Value-Based Cancer Care Issues


August 2011, Vol 2, No 5

Northwestern University Comprehensive Cancer Center

Oncology

Interview with Al B. Benson III, MD, FACP

Professor of Medicine and Associate Director for Clinical Investigations, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL


Q: How would you define the concept of best practices, and what makes an oncology center, such as the Northwestern University Robert H. Lurie Comprehensive Cancer Center, be among the best oncology practices in the country?

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Upper GI Cancers: Are We Getting Value for the Money?

Audrey Andrews

ASCO Annual Meeting

 

Upper GI Malignancies” was a plenary session at ASCO 2011, with 2 experts discussing whether results of recent clinical trials of targeted agents are clinically meaningful or just statistically positive, and what is the value of the enormous amount of money spent in treating noncolorectal gastrointestinal (GI) cancer.

Clinical versus Statistical Significance

 

Eileen Mary O’Reilly, MD, of Memorial Sloan-Kettering Cancer Center, examined some of the major trials.

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Benchmarks for Measuring the Success of a Medical Home in Oncology

Cancer Care

As we move forward in the scheme of healthcare reform, we are being directed toward an integrated care model, one with high quality and economic efficiency. Recently, a model known as an accountable care organization (ACO) was introduced by the US Department of Health and Human Services in the form of a proposed rule open for public comment. [ Read More ]

Novel Nasal Spray Formulation of Fentanyl Citrate for Cancer Pain

FDA Approvals, News & Updates

The US Food and Drug Administration (FDA) approved a new nasal spray formulation of fentanyl citrate (Lazanda; Archimedes) for the rapid relief of cancer-related breakthrough pain in adults who have developed resistance to their opioid regimen.

The recommended dosage is 100 μg sprayed once in each nostril for each cancer-related pain episode. If adequate analgesia is not obtained within 30 minutes, the dose should be titrated up with each subsequent episode.

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New Molecular Test Approved to Detect HER2 in Women with Breast Cancer

FDA Approvals, News & Updates

A new test for detecting the HER2 gene in women with breast cancer has received FDA approval. The test, called Inform Dual ISH (Ventana Medical Systems), facilitates the use of standard microscopy to measure the number of copies of chromosome 17 and HER2 genes in a tumor sample on the same slide. Unlike traditional HER2 amplification, which uses fluorescence microscopy, the Inform Dual ISH test enables laboratory staff to view samples directly under a microscope, and for longer periods.

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FDA Warns Oncologists: Thermography No Substitute for Mammography

FDA Approvals, News & Updates

The FDA has issued a warning to healthcare providers against substituting breast thermography formammography in screening for breast cancer. Some providers prefer thermography over mammography because it does not exposewomen to radiation or breast compression. The FDA, however, points to the absence of valid evidence showing that when used alone,thermography is effective in detecting breast cancer.

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Combination Therapy Improves Survival in Men with Intermediate-Risk, Early-Stage Prostate Cancer

In the Literature

A new large clinical trial funded by the National Cancer Institute has demonstrated the best approach to therapy for men with intermediaterisk, early-stage prostate cancer that can prolong survival. In comparing treatments for early-stage prostate cancer, investigators found strong evidence that short-term androgen-deprivation therapy (ADT) in combination with radiotherapy is more effective than radiation therapy alone for men with intermediate risk (Jones CU, et al. N Engl J Med. 2011;356:107-118).

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Whole-Genome Sequencing Provides Timely Diagnosis

In the Literature

Whole-genome sequencing (WGS) has traditionally been an important tool in nonclinical research. Recently, however, the potential clinical value of the technique was demonstrated in a patient with acute promyelocytic leukemia (APL) that was hard to identify (Welch JS, et al. JAMA. 2011;305: 1577-1584).

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Genome-Forward Medicine in Lung Cancer

Caroline Helwick

ASCO Annual Meeting

Chicago, IL—Whole genome sequencing was the topic of a session at the 2011 ASCO annual meeting in which specialists discussed the implications of “genome-forward medicine” in lung cancer.

This entails “how to get to the nature of tumors and their heterogeneity,” said Elaine Mardis, PhD, Codirector of the Genome Institute at Washington University, St Louis, MO. Next-generation sequencing, she said, will eventually guide treatment decisions.

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Emerging Regimen for Metastatic Pancreatic Cancer Has Survival Benefit, but Is It Cost-Effective?

Neil Canavan

ASCO Annual Meeting

A cost analysis presented at ASCO 2011 and performed at the University of Toronto, Odette Cancer Center, Ontario, showed that the emerging combination regimen that includes oxaliplatin (Eloxatin), iri - no tecan (Camptosar), fluorouracil (Adrucil) and leucovorin (FOLFIRINOX) is not cost-effective when considered within the framework of a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). [ Read More ]

Impressive Results with New Drugs for Advanced Prostate Cancer

Neil Canavan

ASCO Annual Meeting

Chicago, IL—The potential of 2 novel agents still in clinical trials, and 1 drug that was recently approved, offer new hope to patients with metastatic castrate- resistant prostate cancer (mCRPC), a disease with a dire prognosis and few good current treatment options.

First-in-Class R-223

One of the investigational agents, alpharadin (radium-223 chloride [R- 223]), may have just earned a chance for an expedited approval by the US Food and Drug Administration (FDA) because of its positive results.

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Off-Label Drug Use, Advanced Technologies Driving Up Medicare Cost of Cancer Care

Neil Canavan

ASCO Annual Meeting

A series of studies presented at this year’s ASCO annual meeting suggest that the use of unwarranted high-cost imaging procedures, a surge in the use of innovative treatment technologies, and off-label use of supportive cancer agents are helping to escalate Medicare costs, leading researchers to suggest that further regulation may be needed to rein in unnecessary expenses. [ Read More ]

Dose-Monitoring, Split-Fill Programs Reduce Oral Chemotherapy Waste, Save Costs

Caroline Helwick

Oncology

Dose-monitoring programs for oral chemotherapy drugs can reduce wastage and reduce the risk of serious adverse effects associated with these drugs. This translates into cost-savings for patients and for payers of >$2500 per patient, suggested researchers from Walgreens Specialty Pharmacy.

The company developed an oral chemotherapy cycle management program (CMP) that offers a “split-fill” option and close monitoring of pa - tients for adverse events. This is an optional program, and payers can elect to participate.

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Post-ASCO Survey: Oncologists’ and Payers’ Treatment and Coverage Decisions

Caroline Helwick

Reimbursement

An analysis of payer and provider responses to key clinical information presented at the ASCO 2011 annual meeting offers a glimpse of the oncology landscape shared by oncologists and health plans.

The research was conducted by Xcenda (AmerisourceBergen Consulting Services), a specialty pharmaceutical research and consulting firm. The full study, led by Loreen M. Brown, MSW, Vice President of Xcenda’s Access and Reimbursement Consultancy, was published online in the Oncology Business Review (www.oncbiz.com; July 2011).

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Screening for Pancreatic Cancer Is Effective, Has Value— at Least in High-Risk Individuals

Caroline Helwick

Cancer Care

Ongoing efforts to screen asymptomatic persons for pancreatic cancer have been unsuccessful, but targeting persons at high risk for the disease appears to be clinically effective as well as cost-effective.

Researchers have combined the use of a serum biomarker, CA 19-9, and endoscopic ultrasonography to create a screening protocol for persons at risk for the malignancy on the basis of family history and age and reported their results in the July issue of Gastro - intestinal Endoscopy (Zubarik R, et al. Gastrointest Endosc. 2011;74:87-95).

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77,000 Early Adopters to CMS’s EHR Incentive Program Exceed Requirements, Reflecting Value to Patients and Providers

Value Propositions

Approximately 77,000 healthcare providers have already registered by July of this year with the Centers for Medicare & Medicaid Services (CMS) for the electronic health records (EHRs) program. CMS is collecting data on early adopters to the EHR incentive program, which will begin in 2014 but is requiring providers to meet the first stage of “meaningful use” much sooner. By registering with the incentive program, the providers or clinical centers indicate that they meet the first set of requirements associated with instituting an EHR system. [ Read More ]

Inexpensive Immunochemical Stool Test Effective Option for Colon Cancer Screening

Value Propositions

The immunochemical fecal occult blood test (iFOBT), a new version of the traditional FOBT, has demonstrated 90% specificity in detecting colon growths. This new version of the FOBT has been gradually replacing the old FOBT in screening for colon cancer. This high level of specificity firmly establishes the benefit of this test (Chiang TH, et al. CMAJ. Epub ahead of print. August 2, 2011). Although the FOBT is more expensive than the old FOBT, at a cost of approximately $30, its value is considerable compared with colonoscopy, which averages about $3000 per procedure. [ Read More ]

Value of Screening High-Risk Individuals for Lung Cancer Confirmed, but Who Will Pay for It?

Value Propositions

New results from the National Lung Cancer Screening Trial have shown that in individuals at high risk for lung cancer, screening with lowdose computed tomography (CT) significantly reduces mortality in this subpopulation (N Engl J Med. 2011;365:395-409). Based on these findings, the American Society of Clinical Oncology, in concert with other cancer organizations, is developing new practice guidelines to immediately affect current screening practices for those at high risk for lung cancer. [ Read More ]

FDA Grants Priority Review for Ruxolitinib for the Treatment of Myelofibrosis

Value Propositions

The US Food and Drug Administration (FDA) has granted priority review for the investigational drug ruxolitinib as a potential treatment for patients with myelofibrosis, a blood cancer with few treatment options. There are currently no FDA-approved treatments for this condition. The status of a priority review indicate that the drug either is perceived as offering a major advance in treatment or provides treatment to a condition with no approved therapies.

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Personalized Approach to Mammography Most Cost-Effective, but at What Risk to Women?

Value Propositions

The most recent mammography screening recommendations call on women to begin annual screening for breast cancer at age 40 years, regardless of their risk for the disease. This “one-size-fits-all” approach, based on age alone, leads to too many screenings for some women and not enough for others, according to investigators of a recent cost-analysis (Schousboe JT, et al. Ann Intern Med. 2011;155:10-20).

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