Search

157 Background: Many patients receiving treatment for cancer experience high levels of morbidity and reduction in quality of life. Proactive specialty cancer care management programs can be offered to patients experiencing these challenges. These patients are most often self-identified, referred by a physician, or identified by claims from a commercial or government insurer or vendor. While earlier intervention of case management or palliative care services has been shown to improve outcomes for cancer patients, a variety of logistic challenges frequently interfere with early referral. Methods: All oncology patients obtaining regimen-based chemotherapy prior authorizations were referred for specialty cancer care management via the prior authorization process. Additionally, all oncology patients in active treatment or with active disease whose benefits included care management were eligible through standard referral mechanisms. Patient satisfaction scores were measured every 3 months for all patients enrolled in the program. The medical cost savings value of referral to the specialty cancer care management program was evaluated by comparing patients referred to the program within 30 days of diagnosis (very early referrals) against patients found between 30 and 120 days from the time of diagnosis. Results: Compared with patients referred through standard methods, patients referred to the specialty cancer care management team at the time of chemotherapy authorization resulted in a high percentage of very early referrals. Patients enrolled in specialty cancer case management within 30 days of diagnosis saved an average of $16,000 per surviving participant, or 30% more than patients referred between 30 and 120 days from diagnosis. Overall, patients engaged in specialty cancer case management are highly satisfied. Overall satisfaction with the nurse/case manager was 98%. Conclusions: Early referral of high risk oncology patients to patient-centered care management programs improves the overall patient experience while simultaneously reducing health care costs, and should be strongly considered for all oncology patients with high morbidity or mortality risk.

Previous work has shown that (BALB/c x A)F, (CAF 1 ) mice with an immunological disorder, the graft-versus-host reaction (GVHR), express an oncogenic murine leukemia virus (MuLV) which appears to be responsible for the subsequent development of lymphoreticular tumors. A mink cell focus-inducing (MCF) virus has been isolated from a reticulum cell neoplasm induced in a BALB/c mouse by serially passaged B-tropic MuLV originating in a CAF, GVHR mouse. The cloned MCF virus has a dual host range. It grows both in mouse cells where it is XC negative, B tropic, and in mink lung cells where it induces characteristic foci. It is partially neutralized by xenotropic MuLV antiserum and it partially competes in a homologous ecotropic gp70 radioimmunocompetition assay. Both ecotropic and xenotropic MuLV interfere with its infectivity. In these biological properties, the GVHR MCF virus closely resembles recombinant AKR MCF virus. We discuss the possible origin and significance of a presumptive recombinant MuLV in a low virus model where lymphoreticular tumors are triggered by an immunological disturbance.

When a mammalian organism is immunized with an antigenic determinant, a highly complex humoral immune response is induced. This consists of a large number of antibodies complementary to the antigenic determinant. Such antibodies may vary in class and subclass. Furthermore, within a single subclass, there are differences in the energy of interaction with which each antibody of the population binds the antigenic determinant. These interactions may be viewed at a single point in time, although the antibodies expressed at any one time in the immune response may be only a fraction of the number that the animal is capable of producing. Certainly, in viewing these antibodies over a period of time, there are shifts in the populations produced after the initial immunization.

To the Editor.— We were very interested in the article 1 and accompanying editorial 2 concerning herbicide exposure and cancer risk that appeared in the Sept 5 issue of JAMA . It has been our informal experience that the incidence of lymphoma in our rural, agriculturally based community has been higher than expected. Our catchment population of approximately 60 000 people includes Greene and Columbia counties in upstate New York. Study.— Based on the article by Hoar et al, we retrieved all cases of non-Hodgkin's lymphoma and sarcomas from our hospital-based tumor registry for the period 1975 through 1985. The group of sarcomas was too small to be meaningful. The non-Hodgkin's lymphomas (excluding chronic lymphatic leukemia) numbered 92. Thus, the annual incidence is 15.3 new cases per 100 000 people per year for our catchment population. From the National Cancer Institute's Surveillance, Epidemiology, and End Results data, one may obtain similar