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Elizabeth Danielson, Jessica DeMartino, and Jill A. Mullen

A previous NCCN Oncology Insights Report™ described the factors making cancer care a priority for managed care organizations (MCOs) and emerging trends in managing costs of cancer care. To better understand the concerns of MCOs and how they are addressing cancer costs and quality, NCCN interviewed senior physician executives from the 3 largest payors in the United States. The interviews provided insights into how these companies managed oncology care, with an emphasis on drugs and biologics. As a follow-up to the previous report, NCCN conducted additional interviews with medical executives from 10 MCOs between February and April 2010. The organizations represented in these interviews were Aetna, BlueCross BlueShield of Minnesota, BlueShield of Michigan, CareFirst BlueCross BlueShield, Empire BlueCross BlueShield, HealthNow, Humana, Independence BlueCross, Priority Health, and UnitedHealthcare. Although this group is diverse, it does not constitute a representative cross-section of MCOs across the United States. NCCN interviewed these executives about the priority of cancer care management for their organizations and the strategies being used to address cost and quality of cancer care. The information garnered from these interviews was qualitative in nature. A separate quantitative analysis of trends in oncology managed care has already been published, and throughout this report, data from the 2009–2010 Genentech Oncology Trend Report are referenced to supplement findings from the NCCN interviews.

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Jeffrey S. Dome, Elizabeth A. Mullen, David B. Dix, Eric J. Gratias, Peter F. Ehrlich, Najat C. Daw, James I. Geller, Murali Chintagumpala, Geetika Khanna, John A. Kalapurakal, Lindsay Renfro, Elizabeth J. Perlman, Paul E. Grundy, and Conrad V. Fernandez

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Jeffrey S. Dome, Elizabeth A. Mullen, David B. Dix, Eric J. Gratias, Peter F. Ehrlich, Najat C. Daw, James I. Geller, Murali Chintagumpala, Geetika Khanna, John A. Kalapurakal, Lindsay A. Renfro, Elizabeth J. Perlman, Paul E. Grundy, and Conrad V. Fernandez

Refinements in surgery, radiation therapy, and chemotherapy since the mid-20th century have resulted in a survival rate exceeding 90% for patients with Wilms tumor (WT). Although this figure is remarkable, a significant proportion of patients continue to have event-free survival (EFS) estimates of <75%, and nearly 25% of survivors experience severe chronic medical conditions. The first-generation Children’s Oncology Group (COG) renal tumor trials (AREN ‘0’), which opened to enrollment in 2006, focused on augmenting treatment regimens for WT subgroups with predicted EFS <75% to 80%, including those with the adverse prognostic marker of combined loss of heterozygosity (LOH) at chromosomes 1p/16q, pulmonary metastasis with incomplete lung nodule response after 6 weeks of chemotherapy, bilateral disease, and anaplastic histology. Conversely, therapy was reduced for patient subgroups with good outcomes and potential for long-term toxicity, such as those with lung metastasis with complete lung nodule response after 6 weeks of chemotherapy. This article summarizes the key findings of the first-generation COG renal tumor studies and their implications for clinical practice.

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Frank Balis, Daniel M. Green, Clarke Anderson, Shelly Cook, Jasreman Dhillon, Kenneth Gow, Susan Hiniker, Rama Jasty-Rao, Chi Lin, Harold Lovvorn III, Iain MacEwan, Julian Martinez-Agosto, Elizabeth Mullen, Erin S. Murphy, Mark Ranalli, Daniel Rhee, Denise Rokitka, Elisabeth (Lisa) Tracy, Tamara Vern-Gross, Michael F. Walsh, Amy Walz, Jonathan Wickiser, Matthew Zapala, Ryan A. Berardi, and Miranda Hughes

The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.