Erik Goldman

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK – Fish oil supplementation, in daily doses of 2 g or more, may mitigate weight loss, increase appetite, and improve overall quality of life in people with lung cancer, according to a systematic review presented by Dr. Heidi Fritz, at the annual meeting of the Society for Integrative Oncology.

Fish oil supplementation may also have a small but significant impact on survival at higher doses of 18 g/day, said Dr. Fritz, a naturopathic physician at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Fritz and her colleagues have undertaken a comprehensive effort to gather the best available data on the benefits and risks of various popular nutritional supplements in the management of lung cancer, among them vitamin A, green tea, selenium, and fish oils.

The Canadian team searched six medical literature databases, finding 50 papers including 6 randomized controlled trials, 11 observational studies, and 30 preclinical studies on the use of fish oil supplements as an adjunctive or supportive treatment for lung cancer.

For the most part, these studies focused on fish oil’s effects on cancer-associated cachexia or – in the case of the human clinical studies – on its use as a supportive therapy to improve quality of life. However, one phase II study looked at the impact on survival of supplementation with eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid.

Dr. Fritz said that although the conclusions of individual studies varied, overall "modest clinical benefit from the use of fish oil and/or EPA alone was seen on parameters associated with cachexia – notably weight loss, appetite, and physical function – and there were also modest improvements seen in quality of life."

She added that one of the clinical trials showed a "significant benefit on survival with high-dose fish oil using 18 g/day." The generally recommended dose is 2 g/day.

No significant adverse effects were associated with the use of fish oils at any dosage in the human clinical studies in this systematic review, and no thromboembolic events – the biggest potentially life-threatening adverse effect associated with intensive omega-3 fatty acid supplementation – were reported.

"Fish oil, particularly EPA, appears safe and may be effective in the treatment of cachexia and related symptoms," Dr. Fritz concluded. "Use of EPA as part of a multifaceted approach to the treatment of cachexia may be advantageous in a clinical setting."

The Canadian team’s systematic review of 66 published studies on green tea and lung cancer concluded that although there is some evidence that compounds in green tea do have antitumor properties, there is no strong evidence that drinking green tea, even in large quantities, will prevent lung cancer or substantially improve treatment outcomes.

Their vitamin A/retinoids systematic review, based on 232 papers including 5 randomized controlled trials, does not support the use of this vitamin for either prevention or treatment of lung cancer. The available data indicate that beta-carotene should not be given to smokers; however, Dr. Fritz added, vitamin A and the retinoids deserve further study in other types of cancer, as the negative findings for lung cancer do not necessarily apply to all cancers.

Their analysis of selenium in the context of lung cancer was inconclusive. Available studies are conflicting in terms of both safety and efficacy, and there is little consensus about the appropriate form of supplemental selenium, the dosage, and the optimal level in humans.

"There may be potential benefit from selenium supplementation in populations with low baseline status, but increased risk of cancer and diabetes associated with supplementation in populations with higher baseline status," she said. Currently the evidence is insufficient to support a recommendation for routine use of selenium to prevent or treat lung cancer.

NEW YORK — High-dose vitamin D supplementation has potential to reduce risk of primary breast cancer as well as breast cancer recurrence, with minimal risk of toxicity, according to researchers and clinicians at the conference.

The meeting was held just 2 weeks before the Institute of Medicine published its consensus statement suggesting that daily intake beyond 600 IU has little value and that high-dose vitamin D might be dangerous. Data presented at the SIO conference indicate that women with serum levels under 20 ng/mL are at significantly increased risk for breast cancer, that raising levels to 50 ng/mL could mitigate that risk, and that oral doses up to 10,000 IU/day are safe for adult women.

Although many questions about vitamin D in cancer prevention and treatment remain unanswered, speakers at the conference were largely in agreement that the recommended daily allowance of 400 IU/day, which had been in place for many years, has little scientific basis.

The IOM's new recommendation of 600 IU for adults – including postmenopausal women – is considerably lower than the doses some nutrition-oriented oncologists are recommending for cancer prevention, and also much lower than the doses being studied in ongoing cancer prevention trials.

The notion that vitamin D may help prevent breast cancer emerged from epidemiologic and case-control studies; these types of studies were largely discounted by the IOM committee.

Some of the strongest recent data come from the Long Island Breast Cancer Study Project, which involved 1,026 women diagnosed between 1996 and 1997, and 1,075 matched controls. Vitamin D deficiency, defined as a serum level under 20 ng/mL, had a roughly 30% prevalence in both groups, reported Dr. Katherine Crew, an epidemiologist at Columbia University, New York, and the study's lead investigator.

However, the women with blood levels of 40 ng/mL or greater had 40% lower odds of breast cancer, compared with those with serum levels of 20 ng/mL or lower. Women with serum levels of 20–29 ng/mL – a level Dr. Crew defined as low but not technically deficient – showed a 16% risk reduction, compared with those who were frankly deficient. She noted that the data were adjusted for age, race, parity, family history of breast cancer, and other key variables (Cancer Prev. Res. Phila. 2009;2:598-604).

“Higher levels of 25-hydroxyvitamin D confer lower risk of breast cancer,” Dr. Crew said. “This was consistent for both estrogen receptor (ER)–positive and ER-negative breast cancer, which is important because we really don't have effective chemotherapy for ER-negative breast cancer.”

She acknowledged the limitations inherent in a case-control study like this, and urged caution in drawing definitive conclusions. Still, she said that the correlations are significant and should not be ignored.

In a later interview, Dr. Crew said she had read the IOM report and believed that “they took a conservative approach in terms of making broad recommendations on vitamin D for the general public.” Those recommendations may not be relevant for specific subpopulations at risk for specific disorders.

Several other studies suggest that increasing vitamin D intake can reduce breast cancer risk. For example, the Women's Health Initiative's 2007 report, while showing no significant breast cancer risk reduction from vitamin D at the standard dose of 400 IU/day, did show a 20% reduction in incidence among the women who took additional vitamin D on their own, beyond the officially sanctioned 400 IU/day. The biggest reduction was in ER-negative cancers. Dr. Crew noted that these findings are significant but have been largely overlooked.

Another study of 1,179 postmenopausal women showed that those taking 1,100 IU/day of vitamin D plus calcium (1,500 mg/day) had less than one-third the incidence of breast cancer that those taking placebo had (2% versus 6.8%). A third subgroup, taking calcium alone, also had fewer breast cancers but the reduction was not as great (3.6% versus 6.8%) (Am. J. Clin. Nutr. 2007;85:1586-91).

Serum level – not daily intake – is the key variable, experts at the meeting emphasized. According to the best available data, breast cancer odds ratios begin to drop significantly as serum vitamin D levels get over 50 ng/mL (J. Steroid Biochem. Mol. Biol. 2007;103:708-11). Several speakers suggested that 40–60 ng/mL is the target range and that supplementation should be individually tailored to help patients achieve those levels.

How much vitamin D must a woman take to reach those levels? A lot more than the 600 IU recommended in the new IOM guidelines. Depending on the baseline blood levels, supplementation on the order of 2,000-4,000 IU/day is what some clinicians are recommending. This is far higher than the IOM's new recommendation, but still within range of the new upper limit.

The most worrisome potential adverse effects of excessive vitamin D are hypercalcemia, bone demineralization, nephrocalcinosis, and cardiac arrhythmias. However, these conditions don't really arise until serum levels get above 150 ng/mL, Dr. Crew said, a level that would require high amounts of vitamin D supplementation over a long period.

A study done in 2004 looked at daily doses of 10,000 IU for up to 5 months, and found no evidence of toxicity (J. Steroid Biochem. Mol. Biol. 2004;89-90:575-9).

Researchers at Columbia are in the midst of a trial assessing the effect of cholecalciferol (vitamin D₃) at 20,000 IU and 30,000 IU/week, in vitamin D–deficient pre- and postmenopausal women at high risk of breast cancer. The women will be treated for a full year. The study will ultimately involve 80 participants, and investigators are tracking a number of breast-specific outcomes including tissue changes on biopsy, changes in breast fibrodensity, and cancer markers in urine and serum.

The weekly doses in this study translate to roughly 2,800 IU and 4,300 IU/day, which are quite a bit higher than the IOM's new recommendation. In an interview, Dr. Crew said the doses do fall close to the IOM's new safe upper limits, but her group has no plan to change the protocol in light of the IOM report.

“For new participants that we're screening, there has been some hesitation from a few women, but others are still willing to participate,” she noted.

According to Julie Campbell, a research fellow involved in the study, 20 premenopausal and 14 postmenopausal women have completed the yearlong intervention, with no evidence of any adverse effects at either dose level. “There have been no cases of hypercalcemia so far, and only one woman has shown high urine calcium levels,” she said.

The high-dose supplementation did produce fairly rapid increases in serum levels. Among the premenopausal women, mean levels had reached the 50- to 60-ng/mL range within 3 months. The 30,000-IU/week doses resulted in a larger increase than did the 20,000-IU/week doses. But even at these high doses, none of the subjects so far have shown potentially toxic serum levels in the range of 150 ng/mL and higher.

Many of the correlations found between vitamin D level and breast cancer risk have also been observed in studies of colorectal cancer, said Dr. Roberd M. Bostick, professor of epidemiology at Emory University, Atlanta.

A dose-response trial is underway involving 272 patients with sporadic colorectal adenoma. The four-arm, placebo-controlled study will assess tissue changes and biomarkers after 6 months of vitamin D supplementation at 1,000, 2,000, and 4,000 IU/day, Dr. Bostick said at the meeting.

Although the IOM report cites the potential dangers of high-dose vitamin D, it is important to realize that “they still raised the RDA from 400 to 600 IU daily and the upper safety limit was doubled from 2,000 IU to 4,000 IU daily. This is still progress in terms of being able to raise people's serum 25-hydroxyvitamin D to sufficient levels,” Dr. Crew said in an interview.

The researchers did not report any financial conflicts.

NEW YORK — High-dose vitamin D supplementation has potential to reduce risk of primary breast cancer as well as breast cancer recurrence, with minimal risk of toxicity, according to researchers and clinicians at the conference.

The meeting was held just 2 weeks before the Institute of Medicine published its consensus statement suggesting that daily intake beyond 600 IU has little value and that high-dose vitamin D might be dangerous. Data presented at the SIO conference indicate that women with serum levels under 20 ng/mL are at significantly increased risk for breast cancer, that raising levels to 50 ng/mL could mitigate that risk, and that oral doses up to 10,000 IU/day are safe for adult women.

Although many questions about vitamin D in cancer prevention and treatment remain unanswered, speakers at the conference were largely in agreement that the recommended daily allowance of 400 IU/day, which had been in place for many years, has little scientific basis.

The IOM's new recommendation of 600 IU for adults – including postmenopausal women – is considerably lower than the doses some nutrition-oriented oncologists are recommending for cancer prevention, and also much lower than the doses being studied in ongoing cancer prevention trials.

The notion that vitamin D may help prevent breast cancer emerged from epidemiologic and case-control studies; these types of studies were largely discounted by the IOM committee.

Some of the strongest recent data come from the Long Island Breast Cancer Study Project, which involved 1,026 women diagnosed between 1996 and 1997, and 1,075 matched controls. Vitamin D deficiency, defined as a serum level under 20 ng/mL, had a roughly 30% prevalence in both groups, reported Dr. Katherine Crew, an epidemiologist at Columbia University, New York, and the study's lead investigator.

However, the women with blood levels of 40 ng/mL or greater had 40% lower odds of breast cancer, compared with those with serum levels of 20 ng/mL or lower. Women with serum levels of 20–29 ng/mL – a level Dr. Crew defined as low but not technically deficient – showed a 16% risk reduction, compared with those who were frankly deficient. She noted that the data were adjusted for age, race, parity, family history of breast cancer, and other key variables (Cancer Prev. Res. Phila. 2009;2:598-604).

“Higher levels of 25-hydroxyvitamin D confer lower risk of breast cancer,” Dr. Crew said. “This was consistent for both estrogen receptor (ER)–positive and ER-negative breast cancer, which is important because we really don't have effective chemotherapy for ER-negative breast cancer.”

She acknowledged the limitations inherent in a case-control study like this, and urged caution in drawing definitive conclusions. Still, she said that the correlations are significant and should not be ignored.

In a later interview, Dr. Crew said she had read the IOM report and believed that “they took a conservative approach in terms of making broad recommendations on vitamin D for the general public.” Those recommendations may not be relevant for specific subpopulations at risk for specific disorders.

Several other studies suggest that increasing vitamin D intake can reduce breast cancer risk. For example, the Women's Health Initiative's 2007 report, while showing no significant breast cancer risk reduction from vitamin D at the standard dose of 400 IU/day, did show a 20% reduction in incidence among the women who took additional vitamin D on their own, beyond the officially sanctioned 400 IU/day. The biggest reduction was in ER-negative cancers. Dr. Crew noted that these findings are significant but have been largely overlooked.

Another study of 1,179 postmenopausal women showed that those taking 1,100 IU/day of vitamin D plus calcium (1,500 mg/day) had less than one-third the incidence of breast cancer that those taking placebo had (2% versus 6.8%). A third subgroup, taking calcium alone, also had fewer breast cancers but the reduction was not as great (3.6% versus 6.8%) (Am. J. Clin. Nutr. 2007;85:1586-91).

Serum level – not daily intake – is the key variable, experts at the meeting emphasized. According to the best available data, breast cancer odds ratios begin to drop significantly as serum vitamin D levels get over 50 ng/mL (J. Steroid Biochem. Mol. Biol. 2007;103:708-11). Several speakers suggested that 40–60 ng/mL is the target range and that supplementation should be individually tailored to help patients achieve those levels.

How much vitamin D must a woman take to reach those levels? A lot more than the 600 IU recommended in the new IOM guidelines. Depending on the baseline blood levels, supplementation on the order of 2,000-4,000 IU/day is what some clinicians are recommending. This is far higher than the IOM's new recommendation, but still within range of the new upper limit.

The most worrisome potential adverse effects of excessive vitamin D are hypercalcemia, bone demineralization, nephrocalcinosis, and cardiac arrhythmias. However, these conditions don't really arise until serum levels get above 150 ng/mL, Dr. Crew said, a level that would require high amounts of vitamin D supplementation over a long period.

A study done in 2004 looked at daily doses of 10,000 IU for up to 5 months, and found no evidence of toxicity (J. Steroid Biochem. Mol. Biol. 2004;89-90:575-9).

Researchers at Columbia are in the midst of a trial assessing the effect of cholecalciferol (vitamin D₃) at 20,000 IU and 30,000 IU/week, in vitamin D–deficient pre- and postmenopausal women at high risk of breast cancer. The women will be treated for a full year. The study will ultimately involve 80 participants, and investigators are tracking a number of breast-specific outcomes including tissue changes on biopsy, changes in breast fibrodensity, and cancer markers in urine and serum.

The weekly doses in this study translate to roughly 2,800 IU and 4,300 IU/day, which are quite a bit higher than the IOM's new recommendation. In an interview, Dr. Crew said the doses do fall close to the IOM's new safe upper limits, but her group has no plan to change the protocol in light of the IOM report.

“For new participants that we're screening, there has been some hesitation from a few women, but others are still willing to participate,” she noted.

According to Julie Campbell, a research fellow involved in the study, 20 premenopausal and 14 postmenopausal women have completed the yearlong intervention, with no evidence of any adverse effects at either dose level. “There have been no cases of hypercalcemia so far, and only one woman has shown high urine calcium levels,” she said.

The high-dose supplementation did produce fairly rapid increases in serum levels. Among the premenopausal women, mean levels had reached the 50- to 60-ng/mL range within 3 months. The 30,000-IU/week doses resulted in a larger increase than did the 20,000-IU/week doses. But even at these high doses, none of the subjects so far have shown potentially toxic serum levels in the range of 150 ng/mL and higher.

Many of the correlations found between vitamin D level and breast cancer risk have also been observed in studies of colorectal cancer, said Dr. Roberd M. Bostick, professor of epidemiology at Emory University, Atlanta.

A dose-response trial is underway involving 272 patients with sporadic colorectal adenoma. The four-arm, placebo-controlled study will assess tissue changes and biomarkers after 6 months of vitamin D supplementation at 1,000, 2,000, and 4,000 IU/day, Dr. Bostick said at the meeting.

Although the IOM report cites the potential dangers of high-dose vitamin D, it is important to realize that “they still raised the RDA from 400 to 600 IU daily and the upper safety limit was doubled from 2,000 IU to 4,000 IU daily. This is still progress in terms of being able to raise people's serum 25-hydroxyvitamin D to sufficient levels,” Dr. Crew said in an interview.

The researchers did not report any financial conflicts.

NEW YORK — High-dose vitamin D supplementation has potential to reduce risk of primary breast cancer as well as breast cancer recurrence, with minimal risk of toxicity, according to researchers and clinicians at the conference.

The meeting was held just 2 weeks before the Institute of Medicine published its consensus statement suggesting that daily intake beyond 600 IU has little value and that high-dose vitamin D might be dangerous. Data presented at the SIO conference indicate that women with serum levels under 20 ng/mL are at significantly increased risk for breast cancer, that raising levels to 50 ng/mL could mitigate that risk, and that oral doses up to 10,000 IU/day are safe for adult women.

Although many questions about vitamin D in cancer prevention and treatment remain unanswered, speakers at the conference were largely in agreement that the recommended daily allowance of 400 IU/day, which had been in place for many years, has little scientific basis.

The IOM's new recommendation of 600 IU for adults – including postmenopausal women – is considerably lower than the doses some nutrition-oriented oncologists are recommending for cancer prevention, and also much lower than the doses being studied in ongoing cancer prevention trials.

The notion that vitamin D may help prevent breast cancer emerged from epidemiologic and case-control studies; these types of studies were largely discounted by the IOM committee.

Some of the strongest recent data come from the Long Island Breast Cancer Study Project, which involved 1,026 women diagnosed between 1996 and 1997, and 1,075 matched controls. Vitamin D deficiency, defined as a serum level under 20 ng/mL, had a roughly 30% prevalence in both groups, reported Dr. Katherine Crew, an epidemiologist at Columbia University, New York, and the study's lead investigator.

However, the women with blood levels of 40 ng/mL or greater had 40% lower odds of breast cancer, compared with those with serum levels of 20 ng/mL or lower. Women with serum levels of 20–29 ng/mL – a level Dr. Crew defined as low but not technically deficient – showed a 16% risk reduction, compared with those who were frankly deficient. She noted that the data were adjusted for age, race, parity, family history of breast cancer, and other key variables (Cancer Prev. Res. Phila. 2009;2:598-604).

“Higher levels of 25-hydroxyvitamin D confer lower risk of breast cancer,” Dr. Crew said. “This was consistent for both estrogen receptor (ER)–positive and ER-negative breast cancer, which is important because we really don't have effective chemotherapy for ER-negative breast cancer.”

She acknowledged the limitations inherent in a case-control study like this, and urged caution in drawing definitive conclusions. Still, she said that the correlations are significant and should not be ignored.

In a later interview, Dr. Crew said she had read the IOM report and believed that “they took a conservative approach in terms of making broad recommendations on vitamin D for the general public.” Those recommendations may not be relevant for specific subpopulations at risk for specific disorders.

Several other studies suggest that increasing vitamin D intake can reduce breast cancer risk. For example, the Women's Health Initiative's 2007 report, while showing no significant breast cancer risk reduction from vitamin D at the standard dose of 400 IU/day, did show a 20% reduction in incidence among the women who took additional vitamin D on their own, beyond the officially sanctioned 400 IU/day. The biggest reduction was in ER-negative cancers. Dr. Crew noted that these findings are significant but have been largely overlooked.

Another study of 1,179 postmenopausal women showed that those taking 1,100 IU/day of vitamin D plus calcium (1,500 mg/day) had less than one-third the incidence of breast cancer that those taking placebo had (2% versus 6.8%). A third subgroup, taking calcium alone, also had fewer breast cancers but the reduction was not as great (3.6% versus 6.8%) (Am. J. Clin. Nutr. 2007;85:1586-91).

Serum level – not daily intake – is the key variable, experts at the meeting emphasized. According to the best available data, breast cancer odds ratios begin to drop significantly as serum vitamin D levels get over 50 ng/mL (J. Steroid Biochem. Mol. Biol. 2007;103:708-11). Several speakers suggested that 40–60 ng/mL is the target range and that supplementation should be individually tailored to help patients achieve those levels.

How much vitamin D must a woman take to reach those levels? A lot more than the 600 IU recommended in the new IOM guidelines. Depending on the baseline blood levels, supplementation on the order of 2,000-4,000 IU/day is what some clinicians are recommending. This is far higher than the IOM's new recommendation, but still within range of the new upper limit.

The most worrisome potential adverse effects of excessive vitamin D are hypercalcemia, bone demineralization, nephrocalcinosis, and cardiac arrhythmias. However, these conditions don't really arise until serum levels get above 150 ng/mL, Dr. Crew said, a level that would require high amounts of vitamin D supplementation over a long period.

A study done in 2004 looked at daily doses of 10,000 IU for up to 5 months, and found no evidence of toxicity (J. Steroid Biochem. Mol. Biol. 2004;89-90:575-9).

Researchers at Columbia are in the midst of a trial assessing the effect of cholecalciferol (vitamin D₃) at 20,000 IU and 30,000 IU/week, in vitamin D–deficient pre- and postmenopausal women at high risk of breast cancer. The women will be treated for a full year. The study will ultimately involve 80 participants, and investigators are tracking a number of breast-specific outcomes including tissue changes on biopsy, changes in breast fibrodensity, and cancer markers in urine and serum.

The weekly doses in this study translate to roughly 2,800 IU and 4,300 IU/day, which are quite a bit higher than the IOM's new recommendation. In an interview, Dr. Crew said the doses do fall close to the IOM's new safe upper limits, but her group has no plan to change the protocol in light of the IOM report.

“For new participants that we're screening, there has been some hesitation from a few women, but others are still willing to participate,” she noted.

According to Julie Campbell, a research fellow involved in the study, 20 premenopausal and 14 postmenopausal women have completed the yearlong intervention, with no evidence of any adverse effects at either dose level. “There have been no cases of hypercalcemia so far, and only one woman has shown high urine calcium levels,” she said.

The high-dose supplementation did produce fairly rapid increases in serum levels. Among the premenopausal women, mean levels had reached the 50- to 60-ng/mL range within 3 months. The 30,000-IU/week doses resulted in a larger increase than did the 20,000-IU/week doses. But even at these high doses, none of the subjects so far have shown potentially toxic serum levels in the range of 150 ng/mL and higher.

Many of the correlations found between vitamin D level and breast cancer risk have also been observed in studies of colorectal cancer, said Dr. Roberd M. Bostick, professor of epidemiology at Emory University, Atlanta.

A dose-response trial is underway involving 272 patients with sporadic colorectal adenoma. The four-arm, placebo-controlled study will assess tissue changes and biomarkers after 6 months of vitamin D supplementation at 1,000, 2,000, and 4,000 IU/day, Dr. Bostick said at the meeting.

Although the IOM report cites the potential dangers of high-dose vitamin D, it is important to realize that “they still raised the RDA from 400 to 600 IU daily and the upper safety limit was doubled from 2,000 IU to 4,000 IU daily. This is still progress in terms of being able to raise people's serum 25-hydroxyvitamin D to sufficient levels,” Dr. Crew said in an interview.

The researchers did not report any financial conflicts.

NEW YORK – Yoga is finding its way into oncology wards and cancer treatment centers all over the country, echoing the widespread popularity of this ancient practice.

Elsevier Global Medical News Image Library

Several studies presented at the annual meeting of the Society for Integrative Oncology indicate that carefully tailored yoga programs can markedly improve quality of life and overall health following conventional treatment for a wide variety of cancers.

Some of the observed benefits include reduced anxiety, improved sleep, decreased use of medications for sleep and stress, improved flexibility and balance, and attenuated side effects associated with cancer drug therapies.

"Yoga interventions have been found to improve symptoms and quality of life in cancer patients," said Stephanie Sohl, Ph.D., of the comprehensive cancer center at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Dr. Sohl’s group has been collaborating with a team at Mount Sinai School of Medicine in New York to develop a brief yoga intervention for women who are being treated for ovarian cancer.

"The primary goal of any therapy for patients who have persistent or recurrent ovarian cancer is shifted from solely pursuing a cure to the control of symptoms and overall maximization of quality of life," Dr. Sohl said.

The Yoga Skills Training (YST) model being pioneered at Wake Forest and Mount Sinai consists of 15-minute sessions that are focused on simple, nonstrenuous yoga linked to the patients’ chemotherapy appointments.

A study of the efficacy of this intervention is underway to measure the impact on anxiety, pain, fatigue, and other quality of life parameters. Investigators are using standardized assessment scales including the Cancer Behavior Inventory, the State Trait Anxiety Inventory, the Brief Pain Inventory, and the Functional Assessment of Cancer Therapy Fatigue scale.

So far, seven women have completed the trial. Dr. Sohl noted that the yoga intervention resulted in measurable changes in mean scores for anxiety, relaxation, and self-efficacy in coping, but no significant changes in pain and fatigue.

Two other studies of longer, more intensive yoga interventions for cancer patients are ongoing at Wake Forest. But she noted that the brevity of the YST sessions may ultimately be more feasible for patients and more easily integrated into existing cancer care settings.

Researchers at Wayne State University College of Nursing in Detroit are also exploring the effect of yoga as a posttreatment adjunct, but with patients surviving non–small cell lung cancer. The Wayne State program involves a standardized yoga sequence that is designed for cancer care implemented in the clinic setting, but also practiced by the patients at home. Patients participate in weekly 45-minute sessions for a total of 8 weeks, and are encouraged to practice what they learned on their own.

In a pilot feasibility study, nine patients – all of whom had undergone standard treatment for non–small cell lung cancer – were enrolled in the program; seven completed the full 8-week intervention and 6-week follow-up. Judi Fouladbakhsh, Ph.D., who is an advanced practice registered nurse at Wayne State, noted that compared with baseline measurements, patients reported consistent and significant decreases in dyspnea and chest tension following the sessions, as well as improved sleep quality and decreased use of sleep medications.

There were no adverse effects – respiratory or otherwise – associated with the practice, and Dr. Fouladbakhsh added that six of the patients were still practicing the yoga exercises at 3 months’ follow-up.

There are significant logistical and methodologic challenges in bringing yoga into the cancer care setting. The selected postures and movements must be compatible with the limitations of strength, stamina, and stability of people who have undergone surgery, radiotherapy, or chemotherapy, many of whom are elderly and also facing other health challenges. Class leaders must be specially trained in working with cancer survivors, and the interventions must be designed to fit with the often demanding treatment schedules.

Generally, yoga gives optimal results when practiced daily or at least several times per week; long-term adherence is a challenge for many patients.

From a research viewpoint, the challenges are significant because in most cases the benefits are subjective. Most studies so far have been small, short term, and dependent on patient self-assessment, with all the attendant limitations this brings. It is also impossible to design a "blinded" study of yoga or any other exercise modality, making it difficult to evaluate the true impact of yoga practice.

To date, there have not been any studies of yoga’s impact on cancer outcomes such as survival, disease-free survival, or mortality; all available studies are on quality of life parameters. But recently, investigators have been trying to move toward objective measures.

Mary Lou Galantino, Ph.D., and her colleagues at Richard Stockton College of New Jersey, Pomona, have been studying the effect of yoga on flexibility and balance in women with breast cancer who have suffered arthralgias associated with aromatase inhibitors (AIs).

The pilot project involved 10 postmenopausal women with stage I-III breast cancer who experienced debilitating arthralgia following treatment with AIs. They participated in twice-weekly, 90-minute Iyengar-style yoga sessions, led by certified instructors and focused on flexibility, deep breathing, and meditation. Patients were encouraged to practice at home for 15 minutes per day.

Trained physical therapists measured Sit and Reach (the distance a person can reach beyond the feet while in a seated position with legs extended) and Functional Reach (the difference, in inches, between arm’s length and maximal forward reach, using a fixed base of support) following each session. The study also included patient self-assessment of function.

From baseline to the end of the trial, the patients showed significant changes in Sit and Reach (from a mean of 22.9 to 30.1 cm) and in Functional Reach (from a mean of 25.4 cm to 39.1 cm). Scores on subjective self-assessment of function also improved.

"The preliminary data suggest that yoga may improve flexibility and balance in breast cancer survivors who experience aromatase inhibitor–associated arthralgia," Dr. Galantino said.

NEW YORK – Yoga is finding its way into oncology wards and cancer treatment centers all over the country, echoing the widespread popularity of this ancient practice.

Elsevier Global Medical News Image Library

Several studies presented at the annual meeting of the Society for Integrative Oncology indicate that carefully tailored yoga programs can markedly improve quality of life and overall health following conventional treatment for a wide variety of cancers.

Some of the observed benefits include reduced anxiety, improved sleep, decreased use of medications for sleep and stress, improved flexibility and balance, and attenuated side effects associated with cancer drug therapies.

"Yoga interventions have been found to improve symptoms and quality of life in cancer patients," said Stephanie Sohl, Ph.D., of the comprehensive cancer center at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Dr. Sohl’s group has been collaborating with a team at Mount Sinai School of Medicine in New York to develop a brief yoga intervention for women who are being treated for ovarian cancer.

"The primary goal of any therapy for patients who have persistent or recurrent ovarian cancer is shifted from solely pursuing a cure to the control of symptoms and overall maximization of quality of life," Dr. Sohl said.

The Yoga Skills Training (YST) model being pioneered at Wake Forest and Mount Sinai consists of 15-minute sessions that are focused on simple, nonstrenuous yoga linked to the patients’ chemotherapy appointments.

A study of the efficacy of this intervention is underway to measure the impact on anxiety, pain, fatigue, and other quality of life parameters. Investigators are using standardized assessment scales including the Cancer Behavior Inventory, the State Trait Anxiety Inventory, the Brief Pain Inventory, and the Functional Assessment of Cancer Therapy Fatigue scale.

So far, seven women have completed the trial. Dr. Sohl noted that the yoga intervention resulted in measurable changes in mean scores for anxiety, relaxation, and self-efficacy in coping, but no significant changes in pain and fatigue.

Two other studies of longer, more intensive yoga interventions for cancer patients are ongoing at Wake Forest. But she noted that the brevity of the YST sessions may ultimately be more feasible for patients and more easily integrated into existing cancer care settings.

Researchers at Wayne State University College of Nursing in Detroit are also exploring the effect of yoga as a posttreatment adjunct, but with patients surviving non–small cell lung cancer. The Wayne State program involves a standardized yoga sequence that is designed for cancer care implemented in the clinic setting, but also practiced by the patients at home. Patients participate in weekly 45-minute sessions for a total of 8 weeks, and are encouraged to practice what they learned on their own.

In a pilot feasibility study, nine patients – all of whom had undergone standard treatment for non–small cell lung cancer – were enrolled in the program; seven completed the full 8-week intervention and 6-week follow-up. Judi Fouladbakhsh, Ph.D., who is an advanced practice registered nurse at Wayne State, noted that compared with baseline measurements, patients reported consistent and significant decreases in dyspnea and chest tension following the sessions, as well as improved sleep quality and decreased use of sleep medications.

There were no adverse effects – respiratory or otherwise – associated with the practice, and Dr. Fouladbakhsh added that six of the patients were still practicing the yoga exercises at 3 months’ follow-up.

There are significant logistical and methodologic challenges in bringing yoga into the cancer care setting. The selected postures and movements must be compatible with the limitations of strength, stamina, and stability of people who have undergone surgery, radiotherapy, or chemotherapy, many of whom are elderly and also facing other health challenges. Class leaders must be specially trained in working with cancer survivors, and the interventions must be designed to fit with the often demanding treatment schedules.

Generally, yoga gives optimal results when practiced daily or at least several times per week; long-term adherence is a challenge for many patients.

From a research viewpoint, the challenges are significant because in most cases the benefits are subjective. Most studies so far have been small, short term, and dependent on patient self-assessment, with all the attendant limitations this brings. It is also impossible to design a "blinded" study of yoga or any other exercise modality, making it difficult to evaluate the true impact of yoga practice.

To date, there have not been any studies of yoga’s impact on cancer outcomes such as survival, disease-free survival, or mortality; all available studies are on quality of life parameters. But recently, investigators have been trying to move toward objective measures.

Mary Lou Galantino, Ph.D., and her colleagues at Richard Stockton College of New Jersey, Pomona, have been studying the effect of yoga on flexibility and balance in women with breast cancer who have suffered arthralgias associated with aromatase inhibitors (AIs).

The pilot project involved 10 postmenopausal women with stage I-III breast cancer who experienced debilitating arthralgia following treatment with AIs. They participated in twice-weekly, 90-minute Iyengar-style yoga sessions, led by certified instructors and focused on flexibility, deep breathing, and meditation. Patients were encouraged to practice at home for 15 minutes per day.

Trained physical therapists measured Sit and Reach (the distance a person can reach beyond the feet while in a seated position with legs extended) and Functional Reach (the difference, in inches, between arm’s length and maximal forward reach, using a fixed base of support) following each session. The study also included patient self-assessment of function.

From baseline to the end of the trial, the patients showed significant changes in Sit and Reach (from a mean of 22.9 to 30.1 cm) and in Functional Reach (from a mean of 25.4 cm to 39.1 cm). Scores on subjective self-assessment of function also improved.

"The preliminary data suggest that yoga may improve flexibility and balance in breast cancer survivors who experience aromatase inhibitor–associated arthralgia," Dr. Galantino said.

NEW YORK – Yoga is finding its way into oncology wards and cancer treatment centers all over the country, echoing the widespread popularity of this ancient practice.

Elsevier Global Medical News Image Library

Several studies presented at the annual meeting of the Society for Integrative Oncology indicate that carefully tailored yoga programs can markedly improve quality of life and overall health following conventional treatment for a wide variety of cancers.

Some of the observed benefits include reduced anxiety, improved sleep, decreased use of medications for sleep and stress, improved flexibility and balance, and attenuated side effects associated with cancer drug therapies.

"Yoga interventions have been found to improve symptoms and quality of life in cancer patients," said Stephanie Sohl, Ph.D., of the comprehensive cancer center at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Dr. Sohl’s group has been collaborating with a team at Mount Sinai School of Medicine in New York to develop a brief yoga intervention for women who are being treated for ovarian cancer.

"The primary goal of any therapy for patients who have persistent or recurrent ovarian cancer is shifted from solely pursuing a cure to the control of symptoms and overall maximization of quality of life," Dr. Sohl said.

The Yoga Skills Training (YST) model being pioneered at Wake Forest and Mount Sinai consists of 15-minute sessions that are focused on simple, nonstrenuous yoga linked to the patients’ chemotherapy appointments.

A study of the efficacy of this intervention is underway to measure the impact on anxiety, pain, fatigue, and other quality of life parameters. Investigators are using standardized assessment scales including the Cancer Behavior Inventory, the State Trait Anxiety Inventory, the Brief Pain Inventory, and the Functional Assessment of Cancer Therapy Fatigue scale.

So far, seven women have completed the trial. Dr. Sohl noted that the yoga intervention resulted in measurable changes in mean scores for anxiety, relaxation, and self-efficacy in coping, but no significant changes in pain and fatigue.

Two other studies of longer, more intensive yoga interventions for cancer patients are ongoing at Wake Forest. But she noted that the brevity of the YST sessions may ultimately be more feasible for patients and more easily integrated into existing cancer care settings.

Researchers at Wayne State University College of Nursing in Detroit are also exploring the effect of yoga as a posttreatment adjunct, but with patients surviving non–small cell lung cancer. The Wayne State program involves a standardized yoga sequence that is designed for cancer care implemented in the clinic setting, but also practiced by the patients at home. Patients participate in weekly 45-minute sessions for a total of 8 weeks, and are encouraged to practice what they learned on their own.

In a pilot feasibility study, nine patients – all of whom had undergone standard treatment for non–small cell lung cancer – were enrolled in the program; seven completed the full 8-week intervention and 6-week follow-up. Judi Fouladbakhsh, Ph.D., who is an advanced practice registered nurse at Wayne State, noted that compared with baseline measurements, patients reported consistent and significant decreases in dyspnea and chest tension following the sessions, as well as improved sleep quality and decreased use of sleep medications.

There were no adverse effects – respiratory or otherwise – associated with the practice, and Dr. Fouladbakhsh added that six of the patients were still practicing the yoga exercises at 3 months’ follow-up.

There are significant logistical and methodologic challenges in bringing yoga into the cancer care setting. The selected postures and movements must be compatible with the limitations of strength, stamina, and stability of people who have undergone surgery, radiotherapy, or chemotherapy, many of whom are elderly and also facing other health challenges. Class leaders must be specially trained in working with cancer survivors, and the interventions must be designed to fit with the often demanding treatment schedules.

Generally, yoga gives optimal results when practiced daily or at least several times per week; long-term adherence is a challenge for many patients.

From a research viewpoint, the challenges are significant because in most cases the benefits are subjective. Most studies so far have been small, short term, and dependent on patient self-assessment, with all the attendant limitations this brings. It is also impossible to design a "blinded" study of yoga or any other exercise modality, making it difficult to evaluate the true impact of yoga practice.

To date, there have not been any studies of yoga’s impact on cancer outcomes such as survival, disease-free survival, or mortality; all available studies are on quality of life parameters. But recently, investigators have been trying to move toward objective measures.

Mary Lou Galantino, Ph.D., and her colleagues at Richard Stockton College of New Jersey, Pomona, have been studying the effect of yoga on flexibility and balance in women with breast cancer who have suffered arthralgias associated with aromatase inhibitors (AIs).

The pilot project involved 10 postmenopausal women with stage I-III breast cancer who experienced debilitating arthralgia following treatment with AIs. They participated in twice-weekly, 90-minute Iyengar-style yoga sessions, led by certified instructors and focused on flexibility, deep breathing, and meditation. Patients were encouraged to practice at home for 15 minutes per day.

Trained physical therapists measured Sit and Reach (the distance a person can reach beyond the feet while in a seated position with legs extended) and Functional Reach (the difference, in inches, between arm’s length and maximal forward reach, using a fixed base of support) following each session. The study also included patient self-assessment of function.

From baseline to the end of the trial, the patients showed significant changes in Sit and Reach (from a mean of 22.9 to 30.1 cm) and in Functional Reach (from a mean of 25.4 cm to 39.1 cm). Scores on subjective self-assessment of function also improved.

"The preliminary data suggest that yoga may improve flexibility and balance in breast cancer survivors who experience aromatase inhibitor–associated arthralgia," Dr. Galantino said.

DENVER – Physicians might not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study–covering more than 1,700 group practices–showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers–Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem–on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place.

DENVER – Physicians might not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study–covering more than 1,700 group practices–showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers–Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem–on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place.

DENVER – Physicians might not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study–covering more than 1,700 group practices–showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers–Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem–on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place.

DENVER — Physicians may not be enamored of Medicare, but they like it better than private insurance plans, according to a survey by the Medical Group Management Association.

In MGMA's Payer Performance Study—covering more than 1,700 group practices—physician groups ranked Medicare Part B well ahead of six large private insurers in terms of overall satisfaction. The survey asked members of MGMA to rank seven of the largest payers (Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem) on payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale. Aetna took second place with a score of 3.14. The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider-credentialing processes. On that measure, Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA, which released the data at its annual meeting.

The data show particularly strong member dissatisfaction with the private insurers on contract negotiation. “MGMA members feel there is disproportionate power on the side of the payers,” Dr. Jessee said.

The MGMA survey did not ask about satisfaction with actual Medicare reimbursement rates, but Dr. Jessee said he anticipated that Medicare's ranking could drop considerably if the federal government cuts physician fees in the future.

Medical group operating costs have been rising at an average rate of 6.5% per year for the last decade, yet Medicare reimbursement has been flat. That, Dr. Jessee said, is making it difficult for many groups to stay in business. Further fee cuts will likely discourage many doctors from continuing to participate in Medicare.

DENVER — Physicians may not be enamored of Medicare, but they like it better than private insurance plans, according to a survey by the Medical Group Management Association.

In MGMA's Payer Performance Study—covering more than 1,700 group practices—physician groups ranked Medicare Part B well ahead of six large private insurers in terms of overall satisfaction. The survey asked members of MGMA to rank seven of the largest payers (Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem) on payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale. Aetna took second place with a score of 3.14. The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider-credentialing processes. On that measure, Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA, which released the data at its annual meeting.

The data show particularly strong member dissatisfaction with the private insurers on contract negotiation. “MGMA members feel there is disproportionate power on the side of the payers,” Dr. Jessee said.

The MGMA survey did not ask about satisfaction with actual Medicare reimbursement rates, but Dr. Jessee said he anticipated that Medicare's ranking could drop considerably if the federal government cuts physician fees in the future.

Medical group operating costs have been rising at an average rate of 6.5% per year for the last decade, yet Medicare reimbursement has been flat. That, Dr. Jessee said, is making it difficult for many groups to stay in business. Further fee cuts will likely discourage many doctors from continuing to participate in Medicare.

DENVER — Physicians may not be enamored of Medicare, but they like it better than private insurance plans, according to a survey by the Medical Group Management Association.

In MGMA's Payer Performance Study—covering more than 1,700 group practices—physician groups ranked Medicare Part B well ahead of six large private insurers in terms of overall satisfaction. The survey asked members of MGMA to rank seven of the largest payers (Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem) on payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale. Aetna took second place with a score of 3.14. The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider-credentialing processes. On that measure, Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA, which released the data at its annual meeting.

The data show particularly strong member dissatisfaction with the private insurers on contract negotiation. “MGMA members feel there is disproportionate power on the side of the payers,” Dr. Jessee said.

The MGMA survey did not ask about satisfaction with actual Medicare reimbursement rates, but Dr. Jessee said he anticipated that Medicare's ranking could drop considerably if the federal government cuts physician fees in the future.

Medical group operating costs have been rising at an average rate of 6.5% per year for the last decade, yet Medicare reimbursement has been flat. That, Dr. Jessee said, is making it difficult for many groups to stay in business. Further fee cuts will likely discourage many doctors from continuing to participate in Medicare.

DENVER — Physicians may not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study—covering more than 1,700 group practices—showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers—Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem—on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA.

Dr. Jessee said that the data show particularly strong member dissatisfaction with the private insurers on the matter of negotiating contracts. “MGMA members feel there is disproportionate power on the side of the payers.”

Although Medicare may have scored better than the private insurers, the scores suggest there's much room for improvement in the federal program. Dr. Jessee said that the MGMA survey deliberately did not ask about satisfaction with actual reimbursement rates, but he anticipated that Medicare's relatively favorable ranking could drop considerably if the federal government goes forward with its proposed 21% physician fee cuts next year.

The fee-shearing is among a number of federal-level issues on which MGMA is taking action. “We have three major tasks: repeal the sustainable growth rate [SGR] formula as outlined in HR3200 and most other bills; create a reimbursement formula that accurately reimburses physicians for their actual costs; and simplify administrative transactions,” he said.

Medical group operating costs have been increasing at a rate of 6.5% per year, on average, for the last decade, yet Medicare reimbursement has been flat. That, said Dr. Jessee, is making it difficult for many groups to stay in business. Any further cuts in fees will likely discourage many doctors from continuing to participate in Medicare.

MGMA is committed to fighting the cuts and repealing the SGR formula, and the group has made some progress in Washington, but “there's a lot more game to be played,” he said.

DENVER — Physicians may not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study—covering more than 1,700 group practices—showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers—Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem—on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA.

Dr. Jessee said that the data show particularly strong member dissatisfaction with the private insurers on the matter of negotiating contracts. “MGMA members feel there is disproportionate power on the side of the payers.”

Although Medicare may have scored better than the private insurers, the scores suggest there's much room for improvement in the federal program. Dr. Jessee said that the MGMA survey deliberately did not ask about satisfaction with actual reimbursement rates, but he anticipated that Medicare's relatively favorable ranking could drop considerably if the federal government goes forward with its proposed 21% physician fee cuts next year.

The fee-shearing is among a number of federal-level issues on which MGMA is taking action. “We have three major tasks: repeal the sustainable growth rate [SGR] formula as outlined in HR3200 and most other bills; create a reimbursement formula that accurately reimburses physicians for their actual costs; and simplify administrative transactions,” he said.

Medical group operating costs have been increasing at a rate of 6.5% per year, on average, for the last decade, yet Medicare reimbursement has been flat. That, said Dr. Jessee, is making it difficult for many groups to stay in business. Any further cuts in fees will likely discourage many doctors from continuing to participate in Medicare.

MGMA is committed to fighting the cuts and repealing the SGR formula, and the group has made some progress in Washington, but “there's a lot more game to be played,” he said.

DENVER — Physicians may not be enamored of Medicare, but they like it a whole lot better than private insurance plans, according to a survey by the Medical Group Management Association.

MGMA's Payer Performance Study—covering more than 1,700 group practices—showed that physicians groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction. The organization released the data at its annual meeting.

The survey asked participants, all of whom were members of MGMA, to rank seven of the largest payers—Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem—on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

The respondents were much less satisfied with Medicare's provider credentialing processes. On that measure, the Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA.

Dr. Jessee said that the data show particularly strong member dissatisfaction with the private insurers on the matter of negotiating contracts. “MGMA members feel there is disproportionate power on the side of the payers.”

Although Medicare may have scored better than the private insurers, the scores suggest there's much room for improvement in the federal program. Dr. Jessee said that the MGMA survey deliberately did not ask about satisfaction with actual reimbursement rates, but he anticipated that Medicare's relatively favorable ranking could drop considerably if the federal government goes forward with its proposed 21% physician fee cuts next year.

The fee-shearing is among a number of federal-level issues on which MGMA is taking action. “We have three major tasks: repeal the sustainable growth rate [SGR] formula as outlined in HR3200 and most other bills; create a reimbursement formula that accurately reimburses physicians for their actual costs; and simplify administrative transactions,” he said.

Medical group operating costs have been increasing at a rate of 6.5% per year, on average, for the last decade, yet Medicare reimbursement has been flat. That, said Dr. Jessee, is making it difficult for many groups to stay in business. Any further cuts in fees will likely discourage many doctors from continuing to participate in Medicare.

MGMA is committed to fighting the cuts and repealing the SGR formula, and the group has made some progress in Washington, but “there's a lot more game to be played,” he said.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by relative value units provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be a significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, president and chief executive officer of MGMA, who presented the data.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures.

Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership.

During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by relative value units provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be a significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, president and chief executive officer of MGMA, who presented the data.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures.

Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership.

During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by relative value units provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be a significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, president and chief executive officer of MGMA, who presented the data.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures.

Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership.

During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by RVUs provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, who presented the data and is president and chief executive officer of MGMA.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Still, even in the sectors that have seen increases, the percentage increase in gross revenue is only a few points higher than the rising costs of staying in practice, if that much. Many practices, especially the smaller ones, are struggling. Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures. Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly, they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership. During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

Not surprisingly, the economic downturn has affected MGMA itself. The organization acknowledged that attendance at this year's annual meeting—roughly 2,150 paid attendees—was down 21% from its peak several years ago.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by RVUs provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, who presented the data and is president and chief executive officer of MGMA.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Still, even in the sectors that have seen increases, the percentage increase in gross revenue is only a few points higher than the rising costs of staying in practice, if that much. Many practices, especially the smaller ones, are struggling. Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures. Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly, they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership. During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

Not surprisingly, the economic downturn has affected MGMA itself. The organization acknowledged that attendance at this year's annual meeting—roughly 2,150 paid attendees—was down 21% from its peak several years ago.

DENVER — Multispecialty group practice revenue dropped last year for the first time in a decade as practices across the country felt the impact of the recession, but primary care revenue appears relatively healthy.

The Medical Group Management Association's Cost Survey for 2009 showed a 1.9% decline in mean total medical gross revenue among multispecialty groups, as well as a 9.9% drop in volume of medical procedures (indicated by RVUs provided per patient) and an 11% decrease in total patient volume. Not surprisingly, bad debt from fee-for-service charges increased by 13%.

The 2009 report, released at the MGMA's annual conference, was based on 2008 data and so represents a snapshot of the early phase of the recession. Current conditions could be significantly worse, but won't likely show up until the next survey, said Dr. William F. Jessee, who presented the data and is president and chief executive officer of MGMA.

Though fully one-third of practices surveyed reported a decrease in total revenue in 2008, the news isn't all bad. Data on single-specialty groups showed some clear winners, even in these hard times. In particular, cardiologists reported a 7.9% mean increase in total revenue after operating costs. Pediatricians topped that, with a 9% increase. Family physicians reported a 2.4% mean increase.

Hardest hit were gastroenterologists, with a 5% drop in revenue. In general, the procedure-based specialties are feeling the hardest squeeze, Dr. Jessee noted.

Still, even in the sectors that have seen increases, the percentage increase in gross revenue is only a few points higher than the rising costs of staying in practice, if that much. Many practices, especially the smaller ones, are struggling. Dr. Jessee said that group practices are tightening their belts.

On average, practices reported reducing support staff costs by 1.5%, though there were no reported significant changes in number of staff members. That means only one thing: Many employees have taken pay cuts. In some cases, the doctors themselves are taking home less pay, he pointed out.

Thirty-five percent of practices have instituted hiring freezes, and 34% say they've cut operating budgets. Thirty-seven percent said that they have postponed capital expenditures. Over one-third of the practices in the survey said that they have seen an increase in the number of uninsured patients in 2008.

Solo and physician-owned small group practices have been especially hard hit by the recession, and increasingly, they are reaching out to hospitals and the large group practices for a lifeline. MGMA surveys over the last decade show clearly that America's doctors are huddling up and selling out to larger health care entities, Dr. Jessee said.

The number of MGMA member groups owned by hospitals grew by 20% during the 5-year period from 2003 to 2008, and they now comprise 10% of the organization's total membership. During that time, the average number of physicians in MGMA member group practices increased from 16 in 2003 to 19 in 2008. The number of doctors in the average hospital-owned group rose from 64 to 76, a 19% increase. “There's a big, big trend toward consolidation,” Dr. Jessee said.

Not surprisingly, the economic downturn has affected MGMA itself. The organization acknowledged that attendance at this year's annual meeting—roughly 2,150 paid attendees—was down 21% from its peak several years ago.