Value-Based Cancer Care Issues


May 2012, Vol 3, No 3

AVBCC Second Stakeholder Integration Conference

AVBCC Annual Conference

Houston, TX—On March 29-31, 2012, approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other stakeholders convened for the Second Annual Stakeholder Integration Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the central needs of defining value in cancer care and developing strategies for enhancing patient outcomes.

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Optimal Care for Patients with Cancer: Who Decides?

Audrey Andrews

NCCN Conference

Hollywood, FL—Cancer care today is influenced by an ever-broadening array of players, and what was once an intimate relationship between patient and physician now involves multiple decision makers. At the 2012 National Comprehensive Cancer Network (NCCN) meeting, a panel of various stakeholder groups addressed the questions of what and who defines “optimal care” for today’s patient. [ Read More ]

Payer Trends in Oncology: Challenges and Solutions

Caroline Helwick

AVBCC Annual Conference

Houston, TX—The need to optimize the treatment of patients with cancer while using healthcare resources wisely—in other words, providing “value-based cancer care”—is not a topic of debate, but how to achieve this pressing goal is far from clear. In a panel discussion during the Association for Value-Based Cancer Care’s Second Annual Conference, strategists from the payer side of the issue discussed the current trends and the challenges they are facing.

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Votrient Receives New Indication for Advanced Soft-Tissue Sarcoma

FDA Approvals, News & Updates

The US Food and Drug Administration (FDA) approved the oral agent pazopanib (Votrient; GlaxoSmith-Kline) for the treatment of patients with advanced soft-tissue sarcoma who have previously received chemotherapy. Pazopanib received orphan drug designation for this indication and is the first agent to receive approval for this indication in many years. Votrient works by interfering with the angiogenesis process (ie, the growth of new blood vessels that feed the growth/survival of solid tumors).

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Afinitor First Drug Indicated for Noncancerous Kidney Tumors

FDA Approvals, News & Updates

The FDA accelerated the approval of the oral mTOR kinase inhibitor everolimus (Afinitor; Novartis) for the treatment of kidney tumors (ie, renal angiomyolipomas) not requiring immediate surgery in patients with tuberous sclerosis complex (TSC). This is the first drug approved specifically by the FDA for this patient population.

TSC is a rare genetic disease causing noncancerous tumors in the kidney, brain, and other organs. There are approximately 40,000 patients with TSC in the United States, of whom 70% or 80% develop kidney problems.

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Are Higher Costs of Cancer Care in the United States versus Europe Worth It?

In the Literature

The United States spends more on cancer care than European countries. Some people have argued that this extra expense is unwarranted, because US patients with cancer have similar or worse outcomes despite this increased spending. However, data from a new study suggest that the higher spending for cancer in the United States than in 10 European countries may be worth the additional expense (Philipson T, et al. Health Aff [Millwood]. 2012;31:667-675).

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Cancer Therapies Given Preferential Status over Other Diseases in Assessing Value

In the Literature

Cancer is the most dreaded of all diseases, the authors of a new study suggest, which may explain why policymakers have sometimes given cancer therapies preferential status over therapies for other conditions (Neumann PJ, et al. Health Aff [Millwood]. 2012;31:700-708). However, some oncologists and health economists believe that pharmacoeconomic evaluations and reimbursement decision makers should judge cancer interventions by the same standards as those used for all other medical conditions. [ Read More ]

New Collaboration to Enhance Personalized Cancer Drug Development

Value Propositions

Genomic Health announced it has formed an alliance with OncoMed Pharmaceuticals to support the development of DNA-sequencing technologies in the search for diagnostic biomarkers that could identify patients who will best benefit from targeted drugs currently in development by OncoMed. These drugs are designed to block specific pathways believed to play a role in cancer-cell growth after chemotherapy.

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NIH Awards $10.5 Million to New Technologies for the Study of Molecular Genes

Value Propositions

The National Human Genome Research Institute (NHGRI), part of the National Institutes of Health (NIH), has awarded $10.5 million to 10 researchers to develop technologies that will assist research on millions of genomic elements that play a role in determining what genes are expressed, and at what levels in different cells. This has particular implications for cancer therapies.

These multiyear grants are part of the Encyclopedia of DNA Elements (ENCODE) project, which promotes research on the role that the human genome plays in health and disease.

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Vaccine Showing Antitumor Activity: A New Paradigm in Cancer Therapy?

Value Propositions

Injecting antibodies and T cells with cancer stem cells may signal a new paradigm for anticancer immunotherapy, according to a recent study.

“This is a major breakthrough in immunotherapy research, because we were able to use purified cancer stem cells to generate a vaccine, which strengthened the potency of antibodies and T cells that selectively targeted cancer stem cells,” said lead investigator Qiao Li, PhD, Research Assistant Professor, Department of Surgery, University of Michigan, Ann Arbor.

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Mevion S250 Proton Therapy System Lowers Costs, Approved in Europe

Value Propositions

The Mevion S250 Proton Therapy System has received marketing approval in Europe but is still pending clearance by the US Food and Drug Administration.

Proton-beam radiation therapy is most often used for cancer therapy, but it is not widely used and is very expensive. Several studies have shown promising results for this type of therapy for the treatment of locally advanced sinonasal malignancies; it has also been used to treat patients with unresectable hepatocellular carcinoma.

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The Michigan Oncology Medical Home Model

AVBCC Annual Conference

Houston, TX—In Michigan, 7 oncology practices are now participating in Priority Health’s oncology medical home. At the Association for Value-Based Cancer Care second annual conference, John Fox, MD, MHA, Associate Vice President for Medical Affairs, Priority Health, Grand Rapids, MI, described the key components and goals of this model.

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Society Must Begin to Address Value

AVBCC Annual Conference

At the Association for Value-Based Cancer Care (AVBCC) second annual meeting, Ira M. Klein, MD, MBA, maintained that establishing value in cancer care is not just up to healthcare strategists. AVBCC asked Dr Klein to elaborate on this idea in the following interview.

AVBCC: You mentioned that society and the individual are important components of any effort to lower cost and establish value in cancer care. How so?

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WellPoint: Aligning Reimbursement with Value-Based, Patient-Centered Outcomes

Caroline Helwick

AVBCC Annual Conference

Houston, TX—Jennifer Malin, MD, PhD, Manager and Medical Director of Oncology at WellPoint, described new approaches that can help to align reimbursement in oncology to enhance value and patient outcomes by focusing on episode of care rather than on the drugs, by shifting physicians’ incentives to support patient-centered decision-making.

Dr Malin described WellPoint’s new reimbursement programs in oncology at the 2nd Annual Conference of the Association for Value-Based Cancer Care.

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Site of Care Influences Value in Cancer Care

AVBCC Annual Conference

At the Association for Value-Based Cancer Care (AVBCC) second annual meeting, Winston Wong, PharmD, expressed concerns that the site of delivery of cancer care affects efforts to rein in costs and provide value in cancer care. Wong expanded on this issue in the following interview.

AVBCC: Why do you believe that the site of delivery of cancer care can impact the attempt to rein in costs of cancer care and provide value?

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Community Oncology in Crisis

Caroline Helwick

AVBCC Annual Conference

Houston, TX—In the past 2 decades, community oncologists have experienced an era of stability (1991-2003) and a time of adaptation (2004-2006), and are now practicing in an era that may best be described as feeling the “squeeze” (2007-present), said Thomas A. Marsland, MD, President of Cancer Specialists of North Florida, Jacksonville, who discussed the current crisis in the community oncology setting at the Association for Value-Based Cancer Care second annual conference.

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NCCN Clinical Practice Guidelines Update

Audrey Andrews

NCCN Conference

The 2012 updates to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology™ have elevated several drugs to category 1 recommendation and have changed the algorithm for work-up in some tumors. A synopsis of the key updates presented at the 2012 annual conference is reported here.

Breast Cancer

The breast cancer panel recommended a more conservative use of imaging modalities for assessing, staging, and conservative management of the axillae in selected patients.

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Cancer Diagnosis Increases Suicide Risk or CV Death in the First Few Weeks

NCCN Conference

Patients receiving a diagnosis of cancer are at increased risk for suicide and other adverse health effects that are triggered by the trauma associated with such a diagnosis, according to results of a recent study (Fang F, et al. N Engl J Med. 2012;366:1310-1318).

It has previously been shown that receiving a diagnosis of cancer is associated with a high level of psychological stress, but that has often been attributed to the stress associated with the treatment itself or to the burden of living with cancer.

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Updated NCCN Practice Guidelines in Oncology Include 3 New Panels

Audrey Andrews

NCCN Conference

The National Comprehensive Cancer Network (NCCN) introduced 3 new panels to its Clinical Practice Guidelines in Oncology™ at its 2012 annual conference. The key components of these new guidelines are described below.

New Panel on Lung Cancer Screening

The new Lung Cancer Screening Panel recommended that persons at risk for lung cancer be screened regularly (in some cases, annually) with helical low-dose computed tomography (LDCT) in an effort to detect cancer at its earliest stage.

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eviti: Decision Support at the Point of Care for Oncologists

Arlene A. Forastiere, MD

Oncology

An independent health information technology company, eviti, Inc, provides a suite of web-based decision-support services that connects and delivers value to all parties in the care process—patients receive quality care, physicians are assured payment, insurers pay for quality care only, and pharmacy benefit managers (PBMs) or specialty pharmacy improve adherence. This decision support platform is a transformative solution that reduces variability in care, improves quality, and enables realignment of provider incentives.

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Cost-Containment Efforts Top Trend in Community Cancer Centers

Neil Canavan

ACCC Annual Meeting

Baltimore, MD—Results from the latest survey of the Association of Community Cancer Centers (ACCC) membership suggest that although cancer centers have stepped up their efforts to introduce cost-reduction and revenue-enhancing initiatives, the rising tide of underinsured or uninsured patients with cancer is straining even the most optimistic of business plans.

The survey, Cancer Care Trends in Community Cancer Centers, has been conducted annually for the past 3 years. A total of 59 community cancer programs participated in this survey.

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Metformin Protects Against Several Cancers

Richard Hyer

AACR Annual Meeting

Chicago, IL—Metformin cannot seem to stay out of the news. This antidiabetes drug that is derived from the French lilac is now also thought to possibly protect against liver cancer, lower the risk for oral cancer, improve prognosis of pancreatic cancer in diabetic patients, and increase response to melanoma tumors with BRAF mutations when used in combination with a common cancer drug, according to several studies presented at the 2012 American Association for Cancer Research meeting.

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Evolving Practice Standards for Cancer Programs from the Commission on Cancer

M. Asa Carter, CTR

Uncategorized

What is the most important challenge faced by a person who is diagnosed with cancer today? Opinions will differ, but most patients want to be assured that they will work with a group of multispecialty physicians who will provide recommendations for care that provide the best possible outcomes, that all options for effective treatment will be available to them, that care will be provided in a safe and comfortable hospital or other facility, and that the healthcare staff will care about their problems and concerns with managing treatment, professional issues, and family issues.

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