If you're an oncologist, hematologist, or some other type of healthcare professional treating cancer, these tools are essential to keep and reference on a daily basis.
Modern oncologists have a vast array of tools and information at their disposal that can help them deliver better care to their patients, run their practices more efficiently, and stay up to date with the latest research. In fact, there are so many tools available that it can be next to impossible to sort through them all and determine which ones are truly the most useful. We consulted several OncNG editorial board members to determine which tools and resources they rely on and compiled this list of the top tools every oncologist should at least be familiar with, if not use in his or her everyday practice.
Adjuvant! Online is designed “to help healthcare professionals make estimates of the risk of negative outcome (cancer-related mortality or relapse) without systemic adjuvant therapy, estimates of the reduction of these risks aff orded by therapy, and estimates of the risks of side eff ects of the therapy.” The cancer-specific Adjuvant! bases these estimates on information entered by the physician regarding individual patients and their tumors and displays the estimates in graphical and text formats that can be printed out for use during consultations with patients. Information is drawn from the SEER database (explained by Dr. Fogel below), clinical trial overviews, individual clinical trial results, and the literature in general. Healthcare professionals, before printing out the estimates, can modify the program’s output however they see fit.
Three versions of Adjuvant! are currently available for breast cancer: for use in decision making for patients with early breast cancer at initial diagnosis and staging; as a decision aid for patients with nodenegative ER-positive early breast cancer; and for making decisions for ER- and/or PgR-positive postmenopausal patients. The Adjuvant! version for colon cancer “allows the user to perform analyses that provide projections of the net benefit of adjuvant therapy for colon cancer.” The Adjuvant! version for lung cancer is “primarily for weighing the options for systemic adjuvant therapy for patients who have undergone definitive surgery and pathological staging leaving them apparently disease free.” Healthcare professionals can also obtain the Adjuvant! software for Pocket PC and Palm OS handhelds. When new cancer versions of Adjuvant! become available, users can log in to the site as usual and open them under the Adjuvant! menu.
2. Caring4Cancer Practice Management
Actually a collection of tools rather than one individual tool, the frequently updated Practice Management Resource Center from Caring4Cancer offers registered users (registration is free) “all the information you need to manage, bill, and code correctly.” Tools located here include the Oncology Office On-Line Job Exchange for finding billers, coders, managers, and administrators; the Medical Oncology Survival Kit, containing forms comparing ASP quarters 1-4 2006 with 2004, chemotherapy audit information, a chemotherapy flow sheet, demonstration sheets, and advice on how to survive CMS rule changes; a Medical Oncology Medicare Regulatory Library that features information and advice on complying with Medicare regulations; the Five-Minute Practice Manager that offers tips on managing an oncology office, with monthly updates; presentations that can help your practice maximize coding and billing effi ciency; Handy Dandy Forms for Your Practice, a collection of more than 70 forms “to make your life easier,” including those for patient signatures, notice of privacy, and E&M documentation; and an event calendar.
The newest, and perhaps most useful tool provided by Caring4Cancer, is the Practice Business Intelligence System (PBIS), a Web-based tool offered free for the first year that works with any practice management software “to provide management summaries, daily collection aids, and trend analysis singularly focused on increasing your claim revenue.” Users can isolate and possibly eliminate denial trends with the system’s analysis tools, work denials more quickly and effectively with collection tools, and instantly recall any EOB from any remittance processed by PBIS. Download the brochure here to receive more information and to sign up for the introductory offer.
3. C-Tools 2.0
This free “timesaving PDA tool” for both Pocket PC and Palm OS handheld users was designed to “provide you with instant access to the most recent cancer information.” The software package consists of 12 applications, developed to help physicians and their support staff “prevent, diagnose and treat cancer.” The Cancer Screening Tool offers disease-specific reviews and information—covering cancers of the breast, cervix, colon and rectum, endometrium, and prostate, along with cancer-related checkups— designed to aid physicians in identifying and selecting patients for cancer screening and help them determine when and how those patients should be screened. Directories of contact information, Web resources, and other information for helping patients to quit using tobacco substances make up the content of the Tobacco Cessation tool, designed for guiding physicians in helping patients quit smoking. The software’s Drug Calculator will compute dosage equivalents for any two drugs included in the C-Tools database. A Pain Medication Database houses lists of “oral and parenteral equi-analgesic doses, as compared with a standard dose of 10mg or parenteral morphine.” Common indicators of skin cancer, with detailed photos of each type, are included in the Skin Cancer Tool. The Pain/Symptom Management application features lists of “pain definitions, types of pain, categories of pain, scope of the problems, effects of untreated pain, assessing pain, treating pain and specific pain sites, resources, and JCAHO Standards.” The Emerging Technology Tool keeps oncologists and their patients informed on the latest screening techniques. Symptoms and warning signs of cancer in young patients are covered in the Warning Signs of Childhood Cancer tool. A BMI calculator, the Communicating with Patients about Bad News tool, the Questions Patients Ask tool, and a Prostate-Specific Antigen Information application round out the contents of C-Tools 2.0.
4. Internet Interview Questions
Although not a tool in the traditional sense of the word, the questions listed below— from an article appearing in Topics in Advanced Practice Nursing eJournal— are useful for physicians who want to discuss with their patients’ use of the Internet to learn more about cancer and treatments. Th e-questions include:
Read the full article, “Internet Use and Advanced Practice Oncology Nursing,” here.
5. NCCN Clinical Practice Guidelines in Oncology
Covering more than 97% of all cancers, the continually updated NCCN Clinical Practice Guidelines in Oncology are “the recognized standard for clinical policy in the oncology community.” Developed without industry support, the guidelines “are based upon evaluation of scientific data integrated with expert judgment by multidisciplinary panels of expert physicians from NCCN Member Institutions.” Specific treatment recommendations are displayed mostly through algorithms that guide the oncologist from step to step. Along with coverage of many cancer types, the guidelines also address cancer detection, risk assessment and reduction, and supportive care. Guidelines for Treatment of Cancer by Site cover everything from acute myeloid leukemia to uterine sarcoma, including central nervous system cancers, head and neck cancers, hepatobiliary cancers, and neuroendocrine tumors. Guidelines for Detection, Prevention, & Risk Reduction of Cancer cover breast cancer risk reduction, cervical cancer screening, prostate cancer early detection, breast cancer screening and diagnosis, colorectal cancer screening, and genetic/ familial high-risk assessment of breast and ovarian cancers. Among the 11 Guidelines for Supportive Care are those focused on adult cancer pain, fever and neutropenia, and venous thromboembolic disease. The complete library of guidelines is available online or by requesting a free copy on CD-ROM. Also available from the NCCN are the NCCN Guidelines With 2006 CMS Oncology Demonstration Codes.
This free, comprehensive search tool “provides fast access to a database of evidence-based clinical literature selected and reviewed by physicians on [NexCura’s] medical Editorial Boards, who are recognized experts and leaders in their respective specialties.” Searches for studies relevant to an individual patient’s clinical presentation are narrowed to those that only define the current standard of care. Using NexCura’s Virtual Case Model (VCM), oncologists can search for relevant published literature by describing search parameters based on clinical presentations, such as age, performance status, stage, and test results. To ensure that search results include scientifically correct literature that is relevant to the VCM, results can be generated based on each study’s inclusion criteria. Users can also change parameters to produce “what if” scenarios and view single-treatment studies separately from head-to-head treatment comparison studies. Further, as a way of supporting recommendations given to a patient, oncologists can provide patients with full citation information along with literature summaries.
From the Food and Drug Administration’s Center for Drug Evaluation and Research comes this collection of tools that provide common toxicity criteria and assist users in determining patient performance status ratings and disease stage and performing calculations for drug dose and fl uid and caloric requirements. Use the Common Toxicity Criteria tools to look up standard grades for adverse events in summary format, including versions one, two, and three of the National Cancer Institute Common Toxicity Criteria, the NCI Common Terminology Criteria for Adverse Events, Southwestern Oncology Group Toxicity Criteria, Radiation Therapy Oncology Group Radiation Morbidity Criteria, and World Health Organization Toxicity Criteria, each offering information for an extensive number of adverse events. Enter a Karnofsky score, Eastern Cooperative Oncology Group or Zubrd score, or Lansky score for children using the site’s Performance Status rating scales to determine a corresponding performance status. Use the Disease Staging Manual to obtain in-depth, standardized descriptions for staging anything from acute lymphoblastic leukemia to Wilm’s tumor and more than 30 other cancer types. Perhaps the most useful tools located here are the calculators; the dose calculator converts doses in mg/kg or mg/m2 to total doses, and also converts doses from several species, such as those used in preclinical trials, to equivalent human doses. The Human Fluid and Caloric Requirements calculator, using either an active or sedentary patient’s height and weight or weight alone, determines fluid and calorie requirements, as well as calculates body mass index and estimated body surface area.
Providing “oncologist-approved cancer information from the American Society of Clinical Oncology,” the People Living With Cancer (PLWC) site serves as a tool for supplementing the information you provide your patients, as many of the resources provided here are available in “printer-friendly” versions to serve as patient handouts. PLWC provides in-depth information on the basics of cancer, well over 100 cancer types, diagnosis and treatment, coping, and survivorship. Oncologists can also direct patients to the PLWC library, containing weekly articles on such topics as specimen processing, a medical illustrations gallery, medical dictionary, drug information resources, financial resources, support, and information on advocacy and legislation. The latest oncology-specific news, answers to frequently asked questions, and information on managing side effects round out the site’s tools. PLWC is also available en español for your Spanish-speaking patients.
9. The Surveillance Epidemiology and End Results (SEER) Website
By OncNG Editorial Board member Joshua Fogel, PhD, Assistant Professor of Behavioral Sciences, Department of Economics, Brooklyn College, Brooklyn, NY
Oncologists are faced with numerous tasks to accomplish while treating their patients. Sometimes, questions are asked by patients or their caregivers that involve research and answers that may not be readily available from a journal or reference text in one’s office. Many of the more tech-savvy oncologists have gravitated toward using the Internet as a source for information, because it allows one to rapidly research a question online. Here, I provide an overview of a tool from the National Cancer Institute that is available for free online. It can be useful for helping oncologists address such questions as “Doctor, what are the survival rates for this particular cancer?”
The Surveillance Epidemiology and End Results (SEER) website from the National Cancer Institute offers a number of ways to obtain survival information for a number of cancers and is based upon extensive data collected from many regions over many years. The specifi c dates for which the data are provided are dependent upon the search option chosen.
The SEER website provides a weblink offering suggestions about the different available resources. Below are examples of four approaches for obtaining cancer survival data information. Each is relatively simple to perform and does not involve any specialized computer program knowledge or biostatistical expertise. The example and approaches used will refer to a 50-year-old woman of white race/ethnicity who is informed that she has stage I breast cancer.
The simplest approach is to choose one of the relevant “Cancer Stat Fact Sheets” shown on the left side of the SEER homepage. Based upon the above example, choose “breast” and click “go” to view a page with information on five-year relative survival rates, including separate information for white and black race/ethnicities and also information by stage type. However, it will not provide information for combinations of race/ethnicity and stage, nor will it provide age-specific information.
The other approach shown on the left side of the webpage is “FastStats” information on many cancers. Choose “breast,” click “go,” and, on the new page, choose the tab titled, “Survival & Stage.” If “by race category” is chosen for one of the relevant age categories, a graph with information on 10-year relative survival rates is provided. Choose “by stage at diagnosis” to see a graph with information on 10-year relative survival rates for race/ethnicity. However, this FastStats approach does not provide information on the combination of age category, race/ethnicity, and cancer stage.
The “Cancer Statistics Review” search option uses three drop-down menus: for statistic type, choose “survival;” for cancer site, choose “breast;” and for race/ethnicity, choose “white.” Click “search” to see results compiled from the pages in the Cancer Statistics Review that are relevant to this search. Check all four relevant items, and click on “merge” to allow for a custom-made PDF file for the information compiled from this larger manual on this topic. This will include information on survival rate by sex, by race/ ethnicity, and also information on combinations by age group of <50 versus 50+ years, race/ ethnicity, and cancer stage.
To tailor information by approximate or exact age range, race/ethnicity, and cancer stage for a particular patient, the “CanQues Cancer Query Systems (CanQues)” is the best approach. It is found at www.seer.cancer.gov/canques, where clicking on “SEER Survival Statistics” opens www.seer.cancer.gov/canques/survival.html. On the first page, leave the defaults of “relative survival rates” for database and “vertical bar chart” for report type. Th en click “next” and choose what to select. For example, click “site” in the upper “selections” section and then click “breast” in the lower “values” section. It is important to remember to unselect “all sites” by clicking on that option. Then click “update” and notice that it will show site=breast in the upper “selections” section. One would similarly choose, select, and update the appropriate parameters for race, sex, age at diagnosis, and stage at diagnosis. Then click “next” to see a summary of the chosen specifications. At this point, it is important to either disable or turn off any pop-up blocker. Then click “execute,” and a chart will display all the relevant information.
As with any tool, some limitations exist. With all the approaches reviewed above, one cannot plug in the exact age of the patient, and with some of the approaches, the closest is a 10-year age range. Also, not every ethnicity has ethnic-specific data. Typically, there are only extensive results for blacks and whites. Once the brief steps for performing any of the above search approaches is mastered, users can utilize the Internet to provide tailored survival estimates to patients with only minimal effort.