Value-Based Cancer Care Issues


July 2012, Vol 3, No 5

New Androgen Receptor–Signaling Inhibitor Extends Survival, Improves QOL in Advanced Prostate Cancer

Mark Knight

ASCO Annual Meeting

Chicago, IL—The novel androgen receptor–signaling inhibitor enzalutamide, also known as MDV3100, significantly prolonged overall survival (OS), slowed disease progression, and improved quality-of-life (QOL) measures in men with castration-resistant prostate cancer after docetaxel failure, according to results from a large phase 3 clinical trial.

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Defining the Roles of Patient Navigation Can Remove Barriers to Quality Care

Caroline Helwick

AVBCC Annual Conference

Houston, TX—Patient navigation assures timely access to care for many patients, especially the medically underserved population, and it will soon become mandated for institutions accredited by the Commission on Cancer, reported Mandi Pratt-Chapman, MA, Associate Director of the Community Programs, Codirector of the Center for the Advancement of Cancer Survivorship, Navigation and Policy, George Washington Cancer Institute, Washington, DC, at the Second Annual Conference of the Association for Value-Based Cancer Care.

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The Affordable Care Act: The Day of Reckoning Arrives

Ross D. Margulies, JD, MPH; Jayson Slotnik, JD, MPH

Health Policy

Over the past 2 years, we have written about the impact of accountable care organizations, value-based purchasing, health insurance exchanges, and other programs relevant to the oncology community. These initiatives were all born out of the Affordable Care Act (ACA), which, on June 28, 2012, had its major day of reckoning. In a 5 to 4 decision authored by Chief Justice John Roberts, the US Supreme Court upheld the ACA’s individual mandate—the requirement that most Americans obtain health insurance that meets the definition of minimum essential coverage.

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High Response Rate with Brentuximab Vedotin in Patients with Relapsed/Refractory Hodgkin Lymphoma

In the Literature

Despite significant improvements in the treatment of patients with advanced-stage, newly diagnosed Hodgkin lymphoma (HL) with combined chemotherapy and radiotherapy that have led to durable remission rates of approximately 60% to 80%, a large proportion of patients are not cured and new therapies are needed. Patients with relapsed and/or refractory HL have poor prognosis. [ Read More ]

Regorafenib Active in Advanced GIST after Failing Standard Therapy

In the Literature

The treatment of metastatic gastrointestinal stromal tumor (GIST) was revolutionized with the introduction of imatinib as first-line therapy, with 60% control rates and median progression-free survival (PFS) of 27 weeks with sunitinib in the second-line setting. Neverthe less, resistance to tyrosine kinase inhibitor therapy eventually develops in the majority of patients with advanced GIST; no third-line therapy is yet approved. New data suggest that regorafenib, a unique inhibitor of several kinase-associated cancers, has a wide-range activity in this patient population (George S, et al. [ Read More ]

New Biomarker a Promising Development in Ewing’s Sarcoma

Value Propositions

A team of researchers from the University of Colorado led by Tyler Robin, PhD, Department of OB/GYN, Denver Anschutz Medical Campus, has discovered a new biomarker in Ewing’s sarcoma that explains the lack of disease response to current chemotherapy in some patients with this cancer, who until now have had a very poor prognosis. The identification of EYA3 protein as a novel biomarker—a mediator of chemoresistance—in Ewing’s sarcoma explains the mechanism of EYA3 overexpression as the culprit in the resistance to chemotherapy in this disease. [ Read More ]

First US Hospital Integrates Psychosocial Support Services in Its Cancer Center

Value Propositions

Greenville Hospital System (GHS) has launched the Center for Integrative Oncology and Survivorship, which offers emotional services for cancer survivors developed by Cancer Support Community (CSC), an international provider of cancer-related social and emotional services. “Research shows that social and emotional support is as important as medical care in the fact of a cancer diagnosis,” said Larry Gluck, MD, Medical Director, GHS Cancer Center, SC. [ Read More ]

Researchers Highlight Benefits of Exercise for Patients with Cancer

Value Propositions

Several researchers at the University of Rochester Medical Center have been studying the effects of exercise on patients with cancer for some time now.

“In 15 years, we have gone from being afraid to recommend exercise to people with cancer to having enough data that show, by and large, that it is safe and effective, particularly for relief of treatment side effects,” suggests Karen Mustian, PhD, MPH, Assistant Professor of Radiation Oncology, University of Rochester Medical Center, NY.

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ODAC Recommends Carfilzomib for Myeloma

FDA Approvals, News & Updates

The FDA’s Oncologic Drugs Advisory Committee (ODAC) recommended in an 11 to 0 vote (and 1 absentee) to approve carfilzomib (Kyprolis; Onyx), a new-generation proteasome inhibitor, for the treatment of patients with refractory and relapsed multiple myeloma who have failed at least 2 other myeloma therapies—the proteasome inhibitor bortezomib (Velcade) and the immunomodulatory drug lenalidomide (Revlimid).

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Unforeseen Hospital Admissions Are Frequent for Patients Receiving Radiotherapy

Wayne Kuznar

ASCO Annual Meeting

Approximately 1 in 5 patients with cancer who are undergoing radiotherapy as part of their treatment can count on unexpected hospital stays—adding an economic and clinical burden on the patient and on the healthcare system, according to an analysis by Nabeel H. Arastu, BS, and colleagues at the Brody School of Medicine at East Carolina University, Greenville, NC, which was presented at the 2012 ASCO meeting.

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High OOP Costs for Medicare Patients with Cancer

Mark Knight

ASCO Annual Meeting

Chicago, IL—Older patients with cancer and Medicare coverage often incur greater out-of-pocket (OOP) expenses compared with their counterparts without cancer. Factors contributing to the greater expenses for those patients include comorbidities and lack of supplemental insurance. As a result, older patients often hesitate to seek treatment for cancer because of financial concerns, according to a study presented by Amy J. [ Read More ]

Patients Willing to Pay Out of Pocket for Genetic Testing to Assess Colorectal Cancer Risk

Audrey Andrews

ASCO Annual Meeting

Chicago, IL—In a cohort of patients at risk for colorectal cancer (CRC), the majority were willing to pay some out-of-pocket (OOP) expenses for genetic testing, Fox Chase Cancer Center researchers reported in a poster that was presented at the 2012 American Society of Clinical Oncology (ASCO) meeting and earned an ASCO Merit Award.

“These participants are fearful of a positive result and anticipate benefits afforded by genetic testing in controlling cancer risk,” said Jennifer M. Matro, MD, a medical oncology fellow at Fox Chase in Philadelphia.

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Cancer Screening Saves Lives, Is Cost-Effective

Wayne Kuznar

ASCO Annual Meeting

Chicago, IL—Improved cancer screening can save lives, and despite the high cost of implementing such a measure, it was found cost-effective and therefore valuable in a recent analysis using quality-adjusted life-years (QALYs), said Michael S. Broder, MD, President of Partnership for Health Analytic Research, LLC (PHAR), CA, and colleagues, at the 2012 American Society of Clinical Oncology meeting.

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Endocrine Therapy Substantially Underutilized Among Low-Income Patients with Breast Cancer

Caroline Helwick

ASCO Annual Meeting

Chicago, IL—Researchers from the University of North Carolina in Chapel Hill reported at the 2012 American Society of Clinical Oncology meeting that endocrine therapy is substantially underutilized among the low-income breast cancer population.

For women with estrogen receptor (ER)-positive or progesterone receptor (PR)-positive disease, endocrine therapy reduces the 5-year recurrence risk by as much as 40%, but this study showed that low income may be an obstacle to receiving this guideline-recommended treatment.

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Tivozanib Outperforms Sorafenib as First-Line Treatment in Advanced Renal-Cell Carcinoma

Wayne Kuznar

ASCO Annual Meeting

Tivozanib, a potent investigational tyrosine kinase inhibitor with a long half-life, demonstrated significant improvement in progression-free survival (PFS) as first-line targeted therapy for metastatic renal-cell carcinoma (RCC), according to results from a phase 3 randomized, open-label trial.

The results suggest that “tivozanib should be considered a first-line treatment option for metastatic RCC,” said Robert Motzer, MD, an oncologist at Memorial Sloan-Kettering Cancer Center, New York, and the trial’s lead investigator.

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Chemotherapy-Related Toxicity Adds to Economic Burden in Metastatic Breast Cancer

Caroline Helwick

ASCO Annual Meeting

Chicago, IL—Adverse events (AEs) related to chemotherapy for metastatic breast cancer create a substantial economic burden that is primarily explained by increased inpatient, outpatient, and pharmacy costs, said lead investigator Sara A. Hurvitz, MD, Director of the Oncology Breast Can cer Program at University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center and Assistant Clinical Professor at UCLA School of Medicine, who presented an economic analysis at the 2012 Ameri can Society of Clinical Oncology meeting.

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Evidence-Based Guidelines/Pathways Critical for Value-Based Benefit Design in Oncology

Caroline Helwick

AVBCC Annual Conference

Houston, TX—There is no question that evidence-based guidelines and pathways are critical to the success of value-based oncology, but not all stakeholders have an equal voice, said Craig Deligdish, MD, Chief Medical Officer at Oncology Resource Networks of America at the Second Annual Meeting of the Association for Value-Based Cancer Care. The goals inherent in value-based oncology benefit programs include:

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Collaborate, Coordinate to Achieve Value in Oncology

AVBCC Annual Conference

Houston, TX—“Collaboration, coordination, data, and innovation are key to achieving value-based cancer care,” said Loreen M. Brown, MSW, Vice President of Reimbursement and Access Consulting, Xcenda, AmerisourceBergen Consulting Services.

Speaking at the Second Annual Conference of the Association for Value-Based Cancer Care, Ms Brown made the following points about the “evolving market” of oncology:

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Involving the Patient in End-of-Life Care Decisions: Aetna’s Oncology Strategy

Caroline Helwick

AVBCC Annual Conference

Houston, TX—Payer-sponsored programs that promote appropriate endof- life care are beneficial to all stakeholders, according to Ira M. Klein, MD, MBA, Chief of Staff to the Chief Medical Officer, Aetna Oncology Strategy.

At the Second Annual Conference of the Association for Value-Based Cancer Care, Dr Klein discussed advancedcare directives and emphasized that the patient and family “should be at the center of what you do.”

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Tough Times for Small Oncology Practices

Caroline Helwick

AVBCC Annual Conference

Houston, TX—Hard times are getting even tougher for small oncology practices, said Leonard Natelson, Chief Executive Officer, Hematology/Oncology Associates, Rockland, NY, at the Second Annual Conference of the Association for Value-Based Cancer Care.

Hematology/Oncology Associates is an independent practice of 5 physicians, which in the Northeast region is considered “large,” Mr Natelson said. He cited 5 main challenges facing community oncologists today:

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Pathways Offer Providers a True Value Proposition

Caroline Helwick

AVBCC Annual Conference

Houston, TX—“The key question on everyone’s mind is, how do we monetize the value of pathways?” said Peter G. Ellis, MD, Deputy Director of Clinical Services and Associate Chief Medical Officer, University of Pittsburgh Cancer Centers, PA, at the Second Annual Conference of the Association for Value-Based Cancer Care. Clearly, Dr Ellis said, the use of pathways has internal practice value.

Pathways:

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Oncology Genetic Testing: Pharmacists’ Knowledge Gap

AMCP Annual Meeting

San Francisco, CA—Knowledge of pharmacogenomics—the genomic factors contributing to individual variability in response to drug therapy (or personalized medicine)—enhances the ability to diagnose, prevent, and treat disease, especially a variety of cancers. The correct application of pharmacogenomics to patient management is essential for providing cost-effective care, but many providers, includ - ing physicians and pharmacists, are lacking appropriate knowledge of the science. [ Read More ]

Vemurafenib Does Not Impact Health Plan Budget

Caroline Helwick

AMCP Annual Meeting

San Francisco, CA—Although the upfront cost of vemurafenib is high, its use to treat patients with metastatic melanoma actually results in a costsavings per health plan member per month (PMPM), according to an analysis presented at the 2012 Academy of Managed Care Pharmacy annual meeting.

In a hypothetical health plan of 500,000 enrollees, the use of vemurafenib for the treatment of patients with BRAF V600E mutation is costsaving by $0.04 PMPM, reported William B. Wong, MS, PharmD, of the University of Washington, Seattle.

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Updated USPSTF Cervical Cancer Screening Recommendations

In the Literature

Cervical cancer remains an important public health issue. The US Preventive Services Task Force (USPSTF) has issued an update to its 2003 cervical cancer screening recommendations based on current evidence (Moyer VA, on behalf of the USPSTF. Ann Intern Med. 2012;156:880-891). The key updated points in the new guidelines include:

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Childhood Cancer Survivors at Risk for GI Cancers Later in Life: Screening Recommended

In the Literature

In childhood cancer survivors, subsequent malignant neoplasms are a leading cause of premature death, second only to recurrence of the primary cancer. The Childhood Cancer Survivor Study included a cohort of 14,337 childhood cancer survivors (which is believed to be the largest cohort of this type) and assessed the risk for gastrointestinal (GI) malignant neoplasms in this population (Henderson TO, et al. Ann Intern Med. 2012;156:757-766).

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New Test May Spare the Need for Surgery to Diagnose Thyroid Cancer

In the Literature

Diagnostic surgery is often used to evaluate the 15% to 30% of thyroid nodules that cannot be judged benign or malignant by the use of fine-needle aspiration (FNA). However, such surgery is associated with a 2% to 10% risk of serious complications. A new geneexpression test may soon be used for the diagnosis of such nodules, which could reduce the use of diagnostic surgery in this population (Alexander EK, et al. N Engl J Med. Epub 2012 Jun 25).

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In Colorectal Cancer, Treatment Efficacy Is High Among the Elderly

Caroline Helwick

AMCP Annual Meeting

San Francisco, CA—The vast majority of published evidence indicates that the relative treatment effect of chemotherapy for stage III colon cancer is as good for elderly patients as it is for younger ones, according to a systematic literature review by Anna Hung, a student in the program, and C. Daniel Mullins, PhD, Professor, Pharmacoeconomics, Pharmaceutical Health Services Research Department, Associate Director, Center on Drugs and Public Policy. The study was presented at the 2012 Academy of Managed Care Pharmacy annual meeting.

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Is Pemetrexed/Platinum Therapy Cost-Effective in NSCLC?

Audrey Andrews

AMCP Annual Meeting

San Francisco, CA—In what appears to be the first study to use real-world, non–clinical trial data to evaluate the cost-effectiveness of pemetrexed/platinum (Pem/P) therapy used first line in patients with advanced non–smallcell lung cancer (NSCLC), this combination trended toward being more effective and less costly than carboplatin/ paclitaxel plus bevacizumab (C/Pa+B), reported Manan Shah, PharmD, PhD, with Xcenda, Palm Harbor, FL, and colleagues at the 2012 Academy of Managed Care Pharmacy annual meeting.

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