Value-Based Cancer Care Issues


September 2012, Vol 3, No 6

Living Life to the Fullest, with Cancer

Palliative Care

Amy J. Berman, BS, RN, was diagnosed with incurable stage IV breast cancer almost 2 years ago. In the following interview, she discusses with Value-Based Cancer Care (VBCC) her recent experience, and why she chose to focus on quality of life rather than on the length of her life.

VBCC: Can you share with us your professional background, and how this relates to your cancer diagnosis and treatment decisions, and how this may also relate to other patients with cancer?

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New Calculator Shows Financial Impact of Poor Quality of Care to an Institution, and How to Correct It

Rosemary Frei, MSc

Head and Neck Cancer

Toronto, Canada—A Healthcare Qual­ity Calculator (HQCal) created by re­searchers at Vanderbilt University School of Medicine, Nashville, TN, allows decision makers to determine which investments are the most cost-efficient for improving quality of care, according to a new study presented at the 2012 International Conference on Head and Neck Cancer.

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Economics Impede Growth of Supportive Care Services

Phoebe Starr

MASCC Symposium

New York, NY—Supportive care is effective in improving outcomes, but the growth of supportive care programs is hampered by economics, explained Eduardo Bruera, MD, Chair, Palliative Care & Rehabili­tation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, speaking at the 2012 Multinational Association of Suppor­tive Care in Cancer International Symposium. “Financial distress is a huge elephant in the room,” Dr Bruera stated.

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Bosulif Approved for Ph+ CML

FDA Approvals, News & Updates

The US Food and Drug Admini­s­tration (FDA) approved the tyrosine kinase inhibitor bosutinib (Bosulif; Pfizer) for the treatment of patients with chronic, accelerated, or blast-phase Phila­delphia chromosome–positive (Ph+) chronic myelogenous leukemia (CML) who are resistant to or who cannot tolerate other therapies.

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FDA Expedited Approval of Xtandi for Prostate Cancer

FDA Approvals, News & Updates

The FDA expedited the approval of the androgen inhibitor enzalutamide (Xtandi; Astellas Pharma/Medivation) for the treatment of metastatic castration-resistant prostate cancer (CRPC) that has spread or recurred in patients previously treated with docetaxel chemotherapy or with surgery. En­zalutamide is designed to interfere with the ability of testosterone to bind to prostate cancer cells.

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Zaltrap Newest Drug for Metastatic Colorectal Cancer

FDA Approvals, News & Updates

The FDA approved the angiogenesis inhibitor ziv-aflibercept (Zaltrap; sanofi- aventis/Regeneron) for use in combination with a FOLFIRI (folinic acid,
fluorouracil, and irinotecan) che­mo­therapy regimen for the treatment of adults with metastatic colorectal cancer (CRC) whose tumors are resistant to
or progressed after an oxaliplatin-containing chemotherapy regimen.

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Carfilzomib Added to Multiple Myeloma Therapies

FDA Approvals, News & Updates

The FDA approved the proteasome inhibitor carfilzomib (Kyprolis; Onyx Pharmaceuticals) for the treatment of patients with multiple myeloma who have received at least 2 previous therapies that include the proteasome inhibitor bortezomib (Velcade) and one of the immunomodulatory drugs, thalidomide (Thalomid) or lenalidomide (Revlimid).

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Afinitor Gets the Nod for Metastatic Breast Cancer

FDA Approvals, News & Updates

The FDA approved the mTOR in­hib­itor everolimus (Afinitor; Novartis) for use in combination with exemestane (Aromasin) for the treatment of postmenopausal women with ad­vanced hormone-receptor–positive, HER2-negative breast cancer, who had disease recurrence or progression after receiving letrozole (Femara) or anastrozole (Arimidex). The approval was based on a study of 724 postmeno­pausal women with estrogen-receptor–positive, HER2-negative advanced breast cancer that had spread despite previous therapy with letrozole or anastrozole. [ Read More ]

The Number of Cancer Survivors on the Rise in the United States

Value Propositions

A recent report titled “Cancer Treatment & Survivorship—Facts & Figures, 2012-2012” was released earlier this year by the American Cancer Society, in association with the National Cancer Institute. According to this report, approximately 13.7 million Americans are alive in 2012 who have survived cancer. The researchers suggest that this number will reach 18 million by 2022. For this analysis, everyone who has ever been diagnosed with cancer by January 1, 2012, was counted as a cancer survivor.

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A New Molecular Cervical Cancer Test Will Aid Accurate Diagnosis

Value Propositions

Quest Diagnostics, the leading provider of diagnostic testing, has introduced a new laboratory test that identifies molecular changes to cervical cells that may signal increased risk for cervical cancer. “Given that medical guidelines now advise less frequent cervical cancer screening for women, it is more important than ever that testing for this cancer be highly reliable,” said Daniel M. Jones, MD, PhD, Medical Director, Cancer Diagnostics Services, Quest Diagnostics. [ Read More ]

NCCN Awards 5 Grants to Study Afatinib Efficacy in Several Solid Tumors

Value Propositions

The Oncology Research Program (ORP) of the National Com­prehensive Cancer Network (NCCN) has recently awarded 5 grants to study the clinical efficacy of the investigational oral drug afatinib in various settings in solid tumors, including breast, non–small-cell lung (NSCLC), and head and neck cancers. The NCCN awards were funded through a $2-million grant provided by Boehringer Ingelheim Pharma­ceuticals, the drug developer. Afatinib is currently in phase 3 clinical trials of patients with NSCLC, head and neck, and breast cancers.

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Physical Activity Can Lower Risk of Invasive Breast Cancer

Value Propositions

The largest research to date on the potential link between diet, lifestyle, and cancer prevention shows that being physically active, including through activities such as brisk walking, exercising, and gardening can help to reduce the risk of invasive, estrogen-receptor/progesterone-receptor–positive breast cancer. This information is based on data from 257,805 women in the European Prospective Investigation of Cancer (EPIC) study that collects information on occupational, recreational, and household physical activity. [ Read More ]

Anastrozole-Fulvestrant Combination Improves Survival in Metastatic Breast Cancer

In the Literature

The addition of fulvestrant—which downgrades the estrogen receptor—to the aromatase inhibitor anastrozole enhances progression-free survival (PFS) and overall survival (OS) in postmenopausal women with hormone-receptor (HR)-positive metastatic breast cancer compared with anastrozole monotherapy, according to results of a new study (Mehta RS, et al. N Engl J Med. 2012;367:435-444).

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Newer, More Effective Anti­cancer Drugs Increase Toxicity, Requiring Individualized Approach to Therapy

In the Literature

The FDA approval of new drugs for advanced solid tumors is relying heavily on demonstration of increased survival duration in phase 3 clinical trials. Most trials, however, are not designed to detect differences in quality of life (QOL) or in toxicity levels. A new meta-analysis reviewed pivotal clinical trials that have led to FDA approval of new anticancer drugs focusing on QOL outcomes in 3 areas—treatment-related differences in grade 3 or 4 adverse events (AEs), treatment discontinuation, and toxic deaths (Niraula S, et al. J Clin Oncol. 2012;30:3012-3019).

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Intermittent Androgen Deprivation as Effective as Continuous Therapy after Radiotherapy

In the Literature

Many studies have shown that cyclic androgen deprivation is associated with a reduction in toxic effects in patients with prostate cancer. Results of a new international study show that the use of intermittent androgen treatment after radiotherapy in patients with elevated prostate-specific antigen (PSA) levels is noninferior to continuous androgen treatment and leads to improvements in some QOL measures (Crook JM, et al. N Engl J Med. 2012;367:895-903).

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Observation as Good as Radical Surgery for Localized Prostate Cancer, Especially Low-Risk Cancer

Phoebe Starr

Prostate Cancer

In this era of upwardly spiraling healthcare costs, the management of low-risk prostate cancer is changing. Although approximately two thirds of men with a diagnosis of prostate cancer have a low prostate-specific antigen (PSA) value or low-risk disease, approximately 90% of these men receive early intervention, with surgery or with radiation. Findings from a new study from the Minneapolis Veterans Affairs Health Care System suggest that localized prostate cancer, especially low-risk cancer, can be safely managed by observation alone.

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Use of G-CSF Agents Prevents Febrile Neutropenia, but High Cost Limits Their Utilization

MASCC Symposium

New York, NY—Two major advances over the past decades have improved the management of febrile neutropenia (FN)—the MASCC (Multinational Association of Supportive Care in Cancer) scoring system for predicting the risk of FN, and the use of granulocyte colony-stimulating factors (G-CSFs) for the prevention of FN. However, the need for improvement still exists, said Jean Klastersky, MD, Professor, Institut Jules Bordet, Brussels, Belgium, at the 2012 MASCC International Symposium. Among the remaining challenges is refining the optimal use of these agents.

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Medicare Proposes Rewarding Quality, Cutting Payments for Oncology Providers

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

Health Policy

On July 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued the Physician Fee Schedule (PFS) and Hospital Out­patient Prospective Pay­ment System (HOPPS) proposed rules for fiscal year 2013. These rules include a number of proposed changes aimed at improving quality and promoting value in cancer care in the Medicare program. Although many of these changes are positive, a number of proposed cuts to payment rates, particularly to services performed by radiation oncologists, could have a devastating impact on oncology providers and patients.

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Molecularly Targeted Agents Have Lower Rates of Severe Diarrhea than Standard Chemotherapy

Phoebe Starr

Health Policy

New York, NY—Diarrhea is a common side effect of standard chemo­therapy, but the risk is less well characterized with molecularly targeted agents, which may add to the risk of diarrhea when combined with standard chemo­therapy, according to Lowell Anthony, MD, Professor of Medicine, University of Kentucky, and Chief of Medical Oncology, UK HealthCare, Lexington, who discussed this topic at the 2012 Multinational Association of Supportive Care in Cancer Inter­national Symposium.

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Carfilzomib a New Option for the Treatment of Patients with Relapsed, Refractory Multiple Myeloma Previously Treated with Bortezomib and an Immunomodulatory Agent

Lynne Lederman, PhD, Medical Writer

Drug Updates

Multiple myeloma (MM), a clonal malignancy of plasma cells, is responsible for 10% to 15% of all hematologic malignancies and for 20% of deaths resulting from hematologic cancers.1,2 In most patients, MM evolves from monoclonal gammopathy of undetermined significance (MGUS), an asymptomatic plasma-cell disorder. [ Read More ]

Use of Intensity-Modulated Radiotherapy Increasing and Costly in the Management of Head and Neck Cancers, but Value Unknown

Head and Neck Cancer

Toronto, Canada—The popularity of intensity-modulated radiotherapy (IMRT) for head and neck cancer has climbed rapidly in recent years. How­ever, the extra cost associated with this treatment modality may not equate with improved value, according to researchers from the University of California at Los Angeles (UCLA), who presented their analysis at the 2012 International Conference on Head and Neck Cancer.

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