Value-Based Cancer Care Issues


March 2013, Vol 4, No 3

Evaluating Payer Restrictions on Prostate Cancer Treatments

Melinda C. Haren; Kati Sadiwnyk; Joseph Tucciarone

AVBCC 2013 3rd Annual Conference Abstracts

Background: According to the National Institutes of Health, medical expenditures are projected to reach $158 billion by the year 2020. This represents a 27% increase from 2010 costs. Prostate cancer is in the top 5 contributors of this cost, and is projected to reach $12 billion. Advancements in drugs, surgery, and radiation therapy have all contributed to an increase in costs. Payers are feeling increased pressure to make cost-effective choices among these agents.

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Knowledge Gaps and Value-Based Oncology Coverage Related Findings from the 2012 National Employer Survey

F. Randy Vogenberg, PhD, RPh, FASHP; Cheryl Larson, BA

AVBCC 2013 3rd Annual Conference Abstracts

Background: Healthcare costs are a continued concern among employers and other purchasers, and extend especially to biologics that are being increasingly scrutinized to demonstrate value over time. A significant cost challenge to employers, these drugs create logistical issues for patients, physicians, pharmacies, and manufacturers owing to their unique approval requirements, dosing, side effects, and distribution methods. The costs of biologics are also hard to track, because they show up in medical as well as pharmacy expenditures.

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Ochsner CEO Calls for Adding Value in Healthcare

Caroline Helwick

Health Policy

New Orleans, LA—“We must start to think differently if we want to change the healthcare system,” said Ochsner Health System President and CEO Warner L. Thomas, CPA, MBA, FACHE, in a keynote address at the 2013 Health Information and Management Systems Society (HIMSS) annual conference. “We are seeing the most significant changes in healthcare in 30 years.”

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Onyx Pharmaceuticals 360™: A Support Program for Patients with Multiple Myeloma and Their Caregivers

Vicki Kennedy, LCSW; Joanne Buzaglo, PhD; Jennifer Sharretts, MBA Cancer Support Community, Washington, DC; Onyx Pharmaceuticals, Inc, South San Francisco, CA

AVBCC 2013 3rd Annual Conference Abstracts

Background: In 2007, the Institute of Medicine’s Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs outlined a framework to integrate psychosocial health services into routine care for patients with cancer. [ Read More ]

SNPs in Genes Affect Quality of Life Related to Radiation in Men with Prostate Cancer

Phoebe Starr

Personalized Medicine

Orlando, FL—Novel candidate single nucleotide polymorphisms (SNPs) in genes that are associated with inflammation have been identified and will be explored further with regard to their role in long-term quality-of-life (QOL) effects of radiation in men with prostate cancer, according to new research presented at the 2013 Genitourinary Cancers Symposium. The investigators found 7 SNPs that were significantly associated with long-term QOL outcomes after radiation, but these SNPs did not retain statistical significance in a comparator group of men treated with radical prostatectomy.

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Pomalidomide: A New Third-Generation Immunomodulatory Drug for Relapsed and/or Refractory Multiple Myeloma

Lynne Lederman, PhD, Medical Writer

Drug Updates

Multiple myeloma (MM) is characterized by the clonal expansion of malignant plasma cells that proliferate in the bone marrow, which typically produce large amounts of an abnormal immunoglobulin-like protein.1,2 The etiology of MM is unknown, but is associ­ated with exposure to particular chemicals or to radiation and with being overweight or obese.3,4 MM is often preceded by monoclonal gammopathy of undetermined significance, an asymptomatic plasma-cell disorder, which may progress through asymptomatic smoldering MM before becoming symptomatic MM.2,5

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Adding Rituximab to Chlorambucil Improves Event-Free Survival in Patients with MALT Lymphoma

In the Literature

Approximately 8% of patients with non-Hodgkin lymphoma have extra­nodal marginal-zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). The condition can occur in any extranodal location, although the stomach is the most frequent site. There is currently no standardized treatment for advanced cases of extranodal MALT lymphomas. Although eradication of Helicobacter pylori has been shown to be successful in treating localized gastric involvement, no consensus exists about the optimal treatment for patients with extensive MALT lymphoma. [ Read More ]

Screening Colonoscopy Reduces the Risk for Incident Late-Stage CRC in Average-Risk Persons

In the Literature

Evidence is lacking regarding the efficacy of colonoscopy screening in reducing the incidence of and death from colorectal cancer (CRC) in persons with average risk. By contrast, the evidence for the efficacy of sigmoidoscopy or fecal occult blood test (FOBT) has been established. Nevertheless, and despite the high cost of colonoscopy and the potential risks associated with this procedure, colonoscopy is rapidly replacing sigmoidoscopy and FOBT in the United States as the standard screening test for CRC. [ Read More ]

The Burden of Colorectal Cancer

In the Literature

Colorectal cancer (CRC) is the third most common cancer among men and women in the United States, which highlights the need for early diagnosis and treatment of CRC. Late diagnosis of this type of cancer is a main cause of CRC related mortality.

When looking at men and women separately, CRC is the third most common cause of cancer-related death among US men and among US women. However, when combining cancer-related deaths in men and women as 1 group in the United States, CRC rises to the second most common cause of death among all types of cancer.

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Budgetary Impact of Adding Ziv-Aflibercept to a Health Plan Formulary as a Post-Oxaliplatin Biologic Option for Treating Patients with Metastatic Colorectal Cancer

Xin Gao, PhD; Mei Xue, MBA; Dan Hennessy, PhD; Susan Pacconi; Edward Drea, PharmD; Stephen F. Thompson, MS; Pharmerit North America LLC, Bethesda, MD; Sanofi, Bridgewater, NJ

AVBCC 2013 3rd Annual Conference Abstracts

Background: Advanced colorectal cancer treatment options are evolving with a multitude of chemotherapeutic agents, biologics (both epidermal growth factor receptor inhibitors and anti-angiogenic agents), and a newly approved tyrosine kinase inhibitor available to treat metastatic colorectal cancer (mCRC) patients.

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Cesium-131 (Cs-131) Brain Brachytherapy (BT) Post Resection: A Preliminary Cost Comparison Analysis with Other Radiation Therapy

Emad Youssef, MD; Theresa Thomas, MSc; Heyoung Mcbride, MD; David Brachman, MD

AVBCC 2013 3rd Annual Conference Abstracts

Background: Radiation therapy is considered the main line of treatment after resection of brain metastases, atypical meningioma or primary brain tumors. Different techniques are used for radiation therapy, including intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS). The use of SRS in patients with brain metastases increased significantly especially with conflicting data about the survival benefit of whole brain radiation (WBRT). [ Read More ]

Cost-Effectiveness of Denosumab versus Zoledronic Acid in an Ambulatory Oncology Clinic

Dhimant Patel, MD; Jessie Lawton, PharmD, BCOP; Jordan Kennedy, PharmD Candidate; Stephanie Shuey, PharmD; Amy Kamien, PharmD; Jeff Waise, PharmD

AVBCC 2013 3rd Annual Conference Abstracts

Background: Denosumab and zoledronic acid (ZDA) are used in the management of bone metastases and osteopenia secondary to hormonal therapy in patients with cancer. Study results range from suggesting similar efficacy between the two agents to possible superiority of denosumab in certain populations. [ Read More ]

Payer Current and Future Utilization of Pathways: A Research Study

Rhonda Greenapple, MSPH, Reimbursement Intelligence

AVBCC 2013 3rd Annual Conference Abstracts

Background: Clinical pathways are a growing payer management technique for controlling costs and standardizing care. Their use in other therapeutic areas has helped payers control costs and standardize care; however, use of pathways in oncology has not been assessed.
Objective: To determine trends in payer use of pathways in management of oncology therapies and to identify specific tumor types that are current and future focuses in pathway design.

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Evaluating Payer and Physician Adherence and Understanding of Clinical Pathways and Guidelines in Oncology Treatment

Lee Goldberg; Shaili Shah; Cassandra Habura

AVBCC 2013 3rd Annual Conference Abstracts

Background:  Clinical pathways have been in existence since the 1980s1  to guide treatment of oncology patients based on established treatment evidence. Despite their tenure in the healthcare space, there is still much debate over the implementation and use of clinical pathways in medical practices. Faced with rising healthcare costs, payers have begun to show a greater interest in clinical pathways as a utilization management tool and as a way to control costs.

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Anemia-Related Costs and Adverse Event Rates in Cancer Patients Who Do Not Respond to Erythropoietin Stimulating Agents

Allicia Girvan; Gerhardt Pohl; Yiu-Keung Lau; Pamela Landsman-Blumberg; Nianwen Shi; Helen Varker; Paul Juneau; Lee Bowman

AVBCC 2013 3rd Annual Conference Abstracts

Background: While broadly utilized for treatment of anemia in cancer patients, treatment with erythropoietin stimulating agents (ESA) is not recommended in patients who fail to respond within 6-8 weeks.

Objective: This study examined the rate of adverse events (AE) and costs of continued exposure to ESAs in the absence of clinical response compared to those responding to ESA treatment.

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Introducing the Third Annual Conference of the Association for Value-Based Cancer Care

Burt Zweigenhaft, BS

AVBCC 2013 3rd Annual Conference

As we know, the American healthcare system is going through exorbitant changes, changes that will affect all providers and all stakeholders in the cancer care ecosystem. The goal of the Association for Value-Based Cancer Care (AVBCC) is to bring together all the cancer care stakeholders in one unified meeting to discuss the many issues facing us today. One of the main objectives of the AVBCC Annual Conference is to be able to map out and help guide our members and attendees through the various changes in the US healthcare system.

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Healthcare of Tomorrow: Digital, Genomic, and Patient-Focused

Caroline Helwick

Health Policy

New Orleans, LA—As a leader in the movement to modernize healthcare through the latest technology, Eric J. Topol, MD, the Gary and Mary West Endowed Chair of Innovative Med­icine, Professor of Genomics, Depart­ment of Molecular and Experimental Medicine,  Scripps Research Institute, La Jolla; Director of the Scripps Translational Science Institute, La Jolla; and Chief Academic Officer, Scripps Health, San Diego, CA, proposes creative and effective ways to treat patients that will also dramatically reduce the cost of care.

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Transforming Cancer Care by Controlling Costs and Improving Outcomes

Craig Deligdish, MD

From the Editor

Value Based Cancer Care (VBCC) was first published in May 2010, and the first annual meeting of the Association of Value-Based Cancer Care took place in May 2011. During the past 3.5 years, this publication and its annual meeting have provided a forum for stakeholders to address important issues that impact the value proposition facing patients with cancer, providers, and payers in an open and challenging fashion. Both the annual meeting and VBCC have focused on a dialogue around strategies for optimizing value in cancer care delivery.

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ASCO Shines Light on Palliative Care: New Online Program Will Translate Latest Research into Practice

Value Propositions

ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) have announced the launch of a new collaboration to promote the delivery of high-quality palliative care for patients with advanced cancer. The 3-year project will focus on the complex needs of patients with advanced cancer that involve relieving cancer-related symptoms for this patient population. The initiative will create a web-based platform to disseminate evidence-based palliative care approaches in oncology. [ Read More ]

New Biomarkers May Soon Help the Early Diagnosis of Renal-Cell Cancer, Reduce Mortality

Value Propositions

A new immunoassay to detect the presence of 3 biomarkers is under review by the US Food and Drug Administration (FDA) and may soon become available to help the early diagnosis of renal-cell carcinoma. This test is based on the identification of 3 biomarkers for renal-cell cancers: nicotinamide N-methyltransferase (NNMT), L-plastin (LCP1), and nonmetastatic cells 1 protein (NM23A). New data published in March (Kim SD, et al. Cancer Epidemiol Biomarkers Prev. [ Read More ]

With Cost of Gene Sequencing Declining, a New Algorithm Brings Predictive Modeling Closer to Practice

Value Propositions

Two researchers at the University of Southern California (USC) developed a new algorithm that may soon bring gene sequencing closer to clinical practice by predicting the value of DNA sequencing and making it less costly. “It seems likely that some clinical applications of DNA sequencing will become routine in the next five to ten years,” said Andrew Smith, a computational biologist at USC. “For example, diagnostic sequencing to understand the properties of a tumor will be much more effective if the right mathematical methods are in place.”

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New Breast Cancer Drug a Projected Blockbuster, with Annual Cost of Approximately $94,000

Value Propositions

The recently FDA-approved antibody-drug conjugate trastuzumab emtansine (Kadcyla; Roche/Genentech), also known as T-DM1, for patients with advanced HER2-positive breast cancer is expected to become the new blockbuster therapy for patients with breast cancer. This drug will cost $9800 monthly and approximately $94,000 for a course of therapy lasting 9.5 months. Projected peak sales for this drug have ranged from $2 billion to $5 billion annually. [ Read More ]

Copper Depletion Therapy May Prevent Tumor Metastasis in High-Risk Triple-Negative Breast Cancer

Value Propositions

Results of a small, phase 2 study conducted by researchers from Weill Cornell Medical Center show promising benefits of an anti-copper medication (tetrathiomolybdate) in preventing the migration of tumor cells in patients with high-risk triple-negative breast cancer. The median survival for patients with metastatic triple-negative breast cancer is 9 months. The results of this study show that depleting copper in patients with triple-negative breast cancer who are at high risk of relapse extends event-free survival considerably. [ Read More ]

Pomalidomide Receives Accelerated Approval for Myeloma

FDA Approvals, News & Updates

The US Food and Drug Admini­stration (FDA) accelerated the approval of pomalidomide (Pomalyst capsules; Celgene) for the treatment of patients with multiple myeloma who have received at least 2 previous myeloma therapies, including lenalidomide (Revlimid) and bortezomib (Velcade), and whose disease progressed while receiving these therapies or within 60 days of stopping the last therapy.

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Trastuzumab Emtansine the Newest Therapy for Late-Stage HER2-Positive Breast Cancer

FDA Approvals, News & Updates

The antibody-drug conjugate (ADC) ado-trastuzumab emtansine (Kadcyla; Genentech), better known as T-DM1, is the fourth drug approved by the FDA for the treatment of patients with late-stage HER2-positive breast cancer, but this drug offers a new mechanism of action by combining the previously approved drug trastuzumab (Herceptin) for the treatment of HER2-positive disease with ADC technology that targets cancer cell growth more directly and has shown improved survival in clinical trials. [ Read More ]

Radium-223 Granted Priority Review by FDA

FDA Approvals, News & Updates

The FDA has granted priority review to radium-223 (radium-223) dichloride (Bayer), formerly known as Alpharadin, for the treatment of patients with prostate cancer. The New Drug Application for radium-223 is being reviewed for the treatment of patients with castration-resistant prostate cancer (CRPC) with bone metastases. [ Read More ]

Postorchiectomy Surveillance Less Cost-Effective than Other Management Options

Phoebe Starr

Health Economics

Orlando, FL—Para-aortic radiotherapy, dog leg radiotherapy, and 1 cycle of carboplatin (Paraplatin) are cost-effective options for the treatment of patients with stage I testicular seminoma, but surveillance is not a cost-effective option, according to a cost analysis that factored in reimbursement costs for salvage bleomycin (Blenoxane), etoposide phosphate (Etopophos), and platinum (BEP) chemotherapy after a potential relapse. This analysis was presented at the 2013 Genitourinary Cancers Symposium.

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Robotic Gastrectomy No Better, but More Costly, than Laparoscopic Surgery

Charles Bankhead

Health Economics

San Francisco, CA—Patient survival after minimally invasive gastrectomy was identical with robotic-assisted and conventional laparoscopic surgery, according to data from a large patient series that was presented at the 2013 Gastrointestinal Cancers Symposium.

Similar Outcomes
Both techniques led to 5-year 94% overall survival and 92% disease-free survival rates. Disease stage did not significantly alter survival results.

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Similar Outcomes with 18 Months versus 36 Months of Androgen Ablation Added to Radiation in High-Risk Prostate Cancer

Phoebe Starr

Genitourinary Cancers Symposium

Orlando, FL—Similar overall survival (OS) and disease-specific survival were achieved after 18 months of androgen ablation therapy compared with 36 months when combined with radiation therapy as primary therapy for patients with high-risk prostate cancer. A shorter course of androgen ablation has the potential to reduce unwanted side effects and to improve quality of life, and it may reduce the cost of prostate cancer therapy, according to the results of a phase 3 clinical trial reported at the 2013 Genitourinary Cancers Symposium.

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Surveillance an Option for Small Renal Masses in the Elderly

Phoebe Starr

Genitourinary Cancers Symposium

Orlando, FL—Surveillance for small renal masses achieves similar outcomes in the elderly compared with the standard approach of surgery, according to a large retrospective analysis reported at the 2013 Genitourinary Cancers Symposium. These findings suggest that both the costs and the complications associated with surgery can be avoided in elderly patients, especially patients with a shorter life expectancy and/or comorbid conditions.

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Targeted Therapies Added to Docetaxel Don’t Extend Survival in Metastatic Prostate Cancer

Phoebe Starr

Genitourinary Cancers Symposium

Orlando, FL—The latest in a string of failed trials of targeted therapies added to docetaxel (Taxotere) in patients with metastatic castration-resistant prostate cancer (mCRPC) were presented at the 2013 Genitourinary Cancers Symposium. No survival benefit was observed with the addition of aflibercept (Zaltrap) to do­ce­taxel plus prednisone in the VENICE trial or with the addition of dasatinib (Sprycel) to docetaxel plus prednisone in the READY trial.

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What Does the Deficit Reduction Debate Mean for the Oncology Team?

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

Health Policy

First it was the debt ceiling, then it was the fiscal cliff, and now we have sequestration. It seems that as the weeks go by, Washington is faced with one fiscal crisis after another, with little to no progress in making a meaningful dent in the ballooning deficit. No matter what your political leanings, this has been a frustrating process to watch unfold. [ Read More ]

Building a Successful Navigation Program

Lori McMullen, RN, MSN, OCN

AVBCC 2013 3rd Annual Conference Abstracts

Background: Dealing with a cancer diagnosis is emotional and overwhelming; patients are suddenly faced with the difficult task of making healthcare decisions as an ensuing barrage of tests and consultations present them with treatment decisions which are often complex and confusing. Further complicating this process are potential barriers to care such as being under- or un-insured, or having issues with transportation, health literacy, eldercare, childcare, cultural differences, or psychosocial concerns. [ Read More ]

Impact of a Cancer Management Program

J. Russell Hoverman, MD, PhD; Diana K. Verrilli, MS; Jessica McQueen; Mitra Abdullahpour, RN, BSN, OCN; Melissa Jameson, RN, BSN, OCN; Cynthia Taniguchi, RN, BSN, OCN; John Ciaglo; Scott Houldin; Maria Sipala; Jean Stratton; Jody S. Garey, PharmD; Greg C. Nelson; Jad Hayes, MS, ASA, MAAA; Deb Harrison, MS, RN; Roy Beveridge, MD

AVBCC 2013 3rd Annual Conference Abstracts

Background: US Oncology, Inc. and Aetna are engaged in a pilot program, Innovent Oncology (IOP) to evaluate clinical and financial impacts of Pathways (PW), a nursing call intervention for chemotherapy patients (patient support services [PSS]), and an advanced care planning (ACP) initiative. We report quality initiatives, PW compliance, and ACP, from the program at 18 months, and inpatient (IP) and emergency department admissions at 12 months.

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Low Incidence of Treatment-Induced Peripheral Neuropathy (PN) in Patients with Relapsed and Refractory Multiple Myeloma (RRMM) Treated with Single-Agent Carfilzomib

Thomas Martin; Ravi Vij; Ashraf Z. Badros; Leanne McCulloch; Sundar Jagannath University of California-San Francisco, San Francisco, CA, USA; Washington University School of Medicine, St. Louis, MO, USA; Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA; Onyx Pharmaceuticals, South San Francis

AVBCC 2013 3rd Annual Conference Abstracts

Background: Treatment of patients with RRMM can be challenging because of debilitating PN caused by the disease itself or by MM treatments. Neuropathy at diagnosis is prevalent (20–54%, depending on evaluation type [Richardson PA, et al. J Clin Oncol. 2009]) and can commonly be exacerbated by MM treatments (eg, bortezomib- or thalidomide-induced PN; BIPN or TIPN). PN reduces quality of life and leads to increased PN-related healthcare expenditures (eg, diagnostic testing and pharmaceutical and non-pharmaceutical interventions [Snowdon JA, et al. [ Read More ]

Effects of 5-Hydroxytryptamine-3 Receptor Antagonists (5-HT3 RAs) in Lung Cancer Patients with Multiple Risk Factors

Claudio Faria; Russell Knoth; Annette Powers. Eisai, Inc. Woodcliff Lake, NJ 07677

AVBCC 2013 3rd Annual Conference Abstracts

Background: Chemotherapy induced nausea and vomiting (CINV) is a major adverse effect of cancer treatment. The 5-HT3 RAs are indicated for the prevention of CINV. Certain factors such as age <50 years, female gender, prior CINV, anxiety, no or minimal alcohol use, history of motion sickness, and emetogenicity of chemotherapy have been associated with increasing the likelihood of a CINV event. We examined the impact of palonosetron vs. other 5-HT3 RAs on incidence of delayed CINV at cycle 1 based on presence of certain risk factors in patients with Lung Cancer.

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Chemotherapy-Induced Nausea and Vomiting in Lung Cancer Patients Receiving 5-HT3-RA Therapy throughout Chemotherapy Cycles

Faria C; Nagl N; Powers A. Eisai, Inc. 100 Tice Blvd. Woodcliff Lake, NJ 07667

AVBCC 2013 3rd Annual Conference Abstracts

Objective: Current guidelines support the use of 5-HT3-RAs for chemotherapy-induced nausea and vomiting (CINV). Controlling CINV upon chemotherapy initiation is important as the likelihood of CINV in future chemotherapy cycles increases if a patient experiences CINV in the first/previous chemotherapy cycle. The purpose of this study was to evaluate the overall rate of CINV, and compare the odds of CINV per chemotherapy cycle in patients with lung cancer receiving the same 5-HT3-RA throughout chemotherapy cycles.

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An Assessment of Racial Differences in Toxicities and Supportive Care in Patients with Metastatic Breast Cancer (MBC)

George Dranitsaris; Nancy Beegle; Traci Kalberer; Zhixiao Wang; Claudio Faria; Sibel Blau

AVBCC 2013 3rd Annual Conference Abstracts

Background: Racial disparities in clinical outcomes between Caucasian and African American (AA) MBC patients have been identified. Some of these disparities may be attributed to differences in toxicities and access to supportive care interventions. In this study, treatment toxicities and use of supportive care were compared between Caucasian and AA MBC patients treated in 15 community oncology practices across the United States.

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Impact of Treatment Modification on Treatment Duration in Metastatic Breast Cancer Patients Treated with Eribulin Mesylate

AVBCC 2013 3rd Annual Conference Abstracts

Introduction: EM is a microtubule inhibitor shown to improve overall survival in metastatic breast cancer patients who have previously received at least two chemotherapeutic regimens for the treatment of metastatic disease. There are side effects of EM, including neutropenia, anemia, asthenia/fatigue, alopecia, peripheral neuropathy, nausea, and constipation. While some physicians discontinue treatment due to side effects, others manage side effects using dose delays/skipped doses and/or dose modifications. [ Read More ]

Impact of Granulocyte Colony-Stimulating Factor and Treatment Modification on Eribulin Mesylate Therapy in Metastatic Breast Cancer Patients with Neutropenia

Gluck S; Yardley D; Belk K; Craver C; Cox D; Faria C; University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Tennessee Oncology, PLLC, Nashville, TN; MedAssets, Inc., Charlotte, NC; Eisai Inc., Woodcliff Lake, NJ

AVBCC 2013 3rd Annual Conference Abstracts

Background: Eribulin mesylate (EM) is a microtubule inhibitor shown to improve survival in patients with metastatic breast cancer (MBC) who have previously received at least two chemotherapeutic regimens for the treatment of metastatic disease. A common grade 3/4 toxicity of EM is neutropenia which may result in dose adjustments and dose delays. To minimze neutropenic complications, granulocyte colony-stimulating factor (GCSF or GMCSF) may be utilized, as well as dose modifications or treatment discontinuation. [ Read More ]

Say Ahh! Making Sense of Oral Assessments for Mucositis

Joanne Growney, MA, RN, ANP-BC, OCN; Rebecca Martin, BSN, RN, OCN; Phyllis McKiernan, RN, MSN, APN-BC; Joan Collela, RN, DNP, APN-BC, NP-C; Claudia Douglas, RN, MA, CNN, APN-C

AVBCC 2013 3rd Annual Conference Abstracts

Background: Chemotherapy and radiation therapy, the mainstays of current cancer treatment, often result in devastating side effects involving the oral cavity. Mucositis, an inflammatory and/or ulcerative lesion of the oral and/or gastrointestinal tract is a common therapy-related toxicity. Mucositis significantly impacts patients’ overall physical and functional well-being, as well as quality of life. [ Read More ]

Imatinib Can Still Be Used as 1st-Line for Treating Chronic Myelogenous Leukemia

Wesley Wong, PhD

AVBCC 2013 3rd Annual Conference Abstracts

Background: The introduction of tyrosine kinase inhibitors (TKIs) into clinical practice resulted in a very dramatic prolongation of survival for most, but not all patients with chronic myeloid leukemia (CML) in chronic phase. If properly managed, and if adherence is greater than 80%, the 10-year survival rate reaches 85% for patients treated with the 1st-generation (Gen) TKI, imatinib (Gleevec). Currently, there are five TKIs available for CML. Clinicians must weigh the relative advantages and toxicities of each when selecting a course of treatment. [ Read More ]

Cost Analysis of Bortezomib Retreatment Compared with Switching to Carfilzomib in Patients with Relapsed Multiple Myeloma Previously Treated with Bortezomib

Kevin B. Knopf, MD, MPH; Marie-Hélène Lafeuille, MA; Jonathan Gravel, MS; Patrick Lefebvre, MA; Liviu Niculescu, MD; Abbie Ba-Mancini, MBA; Esprit Ma, MPH; Mei Sheng Duh, MPH, ScD

AVBCC 2013 3rd Annual Conference Abstracts

Background: In an era of multiple effective treatment options for relapsed/refractory multiple myeloma (MM), a recent meta-analysis has shown that retreatment with bortezomib continues to be an effective option in previously treated patients who relapsed. As economic pressures rise in oncology, it is important to evaluate the cost-effectiveness of newer therapies relative to standards of care. Carfilzomib was recently approved by the US Food and Drug Administration for the treatment of relapsed/refractory MM.

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Cost Considerations for New Oral Therapies for Patients with Metastatic Castration Resistant Prostate Cancer (mCRPC) Previously

Lorie A. Ellis; Zoe Clancy; R. Scott McKenzie; Mekre’ Senbetta

AVBCC 2013 3rd Annual Conference Abstracts

Background: Two oral agents for mCRPC patients who previously received docetaxel were recently approved by the US Food and Drug Administration—abiraterone acetate plus prednisone (AA+p) and enzulatamide (EN). Phase 3 studies in this population showed median treatment duration of 8 months for AA+p1 and 8.3 months for EN,2 while median survival was 15.81 months and 18.42 months, respectively. The budgetary impact of these products to payers depends, in part, upon real world treatment duration and the proportion of mCRPC patients utilizing each product.

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Is Oral Electrolyte Replacement More Effective than IV Replacement in the Oncology Population?

Rebecca Martin, BSN, RN, OCN; Joanne Growney, RN, MA, ANP-BC

AVBCC 2013 3rd Annual Conference Abstracts

Background: Electrolyte abnormalities are the most common laboratory findings in patients with malignancies. Clinical manifestations of several electrolyte deficiencies occur with frequency in malignancy (Hawthorne JL, Schneider SM, Workman ML). Patients who are admitted for chemotherapy regimens as well as for complications post chemo receive electrolyte replacements on a daily basis. Experience has shown consistent patient and staff nurse dissatisfaction with the current replacement protocol. [ Read More ]

Perspectives of Quality Care in Cancer Treatment: A Review of the Literature

Lisa M. Hess, PhD; Gerhardt Pohl, PhD

AVBCC 2013 3rd Annual Conference Abstracts

Background: Although information about quality care is increasingly available, there remains a gap in knowledge regarding stakeholders’ perceptions of quality cancer care. It is important to maintain high quality of patient care, but perspectives of quality may differ by stakeholder.

Objective: This systematic qualitative literature review was conducted to understand the current perceptions of key stakeholders about quality cancer care.

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