Governor [Jim] Doyle, we are now halfway to our goal of all 50 states going smoke-free. Let this serve as an example to other states where workers are still not protected from deadly secondhand smoke. Smokefree air laws protect public health and combat the economic chokehold tobacco-caused illnesses have on states’ shrinking budgets.”

In its January State of Tobacco Control report, the American Lung Association reported that smoking-related illnesses cost the state of Wisconsin over $3.6 billion annually and kill more than 7,000 residents each year. Smoke-free air laws are a vital component to addressing the burden of tobacco-caused illness. Elected officials in states like Michigan, North Carolina and Texas are also considering smoke-free air laws. The American Lung Association urges these lawmakers to act quickly and decisively on behalf of the health of their constituents.

To learn more about this research, please visit:

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Uninsured & Underinsured

Please share the impact of the uninsured and underinsured on your organization by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit: http://www.surveymonkey.com/s.aspx...

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