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The purpose of the study was to work out economic rationale for intensifying treatment at specialized oncological establishments. Modern modalities of cancer treatment require patients to be admitted to specialized hospitals. However, at present nearly half of them receive treatment in general medical establishments which, as a rule, do not have facilities for combined and complex treatment. It is estimated that shifting patient examination emphasis from hospital to outpatient clinic might increase the clinical bed turnover by 6.7% which, in turn, will allow to treat 43000 patients more in specialized hospitals every year. The introduction of such scheme will cost 6.8 times less than commission of new beds required for management of the equivalent number of cancer patients.

During 1977, M.D. Anderson Hospital and Tumor Institute used 270,575 g of human serum albumin (HSA) at a patient cost of $1.1 million. For a 1-month period in early 1978, a survey of HSA usage was conducted in the 440-bed hospital. Patients who were started on albumin during the study period were included and monitored for the duration of their therapy. The largest groups of patients receiving albumin were those with gynecological tumors (30%) and gastrointestinal tumors (16%). Two-thirds of all patients receiving HSA were also receiving intravenous hyperalimentation (IVH); 80% of all HSA used was given to IVH patients. Although the IVH patients received a smaller daily dose of HSA, the average length of their therapy was about three times longer than that of the non-IVH patients. The mean total dose for the IVH patients was 344 g as compared to 180 g for non-IVH patients. For all patients, the mean total dose of HSA was 289 g at a patient cost of $1212. Of the patients, 66% had an initial serum albumin level determined before therapy was begun, 43% had a serum albumin level run at the termination of therapy, 16% had neither, and 28% had only one serum albumin level during their HSA therapy. Ninety percent of the patients had at least one period of 4 days or longer without a serum albumin level being obtained.

In the provision of cancer therapy, usage of expensive cancer facilities and deployment of cancer services to the full, the aims and performance of a comprehensive cancer centre have been discussed. Increasing utilization of cancer chemotherapy and its cost have been contrasted with that of radiotherapy. With the current expansion in oncology there is a limit to what the cancer centre can make available within the specific tumour clinic role and for general cancer treatment purposes at other hospitals. It is timely to attempt rationalization of the cancer arrangements peripheral to the centre.

During 1972-1976, when the incidence of cancer rose only slightly in the United Kingdom and the number of cancer patients seen at a large metropolitan teaching hospital and oncological centre remained largely unchanged, the use of cytotoxic drugs rose from 5.1% to 14% of the hospital's total drug budget. Most of the rise in cost can be ascribed to the increased use and increased unit cost of four effective but expensive drugs. Although the cost of drugs is but a small proportion of the cost of care of the cancer patient, it is argued that cytotoxic chemotherapy cannot offer a "cheap alternative" to surgery and radiotherapy. In a health service with cash spending limits the use of the more expensive cytotoxic drugs should be limited to the treatment of patients in whom "cure" or long-term ablation of disease is being attempted or to protocol studies in which their effectiveness is compared with that of other, possibly less expensive, drugs. Further studies are required of the use of the less expensive cytotoxic drugs in order to maximise their usefulness in the palliative treatment of advanced disease.

Memorial Sloan-Kettering Cancer Center wanted a herd of higher quality donors. Following concentrated efforts with list segmentation, data processing, mailing packages with a human interest slant, and a change in renewal strategy, the center reached its goal. When it was over, the development department had turned a simple annual giving campaign into a refreshing multiple gift appeal.