Head and neck cancer care at a community-based teaching hospital.

BACKGROUND: The purpose of this analysis was to demonstrate that the National Cancer Institute (NCI) Community Clinical Oncology Program (CCOP) will result in accruals to national research protocols for patients with malignancies in a community-based teaching hospital. METHODS: We retrospectively reviewed the records of oncology patients eligible for clinical trials referred to the Helen F. Graham Cancer Center (HFGCC). RESULTS: The average number of patients who actually enroll in clinical trials nationally is 2.5%. The number of patients who enrolled in clinical trials at the HFGCC CCOP in 2003 was 24%. CONCLUSIONS: The integration of a CCOP in a community-based teaching hospital will enhance adoption of state-of-the-art care and increase accruals to national research protocols.

SES discrepancies and Delaware cancer death rates.

Cancer can be monitored fairly effectively by using cancer registry data for site, stage, age, sex, and race. Adding to this the patient's years of education, now only found on death certificates, should not be difficult since it is an easily measured major SES factor. Most comorbidities should also be easy to obtain since hospitals usually code them. Capturing all treatment and response data remains a challenge as more and more cancer diagnosis and management is done in outpatient settings. Current efforts to establish electronic medical records in compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be a blessing if adequate software can be standardized and used similar to that already present in the VA hospital in Delaware. Such information would aid efforts to reduce Delaware's high cancer incidence and mortality rates. A proposed state cancer plan should stimulate improved integration of the state's health resources to focus on the quality of individual health care and to use cost-effective measures to improve the public's health. A plan should (1) stimulate a public awareness to reduce risk factors for all major chronic diseases with a special focus on cancer deaths; (2) use medical office settings to provide simple screens to improve the early detection of a number of chronic diseases depending on such risks as age and sex (such studies might include weight, height, blood pressure, sugar, cholesterol, PSAs, exams of skin, oral cavities, breasts, abdomen, rectum, and vagina with pap smears, all of which can be accomplished in a cost-effective fashion); and (3) offer equitable access to a state's health care system for information, screening, and treatment. Current evidence shows that it is less expensive to manage patients with early cancers than those with advanced cases, which often occur because of ignorance and lack of access to health services, and by socioeconomic, educational, and cultural barriers. Implementing the recommendations in the Governor's Advisory Council's report should go a long way toward reducing both Delaware's cancer incidence and death rates. An increase in taxes on tobacco (one of the Council's recommendations) could provide resources to explore relationships between the environment, occupation, and cancer, and provide early access to competent cancer care for those at risk because of limited education, income, and health insurance.