Value-Based Cancer Care Issues


November 2012, Vol 3, No 8

Delta Air Lines’ Approach to Patient Care: High-Performance Cancer Networks

Caroline Helwick

AVBCC Annual Conference

?Houston, TX—Delta Air Lines has a commitment to preventive health and comprehensive cancer care for its 140,000 health plan members; the company is pi­loting a “high-performance cancer network,” said Lynn Zonakis, Managing Director of Health Strategy and Resources, Delta Air Lines, Atlanta, GA, at the 2012 Second Annual Conference of the Association for Value-Based Cancer Care. Ms Zonakis was part of the employers’ panel at the conference who presented perspectives from different employer groups related to cancer care.

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Oncotype DX Score Predicts Residual Disease after Chemotherapy

Audrey Andrews

Breast Cancer Symposium

?San Francisco, CA—The Oncotype DX Recurrence Score (the 21-gene) test can help identify patients with estrogen receptor (ER)-positive breast cancer with any number of positive lymph nodes who will have residual disease after adjuvant chemotherapy, and who may benefit from additional treatment, reported Eleftherios P. Mamounas, MD, Medical Director, Aultman Hospital Cancer Center, Canton, OH, at the 2012 Breast Cancer Symposium.

This new retrospective analysis was conducted by investigators from the National Surgical Adjuvant Breast and Bowel Project (NSABP).

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Stereotactic Body Radiation Therapy Cost-Saving, Convenient for Patients with Prostate Cancer

Phoebe Starr

ASTRO Annual Meeting

?Boston, MA—In the United States right now, intensity modulated radiation therapy (IMRT) has largely replaced 3-dimensional conformal radiation therapy as the technique of choice for most patients with organ-confined prostate cancer that is being treated with radiation as the primary therapy.

Another technique in use is brachytherapy, and, at some centers, proton beam therapy is being studied.

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Synribo approved for CML Abraxane for NSCLC

FDA Approvals, News & Updates

?Synribo Approved for Chronic Myelogenous Leukemia
The US Food and Drug Admini­s­tration (FDA) approved omacetaxine mepesuccinate (Synribo; Teva Phar­ma­­ceutical) to treat adults with chron­ic myelogenous leukemia (CML), a he­matologic disease. An estimated 5430 Americans will be diagnosed with CML in 2012, according to the Na­tional Institutes of Health.

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Statin Therapy Improves Survival in Patients with Cancer

In the Literature

It is well understood that cancer-cell proliferation encourages tumor growth and metastasis. It is also known that the use of statins blocks the production of cholesterol, and endogenous cholesterol is crucial for human cell proliferation. Linking these 2 disparate mechanisms, researchers in Denmark set out to investigate whether statin therapy can help to reduce cancer-related mortality by limiting cancer-cell proliferation in patients who have used statins before they were diagnosed with cancer (Nielsen SF, et al. N Engl J Med. 2012;367:1792-1802).

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Proton Beam Therapy: Similar Toxicity to Standard Radiation, at Much Higher Cost

Phoebe Starr

ASTRO Annual Meeting

?Boston, MA—The use of proton beam radiation therapy (PBRT) for the treatment of prostate cancer is increasing across the United States, but there is no evidence from randomized, controlled trials to suggest that PBRT is more effective than intensity modulated radiation therapy (IMRT), which is the current standard of care. A study presented at the 2012 American Society for Radiation Oncology annual meeting found few differences in toxicity between the 2 techniques, but demonstrated that PBRT was associated with a 57% increase in median cost per patient.

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A Rational Step in Holding Down Costs in Cancer Care

Alice Goodman

Economics of Cancer Care

?The cost of cancer care matters; in fact, it matters so much that Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City has decided not to include in its formulary the newly approved drug ziv-aflibercept (Zaltrap), which was re­­cently approved for use in patients with progressive metastatic colorectal cancer. The decision is based on considering cost versus benefit rather than on “newer is better.”

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Payers’ Support of Clinical Decisions Allows Providers to Choose Most Effective, Cost-Saving Therapies

Ira M. Klein, MD, MBA, FACP

VBCC Perspectives

?The cost of cancer care is staggering. Global sales of cancer drugs alone are forecast to grow at a rate of 12% to 15% annually, reaching $75 billion to $80 billion by the end of this year, according to IMS Health.1

Clinical leadership is one of the critical keys to controlling quality and costs in healthcare. Every other segment of the healthcare system also has a role to play. At Aetna, we work to influence the creation of safer, more effective, and more affordable healthcare through clinical evidence and unprecedented collaboration.

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How Will We Pay for Cancer Treatment?

Ted Okon, BS, MBA

VBCC Perspectives

?With the fanfare of a New York Times Op-Ed piece by Peter B. Bach, MD, and colleagues, the announcement was made that Memorial Sloan-Kettering Cancer Center (MSKCC) would ex­clude the new colorectal cancer drug ziv-aflibercept (Zaltrap) from its formulary. Regardless of questions raised about the accuracy of the cost and the dosing comparisons and certain conflicts, the question is—Will the MSKCC decision influence community oncology clinics to consider a similar restriction?

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The Missing Perspective in Personalized Cancer Care

Caroline Helwick

Personalized Medicine

?Vienna, Austria—The identification of genetic mutations and tumor biomarkers to select the right drug for the right patient are not enough to satisfy the need for personalized cancer care, according to Kathy Redmond, MSc, RN, Editor of Cancer World magazine, a publication of the European School of Oncology and former president of the European Oncology Nursing Society, who addressed the topic of personalized medicine at the 2012 European Society for Medical Oncol­ogy Congress.

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CMS Finalizes Payment Policies for 2013, Signaling a Shift toward Paying for Value

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

Health Policy

?In this article we address the final payment rules issued on November 1, 2012, by the Centers for Medicare & Medicaid Services (CMS), the Physician Fee Schedule (PFS), and the Hospital Outpatient Prospective Pay­ment System. These annual updates to Medicare payment rates for physicians and hospitals can have a dramatic impact on reimbursement and incentives within the Medicare program, but they also tend to impact trends in the commercial insurance market.

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Abraxane Receives New Indication for Locally Advanced or Metastatic Non–Small-Cell Lung Cancer, in Combination with Carboplatin, in Patients Who Are Not Candidates for Curative Surgery or Radiation Therapy

Lynne Lederman, PhD, Medical Writer

Drug Updates

?For the purposes of treatment, lung cancer is classified as non–small cell, which accounts for approximately 85% of cases, or as small cell, representing 14% of cases.1 Non–small-cell lung cancer (NSCLC) is the leading cause of death worldwide.2 The greatest risk factor for lung cancer is cigarette smoking. Other risk factors include smoking pipes or cigars and exposure to agents such as radon gas, secondhand smoke, asbes­tos, chromium, cadmium, arsenic, some organic chemicals, radiation, and air pollution. [ Read More ]

Newer, More Costly Radiation Technologies Adopted in Elderly Patients with Breast Cancer

Phoebe Starr

ASTRO Annual Meeting

?Boston, MA—The patterns of use of radiotherapy have changed over time in elderly patients with stage I breast cancer, and these changes have financial implications for the healthcare system. In elderly patients with favorable-risk breast cancer, the use of intensity modulated radiation therapy (IMRT) and brachytherapy steadily increased from 2001 to 2007, while the use of standard external beam radiation therapy (EBRT) decreased. Data are lacking on whether the new­er technologies improve outcomes in this patient population. [ Read More ]

Costly Acute Care Episodes Are Common for Patients with Early Breast Cancer

Breast Cancer Symposium

?San Francisco, CA—Acute care utilization, namely, emergency department visits and hospitalizations, are surprisingly common among patients with early breast cancer, according to a retrospective study using an administrative database in Ontario, Canada.

The findings coincide with current efforts, at least in the United States, to reduce acute care utilization as a chief means of reducing the cost of treating cancer. In fact, keeping patients with cancer away from emergency departments and hospitals has become a quality measure in many healthcare systems.

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No Increase in Leukemia or MDS with Adjuvant Chemotherapy for Breast Cancer

Audrey Andrews

Breast Cancer Symposium

?San Francisco, CA—According to a study from the US Oncology Network, patients with breast cancer who are treated with adjuvant chemotherapy have no increased risk for acute myeloid leukemia (AML) or myelo­dysplastic syndromes (MDS), at least within the first 3 years of treatment.

“The rates of AML/MDS were found to be low after adjuvant chemotherapy, and similar to those noted in nonchemotherapy-treated pa­tients,” reported Neelima Denduluri, MD, a medical oncologist at Virginia Cancer Specialists, Arlington, during the 2012 Breast Cancer Symposium.

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Employers’ Challenge: Cut Healthcare Costs Without Limiting Employees’ Benefits

Caroline Helwick

AVBCC Annual Conference

?Houston, TX—Employers’ health plan managers must “balance members’ access to new treatments with the fiscal responsibility of managing the healthcare financial resources wisely,” said Bridget Eber, PharmD, Senior Consultant and Clinical Lead of Rx Group Purchasing, Towers Watson, at the 2012 Second Annual Association for Value-Based Cancer Care Con­ference. Towers Watson’s clients in­clude 175 employers with self-funded benefits programs totaling $3 billion in annual drug spending.

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To Many Employers, Specialty Pharmacy Is a Vague Concept

Caroline Helwick

AVBCC Annual Conference

?Houston, TX—Most employers do not understand biologics and specialty pharmacy well enough to use services appropriately and to take advantage of their benefits, said F. Randy Vogenberg, RPh, PhD, Principal, Institute for Integrated Healthcare, Sharon, MA, an employer benefit consulting company.

Speaking at the Second Annual Association for Value-Based Cancer Care Conference, Dr Vogenberg drew from a recent survey of employers to suggest actions that need to be taken to better integrate healthcare stakeholders.

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Platinum-Resistant Ovarian Cancer: Bevacizumab Improves Survival When Added to Chemotherapy

Phoebe Starr

ESMO 2012 Conference

?Vienna, Austria—Adding bevacizumab (Avastin) to chemotherapy im­proves outcomes in patients with platinum-resistant recurrent ovarian cancer, according to results of the phase 3 clinical trial AURELIA, which was presented at the 2012 European Society for Medical Oncology Congress. Bevacizumab im­proved progression-free survival (PFS) and overall response rate (ORR) with any of the 3 chemotherapy regimens in the study, but adding bevacizumab to weekly paclitaxel was the most active combination in an exploratory analysis of the trial.

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