PDQ--Effort to Keep Doctors Up to Date in Cancer Field
This year 900,000 Americans with cancer will be diagnosed in the United States, but only about 20% of them will be seen by physicians who are apt to know the most or the latest about cancer treatment.
“If we could get every patient to be seen by state-of-art physicians, 40,000 additional lives could be saved every year,” said Dr. Gregory Curt, the National Cancer Institute’s deputy director for cancer treatment. This year about 462,000 will die of the disease.
Therapy for certain types or stages of some cancers is advancing so quickly, according to oncologists, that it has become virtually impossible for the average physician to keep up with the changes. It is estimated that only about 20% of all cancer patients today are treated by oncologists.
Whether Curt’s assessment comes true will depend largely on the success of a herculean effort by the institute to help the nation’s private physicians learn who the cancer specialists are and where state-of-art treatment can be obtained.
Called PDQ, for Physician’s Data Query, the nationwide cancer information file--newly expanded this year--contains information on the prognosis and treatment of all stages of all major cancers, as well as the names and locations of 10,000 specialists. Access is limited to medical libraries or doctors with a personal computer.
PDQ also contains information on more than 1,000 experimental cancer therapies currently undergoing clinical trials at hundreds of centers, involving 20,000 patients. While most of these therapies involve already existing drugs or other treatments being used in new ways, some are for new agents being tried for the first time.
Prime examples of the latter category are the half-dozen or so new drugs and so-called biological response modifiers that go into clinical trials annually with National Cancer Institute financing.
Biological response modifiers are a new class of cancer treatments that act on the patient’s immune system in various ways to enhance its effectiveness. One example currently in the news is interleukin-2, a compound that has been used with some success to activate white blood cells into becoming lymphokine activated killer cells, or LAKS, in patients with certain kinds of cancer who no longer respond to conventional treatments.
While there has been no problem enlisting patients to enter LAKS trials--partly because of the publicity it has received--this is not the case with nearly every other trial, including those involving new anti-cancer drugs, according to NCI officials.
Clinical trials are a joint effort by qualified physicians who are willing to do research--as well as patients--the NCI, the Food and Drug Administration, pharmaceutical companies or other initiators of new therapies. Trying new approaches, for instance, has increased the cure rate for childhood leukemia from less than 10% to at least 50% over the last 15 years.
Because the protocols for each study vary, cancer patients interested in participating in clinical research programs can learn the requirements of an existing study by asking their doctor to use PDQ.
“PDQ is a revolutionary change in the way we can do business,” said Dr. Samuel Broder of NCI’s clinical oncology program. “PDQ now makes it possible for an interested physician to screen the latest protocols for any type of cancer.”
According to Dr. Robert Wittes, chief of NCI’s therapy evaluation program, many patients are unaware that trials exist, and their physicians, for various reasons, are reluctant to tell them.
