Tuesday, November 29, 2005

Jaw osteonecrosis with bisphosphonates; new PC-FACS

A couple things:
The current J of Clinical Oncology has a study on the incidence of jaw osteonecrosis in cancer patients receiving bisphosphonates. This is a prospective cohort study of 252 patients with heterogeneous cancers who received long-term bisphosphonates (median of 15 infusions over 20 months). Zoledronic acid & pamidronate were mostly used. Amount of exposure (median of 35 vs 15 treatments in those who did vs did not develop osteonecrosis) and time of exposure (median of 39 vs 19 months in those who did vs did not develop osteonecrosis) were strongly correlated with risk of osteonecrosis. The authors conclude with this:
The American Society of Clinical Oncology guidelines for [multiple myeloma] and breast cancer suggest that bisphosphonates should be administered "until there is evidence of a substantial decline in the patient's general performance status." Taking into consideration the natural history of these diseases, this could result in administration of bisphosphonates to some patients for several years. Nevertheless, the studies on which current guidelines were based usually administered bisphosphonates for a maximum of 2 years. In view of the data reported by us as well as by others, caution is required for use of pamidronate and zoledronic acid beyond 2 years.

This article is part of a larger focus of the issue of cancer treatment complications, including an interesting paper on regression of radiation fibrosis with pe

Also, the latest PC-FACS are out--excellent as always--but it seems the AAHPM is going to restrict them to members only (other than a free trial for non-members) & there are hints they may become subscription only. Perhaps this is part of a larger effort to improve the offerings to AAHPM members & thereby boost membership but there must be better ways. Mostly I'm afraid that this is going to have the inevitable effect of limiting the scope and influence of this valuable resource. Should people sign-up and pay for these? Hell yes. But I've been noticing what has happened at the NY Times ever since it hid its Op-Ed columnists behind a pay-only scheme ("NY Times Select"). Previously, 2-3 of the "top emailed articles" on NYtimes.com were always the latest from Krugman, Friedman, Dowd, and company. Now you rarely see any of them on the list. Sigh. Anyway, maybe there's some master plan that we aren't privvy to.

And finally--I'm trying to be brief--the current New England Journal of Medicine has a piece by GJ Annas about the Supreme Court's California medical marijuana ruling and the commerce clause and what it may all mean for medicine. The upcoming decision on the Oregon physician assisted suicide challenge is mentioned.

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