At a celebration event today, Governor Bob McDonnell ceremonially signed four cancer-related bills at Virginia Commonwealth University (VCU) Massey Cancer Center. The legislation continues the Commonwealth's unprecedented support for advancing cancer research, treatment and education at Massey and throughout Virginia.

Last year, the Governor presented $5 million in state funds for cancer research at Massey, representing a substantial increase over the $1 million in annual funding provided previously by the Commonwealth. This year, state support for Massey climbed even further to $7.5 million, with the opportunity to apply for additional funding through the Tobacco Indemnification and Community Revitalization Fund as stipulated in one of the bills signed.

The increased funds for cancer research and new cancer legislation underscore the Commonwealth's commitment to reducing suffering and death from cancer, which is the core mission of Massey.

"The legislation signed today expands Virginia's support for advancing the life-saving cancer research at institutions like VCU Massey Cancer Center," said Governor McDonnell. "While we can celebrate that more and more Virginians are surviving cancer today because of the work of cancer organizations like Massey, we must continue to work to find a cure. With the Commonwealth's support, that important work will continue and expand."

"VCU is proud to host Governor McDonnell and our state legislators at Massey Cancer Center for the signing of critical cancer-related bills," said VCU President Michael Rao, Ph.D. "The University is also deeply thankful to the Commonwealth for investing additional resources in Massey's ground-breaking and valuable research. Massey serves on the front lines of the war on cancer and the work done here exemplifies VCU's laser focus on research that makes a difference and our unwavering commitment to human health."

Said Sheldon M. Retchin, M.D., CEO of the VCU Health System and vice president of health sciences at VCU: "This legislative endorsement demonstrates the state's acknowledgment of the importance of VCU Massey Cancer Center's nationally recognized research in advancing the prevention, diagnosis and treatment of cancer and the value of our world-class care in Virginia."

"VCU Massey Cancer Center is pleased and appreciative of the Commonwealth's commitment to alleviating the effects of cancer," said Massey Director Gordon D. Ginder, M.D. "The increased funding and new legislation will enhance Massey's ability to continue pursuing the scientific innovations that will ultimately save and improve lives."

The following are the cancer bills that were signed:

• HB1182 (Cox, Jones) Tobacco Indemnification and Community Revitalization Fund; uses - Allows the Tobacco Indemnification and Community Revitalization Fund to provide grants to Virginia's NCI-designated cancer centers to conduct cancer research in the Commonwealth's tobacco-dependent counties

• HB83 (Orrock)/SB544 (Edwards) Mammograms; information on breast density -   Requires physicians to report dense breast tissue to patients post mammogram

• HB1273 (Peace)/SB450 (Vogel) Health insurance: parity of coverage for oral chemotherapy medications - Requires health insurers to provide coverage for oral chemotherapy on par with coverage provided for intravenously administered or injected anticancer medications

• HJ120 (Sickles) Designating Mesothelioma Awareness Day - Designates September 26 as Mesothelioma Awareness Day

Click on the media player below to watch video of the event on our YoutTube channel:

Egidio Del Fabbro, M.D., has been named program director of palliative care at Virginia Commonwealth University Massey Cancer Center, effective May 1, 2012.

A nationally recognized expert in palliative care - comprehensive care
for patients and families with a focus on alleviating suffering from serious illness - Del Fabbro comes to VCU Massey from The University of Texas MD Anderson Cancer Center in Houston, where he is currently an associate professor in the Department of Palliative Care and Rehabilitation Medicine. He is also director of the Outpatient Cachexia Clinic and associate director of the Palliative Care Fellowship Training Program.

Del Fabbro, who will also serve as an associate professor of internal medicine within the Division of Hematology, Oncology and Palliative Care of the Department of Internal Medicine at the VCU School of Medicine, is a physician and scientist with specific clinical and research interests in cancer-related fatigue and cachexia (involuntary loss of weight caused by disease). He directs a robust research program with a history of peer-reviewed funding, and he is a member of the American Academy of Hospice and Palliative Medicine (AAHPM) Research Committee.

At VCU, Del Fabbro will work closely with Steven R. Grossman, M.D., Ph.D., chair of the Division of Hematology, Oncology and Palliative Care, and Gordon D. Ginder, M.D., director of VCU Massey Cancer Center, to focus on the continued growth of the palliative care program, specifically on increasing its outpatient presence and integration of palliative care across all oncology services, as well as further enhancing its national and international reputation.

"We are delighted to have Dr. Del Fabbro join us to lead our Thomas Palliative Care Program. His addition is integral to the Program's long-term growth and continued success as one of the world's foremost leaders of palliative care treatment, research and training," said Grossman.

"Dr. Del Fabbro brings valuable knowledge and experience to an important leadership role at VCU Massey Cancer Center," Ginder said. "He will significantly contribute to the Center's excellence in cancer care, research and education."

Dr. del Fabbro received his medical degree from the University of the Witwatersrand in Johannesburg, South Africa. He completed his residency in internal medicine at Barnes-Jewish Hospital in St. Louis and his fellowship in palliative care at MD Anderson.

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Although cancer recurrence may be the overriding fear for many survivors, a study from VCU Massey Cancer Center found only 51 percent of cancer survivors died from cancer, meaning nearly half of survivors died from other conditions.

These results indicate survivors could potentially benefit from a more comprehensive, less cancer-focused approach to their health, according to lead researcher Yi Ning, M.D., Sc.D., assistant professor in the department of epidemiology and community health at Virginia Commonwealth University (VCU) and associate research member at VCU Massey Cancer Center. Ning presented the results at the American Association for Cancer Research (AACR) Annual Meeting 2012, held in Chicago, March 31 - April 4.

"We realized that the mortality rates for some types of cancer, such as breast cancer, had declined," said Ning. "Cancer survivors live much longer than they did several decades ago. So with this large group of cancer survivors, we need to pay more attention to cancer survivors' overall health."

Ning and colleagues evaluated 1,807 cancer survivors who had participated in the National Health and Nutrition Examination Surveys (NHANES) study. The most common forms of cancer among the study group were breast, prostate, cervical, lung and colorectal.

When originally surveyed through NHANES, a large percentage of the study group suffered from conditions other than cancer, including cardiovascular conditions, hypertension and diabetes.

Researchers followed patients for as long as 18.2 years. Over the course of the study, 776 cancer survivors died. Fifty-one percent died from cancer and 49 percent died from other causes. Cardiovascular disease was the primary cause of non-cancer deaths.

Researchers found that the longer patients survived after their initial cancer diagnosis, the more likely they were to die from another disease: 32.8 percent died from another condition within five years of diagnosis compared with 62.7 percent after 20 years.

With nearly half of cancer survivors dying from other causes, Ning said that physicians and patients must improve efforts to manage those risks.

"After the detection of cancer, clinicians and cancer survivors pay less attention to the prevention and treatment of other diseases and complications," said Ning. "We shouldn't neglect other aspects of health because we are focused on cancer and overlook other chronic conditions."

Physicians at Virginia Commonwealth University (VCU) Massey Cancer Center were recognized as "Top Docs" in Richmond Magazine's April 2012 issue.

Topping the list were 33 doctors from varied specialties who provide oncology-related care to Massey's patients. These doctors were selected through a survey of Richmond-area physicians which asked who they would recommend in a range of specialties.

"This recognition demonstrates that VCU Massey Cancer Center is providing the highest quality, coordinated cancer care advanced by our research discoveries," said Gordon D. Ginder, M.D., director of VCU Massey Cancer Center. "All of our clinicians, including physicians, nurses and other medical professionals, are top performers in cancer care."

"I proudly praise our doctors for leading their fields and for coming together from multiple disciplines to provide comprehensive, coordinated cancer care," said Sheldon M. Retchin, M.D., CEO of the VCU Health System and vice president of health sciences at VCU.

The following full-time physicians were listed as top performers in the below categories:

Mitchell Anscher: radiation oncology
Doug Arthur: radiation oncology
Charles Bagwell: general surgery
Harry Bear: surgical oncology
Jonathan Bekenstein: neurology
Cecelia Boardman: gynecologic oncology
Doumit BouHaidar: gastroenterology
Anthony Cassano: cardiothoracic surgery
Weldon Chafe: gynecologic oncology
Laurie Cuttino: radiation oncology
Laurence DiNardo: otolaryngology
Algin Garrett: dermatology
Kamar Godder: oncology/hematology
R. Scott Graham: neurosurgery
B. Mayer Grob: urology
Amelia (Aimee) Grover: surgical oncology
Mary Helen Hackney: oncology and hematology
Lance Hampton: urology
Jeffrey Haynes: general surgery
Brian Kaplan: surgical oncology
Asadullah Khan: oncology/hematology
David Lanning: general surgery
Laurie Lyckholm: hospice and palliative care
Gita Massey: oncology/hematology, palliative medicine
Julia Nunley: dermatology
Claudio Oiticica: general surgery
Andrea Pozez: plastic and reconstructive surgery
Evan Reiter: otolaryngology
Wesley Shepherd: pulmonary disease
India Yount Sisler: oncology/hematology
Gary Tye: neurosurgery
Scott Vota: neurology
Harold Young: neurosurgery

This is the ninth time Richmond Magazine has conducted the survey. Past surveys were conducted in 1988, 1998, 2000, 2004, 2006, 2008, 2010 and 2011.

Scientists at Virginia Commonwealth University's (VCU) Massey Cancer Center and Harold F. Young Neurosurgical Center with researchers at Old Dominion University have discovered a mechanism in glioblastoma (GBM) cells, the most common and aggressive form of brain cancer, that promotes the disease's characteristic invasiveness. This finding could potentially lead to new therapies for this difficult-to-treat disease.

Reported in the Journal of Neurosurgery, the scientists showed that suppression of the Wilms tumor 1 protein (WT1) decreases the amount of CD97 gene expression in three glioblastoma cell lines and reduces the cancer's ability to invade healthy brain tissue. WT1 is a protein that controls the development of several tissue types in humans through a process known as transcription, which is the first of a series of steps leading to gene expression. CD97 is a protein that has been shown in prior research to facilitate tumor cell invasiveness in other malignancies. This study revealed for the first time that CD97 is overexpressed in GBM cells.

"The invasive nature of brain tumors is what makes them difficult to treat," says lead researcher William C. Broaddus, M.D., Ph.D., F. Norton Hord, Jr. Professor at the VCU School of Medicine and researcher at VCU Massey Cancer Center. "We think that some treatment approaches that limit blood supply to the tumor such as bevacizumab, or Avastin, may actually contribute to the disease's invasive behavior. Therefore, if we are able to reduce invasiveness by targeting CD97, then we may increase the effectiveness of other treatments."

In order to reduce WT1 gene expression in their laboratory experiments, the researchers used short interfering RNA (siRNA). siRNA can interfere with the expression of genes, and are often referred to as "silencing" RNA for this reason. The researchers directed the siRNA against WT1 in three different GBM cell lines, U251-MG, U1242-MG and GBM-6, and reduced invasiveness in all of them. In addition, they demonstrated that WT1 silencing increased the expression of seven genes that play a role in tumor suppression and decreased the expression of nine genes that play a role in tumor formation.

Moving forward, the researchers hope to replicate their findings in animal models and other complex experiments that more closely mimic the conditions in the human body. In these studies, the researchers will try to isolate the exact isoform(s) of CD97 that are expressed in GBM cells, as there are several different types of the CD97 protein.

"By demonstrating for the first time the role of CD97 in cellular invasiveness, and the ability to inhibit it by silencing the WT1 protein, we have potentially opened the door to a new treatment approach," says Broaddus. "While we are encouraged by our findings, more research is needed in order to fully understand the biological mechanisms involved."

Broaddus collaborated with Archana Chidambaram, Ph.D., from the VCU Departments of Anatomy and Neurobiology; Timothy E. Van Meter, Ph.D., from the VCU Departments of Anatomy, Neurobiology, Neurosurgery and Pediatric Hematology-Oncology and the Harold F. Young Neurosurgical Center; and Catherine I. Dumur, Ph.D., VCU Massey Cancer Center researcher from the Department of Pathology; and Helen L. Fillmore, Ph.D., who is affiliated with VCU's Department of Neurosurgery and Harold F. Young Neurosurgical Center as well as with Old Dominion University's Office of Research.

The full manuscript of this study is available at: http://thejns.org/doi/abs/10.3171/2011.11.JNS111455.

New technology from ApoCell, Inc. that can detect liver cancer cells circulating in a patient's bloodstream may remove the need for potentially dangerous liver biopsies, be used as a screening tool and, ultimately, speed up drug development, according to a pilot study presented this week by Virginia Commonwealth University (VCU) Massey Cancer Center researcher Andrew Poklepovic, M.D., at the AACR Annual Meeting 2012 in Chicago, IL.

Poklepovic, an oncologist at VCU Massey in the Division of Hematology, Oncology and Palliative Care and an assistant professor of internal medicine at VCU School of Medicine , examined ApoCell's ApoStream™ dielectrophoretic cell separation system in 10 patients with advanced hepatocellular carcinoma (HCC), or liver cancer. The study's results showed that the device could effectively collect circulating tumor cells (CTC) from patients while preserving the cells for analysis outside of the body.

"This is the first time circulating liver cancer cells have been collected without relying on magnetic beads to attach to a protein on the cell's surface," says Dr. Poklepovic. "While we tested the device in liver cancer, theoretically it could work in a number of different cancers."

ApoCell's capture technique relies on differences in electrical charges between cancer cells and normal blood cells. Due to the difference in charges, cancer cells are attracted to an electrical frequency emanating from a plate in the device whereas blood cells are repulsed. Alternative capture techniques rely on antibodies attached to magnetic beads that bind to epithelial cellular adhesion molecules (EpCAM) on the cancer cells. These alternatives are limited to collecting cancer cells that express significant amounts of EpCAM, which is expressed in less than a third of all HCC tumors. Additionally, the tumor cells are fixed in the alternatives' capture process and cannot be manipulated after they are collected.

In Poklepovic's study, different types of liver cancer cells were collected from the same patient, suggesting differences within the tumor cells that were previously unknown. The device may have also captured cells that have undergone epithelial-mesenchymal transformation (EMT), which is a process thought to be induced by chemotherapy and radiotherapy that increases the cells' resistance to these treatments.

 "By analyzing the collected cells, we can monitor the patient's response to treatment, view genetic changes within the cancer and obtain new insight into the diagnosis and evaluation of each patient's unique disease," says Poklepovic. "This technology opens the door to a deeper understanding of the mechanisms of liver cancer."

Liver cancer is the third leading cause of cancer death in the world, and there is currently only one FDA approved drug - sorafenib - that has been shown to extend survival. Reliable CTC capture techniques could provide a non-invasive way to harvest liver cancer cells, potentially speeding up the development of new drugs. 

VCU Massey Cancer Center is already using this technology to evaluate liver cancer cells' response to a new treatment, combining sorafenib with another anti-cancer drug, vorinostat. There are also studies underway in prostate cancer.

Moving forward, Poklepovic plans to test the ApoCell device on additional samples and utilize genetic analyses to better understand the different types of cancer cells collected using this technique.

Scientists have identified a new compound that rapidly kills hepatocellular carcinoma (HCC) cells, the most common form of liver cancer and fifth most common cancer worldwide, while sparing healthy tissue. The compound, Factor Qunolinone Inhibitor 1 (FQI1), works by inhibiting an oncogene originally discovered by a team of researchers led by Devanand Sarkar, M.B.B.S., Ph.D., Harrison Scholar at Virginia Commonwealth University (VCU) Massey Cancer Center, Blick Scholar and assistant professor in the Department of Human and Molecular Genetics and member of the VCU Institute of Molecular Medicine at VCU School of Medicine.

Recently published in the journal Proceedings of the National Academy of Sciences, the study demonstrates that HCC cells have what is known as an "oncogene addiction" to the transcription factor Late SV40 Factor (LSF). Oncogene addiction is a term used when a cancer cell is found to be dependent on a single gene to survive. Using the compound Factor Qunolinone Inhibitor 1 (FQI1), the scientists prevented LSF from binding to HCC DNA during the transcription process, which is the first step in a series of actions that lead to cell division and duplication. This action caused rapid HCC cell death in laboratory experiments and a dramatic reduction in tumor growth in mouse models with no observable toxicity to normal liver cells.

"We may be on the verge of developing a new, effective drug for liver cancer," says Sarkar. "In the last 2-3 years, my laboratory demonstrated the role of LSF in liver cancer and my collaborators at Boston University screened over 110,000 compounds to identify the ones that inhibit LSF function. FQI1 was identified as one of a class of effective compounds, but we never anticipated it would work this well."

Sarkar discovered LSF's role in liver cancer in 2010 when he demonstrated significantly higher LSF levels in HCC patients in comparison to healthy individuals, and showed that inhibition of LSF reduced the progression of HCC in laboratory experiments. This finding led to the collaboration between VCU and Boston University that resulted in the discovery of FQI1.

Now that FQI1 has been identified, pharmacokinetic studies are being conducted to determine how the drug behaves in the human body. Once the scientists have determined how the drug is absorbed, distributed, metabolized and eliminated from the body, they will work with clinicians to translate their findings into phase I clinical trials in patients with liver cancer.

"We have proven this compound is effective and nontoxic in living animals," says Sarkar. "While we won't know how FQI1 reacts in humans until the first clinical trial, we are very excited by our findings and hope they lead to a new drug for a disease that is currently very difficult to treat."

The lead investigators on this study were Trevor J. Grant and Joshua Bishop, Ph.D., from Boston University. In addition to Grant and Bishop, Sarkar collaborated with Ayesha Siddiq, Ph.D., Rachel Gredler and Xue-Ning Shen, M.D., from VCU School of Medicine; Jennifer Sherman and Kevin Fitzgerald, Ph.D., from Alnylam Pharmaceuticals, Inc.; Sriharsa Pradhan, Ph.D., from New England Biolabs, Inc.; Laura A. Briggs, Ph.D., and William H. Andrews, Ph.D., from Sierra Sciences, LLC; and Lisa Christadore, Girish Barot, Ph.D., Hang Gyeong Chin, Sarah Woodson, John Kavouris, Tracy Meehan, Scott E. Schaus, Ph.D., and Ulla Hansen, Ph.D., from Boston University.

The full manuscript is available online at: http://www.pnas.org/content/early/2012/03/02/1121601109.full.pdf+html

Oncologists may fear that involving newly diagnosed patients in treatment decisions is overly burdensome at a particularly difficult time for the patients. However, the results of an international study of early stage breast cancer patients reveal that oncologists should work to understand how involved patients want to be in deciding their own care, and that patients who direct their own treatment decisions, even if more than they initially hoped, are more satisfied with the decision-making process and its outcomes. 

Published in the Journal of Clinical Oncology, the study investigated how breast cancer patients' involvement preferences change during the treatment decision-making process, and how satisfying those preferences impacts how the patients feel about the outcomes of those decisions. Led by Richard Brown, Ph.D., a cancer prevention and control researcher at Virginia Commonwealth University (VCU) Massey Cancer Center and professor in the Department of Social and Behavioral Health at VCU School of Medicine, the study included 683 early stage breast cancer patients of 62 oncologists from Australian, New Zealand, Swiss, German and Austrian clinics.

"The findings of this research are relevant to clinicians because they show patients' involvement preferences are fluid, and that oncologists' ability to meet these preferences can impact patients' satisfaction with their medical care," says Brown.

In the study, decision-making preferences were divided into three categories - patient-directed, oncologist-directed and shared decision making between oncologist and patient. Using questionnaires completed before and after the patients' initial consultation with their oncologists, the researchers found:

• Prior to their initial consultation, most patients preferred shared or patient-directed decision making

• Preferences regarding involvement in decision making changed in 43 percent of patients after their consultation. Of those patients whose preferences changed, most shifted toward becoming more involved in their treatment decisions

• Overall, only 36 percent of patients reported that their treatment decision was made according to their pre-consultation preference for their involvement in the decision

• Of those patients whose preferences did not change after their initial consultation, 53 percent reported the final decision was made according to their preference

• Overall, 60 percent of patients whose decisional involvement preferences changed reported a match between their post-consultation preference and how their treatment decision was actually made. Only 12 percent of patients whose preferences changed reported their treatment decision matched their pre-consultation preference

The post-consultation questionnaire also included measures to assess patients' satisfaction with decision-related outcomes. The results showed that patients who directed treatment decisions, even if more than they initially hoped, were less conflicted over and more satisfied with the final treatment decision, and rated their oncologists better at the ability to involve them in the decision-making process.

"This is the first study to show that when oncologists meet or exceed their patients' involvement preferences, the patients fare better on decision-related outcomes," says Brown. "Our results underscore the importance for oncologists to elicit patient involvement preferences, and also provide evidence of the beneficial impact of facilitating patient involvement in treatment decisions."

The researchers hope to next examine other variables that contribute to changes in decision-involvement preferences, explore disease and cultural differences that relate to fulfilling patient decision-making preferences and document associations between meeting or exceeding involvement preferences and patient outcomes.

Brown collaborated with Maureen Wilson-Genderson, Ph.D., from the Department of Social and Behavioral Health at VCU; Phyllis Butow, Ph.D., M.P.H., and Ilona Juraskova, Ph.D., from the University of Sydney in Australia; and Jurg Bernhard, Ph.D., and Karin Ribi, Ph.D., from the International Breast Cancer Study Group in Bern, Switzerland.

Funding for this study was provided by the National Breast Cancer Foundation of Australia, Oncosuisse/Swiss Cancer League, Deutsche Krebshilfe and the International Breast Cancer Study Group.

The full research manuscript is available online at: http://jco.ascopubs.org/content/early/2012/02/06/JCO.2011.37.7952.abstract

Consumer health information and resources for the cancer community are now easier to find and access in Southside Virginia thanks to the new Cancer Resource Center of Southern Virginia (Resource Center). The Resource Center's mission is to facilitate the availability of local, state and national cancer programs and resources to individuals living within the southern regions of the Commonwealth. It identifies the specific needs and services that are of the greatest help to residents affected by cancer through the guidance of a Cancer Task Force composed of local cancer care providers, cancer community organizations and health district leaders - all in partnership with Virginia's leading cancer resource, Virginia Commonwealth University Massey Cancer Center (VCU Massey). Located in Danville, the Resource Center supports the findings of a cancer needs assessment conducted of several local health districts by VCU Massey. The Resource Center is supported by VCU Massey through a grant from the Virginia Tobacco Indemnification and Community Revitalization Commission.  

The Resource Center acts as a switchboard and search engine for directing individuals living in southern Virginia to community cancer resources, such as identifying transportation to treatments and doctors' appointments, co-payment assistance programs and providers for the uninsured, as well as managing an online calendar of community cancer events. It also plans cancer-related programs and activities, such as the upcoming, free cancer prevention and survivorship program series, Keeping Well, which begins on January 17. In addition, the Resource Center provides disease-related, site-specific education packets to cancer patients through the Cancer Task Force and local oncology practices. And collaborating with the Health Information and Advocacy at Your Library program available at 20 local library branches, it offers the public accurate, reliable and current information related to cancer prevention, detection, treatment and survivorship.

"Cancer exacts a burden on the physical, mental and economic well-being of cancer patients, survivors and their loved ones. There are a great number of varied sources of support to help lift the burden, but these are often underutilized because their existence is unknown," says Melanie Vaughan, coordinator at the Resource Center with Charlotte Litzenberg. "Our goal at the Cancer Resource Center of Southern Virginia is to serve as the connection between these helpful resources and the folks who need them. Many of these support services can have a positive impact on someone facing cancer."   

Local cancer survivor Tracy Keller, DVM, was grateful to have received assistance from the Resource Center. "Since being diagnosed in 2008 with stage IV colon cancer, I have tried to stay up-to-date and participate in cancer education events because they have really helped during my long, difficult cancer journey," she says. "Through the Cancer Resource Center of Southern Virginia, I stay informed of local cancer programs and have learned of new ways to get support here in my hometown."

Patient assistance director at the Danville Cancer Association, Cathy Love, believes there was a great need in Southside for the Resource Center's comprehensive compilation of available cancer services. "The Cancer Resource Center of Southern Virginia has begun a great effort to assemble and inform people of the whole picture of cancer care and support in our community. Melanie and Charlotte at the Resource Center are educating people in our area about their cancer options and doing so with a lot of compassion."

The Resource Center is open every weekday except Thursday, 11 a.m. to 2 p.m., and is also available by appointment by calling (434) 766-6650 or contacting Charlotte Litzenberg at cllitzenberg@vcu.edu and Melanie Vaughan at mvaughan5@vcu.edu. Located at The Institute for Advanced Learning and Research, the Resource Center's address is 150 Slayton Avenue in Danville.

More than 20 percent of U.S. adults receive periodic health examinations (PHE) each year, yet new research shows that patients who have an annual routine visit to their doctor may not receive recommended preventive screening tests and counseling services that could benefit their health.

Recently published in the American Journal of Preventive Medicine, a study performed by a team of researchers led by Jennifer Elston Lafata, Ph.D., co-leader of the Cancer Prevention and Control program at Virginia Commonwealth University (VCU) Massey Cancer Center and professor of Social and Behavioral Health at VCU, found that 46 percent of eligible and due services were missed during PHEs. The results came from audio recordings of 484 PHE visits to 64 general internal medicine and family physicians in southeast Michigan.

"While the percentage of services delivered may appear low, when you account for the lack of incentives to physicians for screenings and preventive counseling and the limited amount of time during visits to address all recommended services, the numbers are not surprising," says Elston Lafata.

By analyzing the audio recordings to determine if physicians suggested or delivered 19 guideline-recommended preventive services, the researchers discovered that the services most likely to be delivered were screenings for colorectal cancer, hypertension and breast cancer. Patients were least likely to receive counseling about aspirin use and vision screening, and were also unlikely to have an influenza immunization recommended or delivered.

The team also evaluated the factors contributing to service delivery. Service delivery decreased with patient age and increased with the patient's body mass index (BMI), an indicator of body fatness based on height and weight. While approximately half of the 19 preventive services studied were prompted in the patient's electronic medical record (EMR), the researchers were surprised to find that services were less likely to be delivered during visits where the physician accessed the EMR in the exam room. Interestingly, the patients whose doctors ran behind in their appointments seemed to receive more preventive services.

"It appears that while some preventive services are likely to be received by some patients, several services which are known to reduce disease go undelivered during routine PHEs," says Elston Lafata. "Relying on face-to-face interactions between physicians and patients will likely continue to result in less-than-optimal service delivery. However, technological advances that provide patients with easy access to their personal health records coupled with automated reminders may be one way patients can work with physicians to increase delivery of preventive services and subsequently lower overall health care costs."

The full research manuscript is available online at: http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3290-embargoed-stamped.pdf

Elston Lafata collaborated with Scott Ratliff, M.S., from Virginia Commonwealth University's Department of Social and Behavioral Health; Deidre A. Shires, M.P.H, M.S.W, Ronak Vashi, B.A., Kurt C. Stange, M.D., and George Divine from Henry Ford Health System; and Ming Tai-Seale, Ph.D., M.P.H., from Palo Alto Medical Foundation Research Institute.