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January 11, 2013

EHRs: Bad In More Ways Than One

I have previously written about the disruption of the physician-patient relationship with the introduction of office-based electronic health records (EHRs) into the US healthcare system. At the time, my concern was related to converting physicians to typists; I took at face value the pitch that EHRs would increase efficiency and this was simply a sacrifice that we had to make at the altar of quality.

As it turns out- not so much.

The original study that drove widespread recommendations for EHRs was written by the RAND corporation in 2005 and anticipated a $81 billion annual savings with widespread EHR adoption. (Ironically, the same Congress that has been pushing for conflict of interest reporting by physician-investigators conveniently did not notice that this study was...

Posted By: Alok Khorana  

November 10, 2012

Gem/Abraxane Shows Survival Benefit in Pancreatic Cancer

In a brief press release, Celgene has indicated that the phase III study evaluating the benefit of adding Abraxane to gemcitabine in treatment of advanced pancreatic cancer shows a statistically significant benefit for the combination when compared to gemcitabine alone. No details have been pr...

Posted By: Alok Khorana  

November 8, 2012

Is This Really Happening? 50% Price Cut For Aflibercept

I had recently blogged about the cost controversy regarding Sanofi's new agent for secondline treatment of metastatic colorectal cancer: aflibercept, which was recently approved by the FDA in conjunction with FOLFIRI for this indication. 

To recap this controversy: physicians from Memorial Sloan published an

Posted By: Alok Khorana  

November 1, 2012

Colorectal Cancer Changes III: Not all KRAS Mutations Are Equal

The story of KRAS mutations being predictive of non-response to anti-EGFR therapy in the setting of metastatic colorectal cancer is a poster child for biomarker-based approaches to treating cancer. However, as it turns out, there is much more complexity to this story than current standard of care decisionmaking would suggest. 

The first hole in the KRAS-mutants-dont-respond-to-anti...

Posted By: Alok Khorana  

October 18, 2012

Colorectal Cancer Changes II: Aflibercept (And, Yes, Cost)

In my previous post, I discussed regorafenib as a new option for patients who have failed multiple lines of chemotherapy and pointed out that patients on this new agent require close monitoring for hand-foot syndrome, hypertension and LFTs, among other toxicities. However, thers is no real controversy about where regorafen...

Posted By: Alok Khorana  

October 15, 2012

Colorectal Cancer Changes: Regorafenib

Over the past few weeks, the algorithm for treating metastatic colorectal cancer has changed. After a prolonged period of no new drug approvals, both aflibercept and regorafenib were approved within a few weeks. In addition, some doubt has been cast on whether all KRAS mutants are resistant to anti-EGFR approaches In my next three posts, I'd like to cover all of these changes which have led to ...

Posted By: Alok Khorana  

September 10, 2012

EMR Notes and John Lennon's Elbow

When my institution transitioned to a full-scale EMR, I wrote about my concerns in an essay in the JCO entitled Physician as Typist. I regret to say that many of my fears about note-taking have in fact materialized. Many institutions have now made the transition to full-fledged EMR note-taking (as opposed to just order-entry...

Posted By: Alok Khorana  

August 30, 2012

Is Maintenance of Certification Obsolete?

As someone who recently had to suffer through preparing for my Maintenance of Certification (MoC) Boards, I empathized with Andrew Seidman's column in the Aug. 15 issue of ASCO Post. Dr. Seidman's (and mine as well) biggest issue with the boards is its current "one size fits...

Posted By: Alok Khorana  

August 27, 2012

Primary or Metastasis for Genomic Profiling?

The advent of tumor genomic profiling has brought issues that were previously theoretical to the clinical forefront. In metastatic colon cancer, KRAS testing to determine use of anti-EGFR therapy is commonplace. But are KRAS mutations more common in primary tumors versus metastatic sites? Should KRAS testing be repeated at the time of recurrence or can we safely rely on previously obtained prim...

Posted By: Alok Khorana  

July 31, 2012

A VEGF Pathway SNP As A Possible Biomarker for Bevacizumab?

It has been a source of particular frustration for clinicians that despite the fact that bevacizumab has been approved for several years now, there is still not a biomarker predictive of response. This, coupled with the high cost of this agent, has also contributed to the swirling controversy around the use of bevacizumab in settings where improvement in outcomes cannot be as clearly defined as...

Posted By: Alok Khorana  

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About This Blog

Thoughts on cancer therapeutics, cancer biology and cancer complications with occasional forays into the art of medicine. The bar is set at: Interesting.

Poll: Do electronic medical records make life easier? Yes, for writing chemo orders but no for writing notes|No, its more stuff that takes away from patient care|Yes, a big improvement over finding and writing in paper charts|It doesn't matter- we all have to get them now|

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