Value-Based Cancer Care Issues


November 2013, Vol 4, No 9

Need for Innovative Strategies for Quality Care Will Continue to Grow

Charles Bankhead

ASCO Quality Care Symposium

San Diego, CA—Current economic trends mandate the development of innovative strategies to affect quality and efficiency in cancer care, applying the same rigor as used in clinical trials, according to Lee N. Newcomer, MD, MHA, Senior Vice President, UnitedHealthcare, who addressed cost issues and barriers in provider reimbursement at the 2013 ASCO Quality Care Symposium.

[ Read More ]

Health Disparities in Oncology: Western Europe Spends More, Achieves Better Patient Survival Outcomes than Eastern Europe

Audrey Andrews

Economics of Cancer Care

Amsterdam, The Netherlands—The more a European Union (EU) country spends on health, the fewer the cancer-related deaths occur in that country, and there is a great disparity between Western and Eastern EU countries, according to research presented at the 2013 European Cancer Congress.

Greater wealth and higher health expenditures were strongly associated with decreased cancer mortality, as well as with increased cancer incidence, according to Felipe Ades, MD, a member of the Breast European Adjuvant Studies Team (BrEAST), a clinical trials unit and data center in Belgium.

[ Read More ]

Bronchial/Nasal Gene-Expression Tests for Early Detection of Lung Cancer

Wayne Kuznar

Personalized Medicine

Boston, MA—Diagnosing lung cancer by swabbing a patient’s nose may be possible in the not-too-distant future. Changes in nasal gene expression in patients with lung cancer have been found to correlate with changes in gene expression in the bronchus, opening the door to the possibility of nasal gene expression as an early diagnostic biomarker of lung cancer, said Avrum Spira, MD, MSc, Director, Translational Bioinformatics Program, Boston University Clinical and Translational Science Institute.

[ Read More ]

Rising Costs of Cancer Survivorship a Growing Concern

Neil Canavan

Economics of Cancer Care

Survival is not cheap. In fact, according to the results of a new study, cancer survivors have ongoing annual medical expenditures averaging $17,000 per patient in the first year after diagnosis, or $6400 per patient at least 1 year postdiagnosis (Guy GP Jr, et al. J Clin Oncol. 2013;31:3749-3757). Considered in aggregate, this comes to a nationwide expense of approximately $41 billion for patients younger than age 64 years—and for older patients, the figures are even higher.

[ Read More ]

Imbruvica, Second Breakthrough Therapy Drug, Gets FDA Approval for Mantle-Cell Lymphoma

FDA Approvals, News & Updates

A few days after the first drug with a breakthrough therapy designation was approved by the US Food and Drug Administration (FDA), ibrutinib (Imbruvica; Pharmacyclics/Janssen Biotech)—the second drug with such a designation—received an accelerated FDA approval for the treatment of patients with mantle-cell lymphoma (MCL), a rare form of non-Hodgkin lymphoma (NHL). MCL represents approximately 6% of all cases of NHL in the United States.

[ Read More ]

New Technique Selectively Enables Cancer Drugs to Target Malignant Cells while Sparing Healthy Cells

Value Propositions

Researchers led by Nobuhide Ueki, PhD, Assistant Research Profes­sor, Department of Molecular Genetics & Microbiology, Stony Brook University, have found a new way to get targeted cancer drugs to selectively affect only the cancer cells of a patient and not the healthy cells that are also normally affected by the drug (and cause its toxicity), thereby removing many of the potential side effects of the drugs, which would of course greatly enhance the value of cancer drugs.

[ Read More ]

Denosumab Improves Bone Metastasis–Free Survival in Patients with CRPC

In the Literature

In a recently reported phase 3 trial of men with nonmetastatic castration-resistant prostate cancer (CRPC) and high risk for disease progression based on baseline prostate-specific antigen (PSA) ≥8 ng/mL and/or PSA doubling time of 10 months or less, denosumab (Xgeva)—an anti-RANK ligand monoclonal antibody—significantly increased bone metastasis–free survival (BMFS) and delayed time to first metastasis, but did not improve overall survival (OS) or progression-free survival compared with placebo. [ Read More ]

Gemcitabine Increases Survival for Patients with Resected Pancreatic Cancer

In the Literature

The prognosis for patients with pancreatic cancer is poor, even for patients with surgically resectable tumors. Gemcitabine (Gemzar) is the standard chemotherapy for advanced pancreatic cancer. Despite the lack of a clear consensus, gemcitabine has also become the mainstay of adjuvant treatment for this deadly disease, even though its effects on survival after surgery have not been demonstrated. [ Read More ]

Long-Term Cetuximab Therapy Shows Early Tumor Shrinkage in Colorectal Cancer

In the Literature

Although colorectal tumors with a mutation in the KRAS gene generally do not benefit from epidermal growth factor receptor (EGFR)-targeted therapy such as cetuximab (Erbitux), there are no current biomarkers to select patients who are more likely to respond to EGFR therapy. In a new study, researchers analyzed data from 2 trials to determine if early tumor shrinkage was associated with long-term outcomes in patients with colorectal cancer receiving first-line treatment with cetuximab (Piessevaux H, et al. J Clin Oncol. 2013;31:3764-3775).

[ Read More ]

Cost-Effective Strategy for Early NSCLC Hinges on Operability of the Disease

Charles Bankhead

Economics of Cancer Care

Atlanta, GA—Surgery and stereotactic body radiotherapy (SBRT) proved cost-effective strategies for stage I non–small-cell lung cancer (NSCLC) when applied to specific patient populations, according to a study reported at the 2013 American Society for Radiation Oncology meeting.

SBRT had the advantage for older patients with marginally operable disease, whereas lobectomy offered the most cost-effective option for patients with clearly operable disease.

[ Read More ]

Panel Recommends Major Changes for Cutting Down Cancer Overdiagnosis and Overtreatment

Eileen Koutnik-Fotopoulos

Economics of Cancer Care

For the past 30 years, awareness and screening have led to an emphasis on the early diagnosis of cancer. The goals were to get screened and to catch cancer early to reduce the rate of late-stage disease and to decrease cancer mortality. However, improved screening has resulted in the overdiagnosis and overtreatment of cancers that are not life-threatening, without significantly decreasing the death rate from the disease. In March 2012, the National Cancer Institute (NCI) convened a meeting to review the evidence on overdiagnosis.

[ Read More ]

Recent Surveys Highlight Ongoing Challenges for Oncology Practices

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—Many current forces are colliding to challenge community oncology, according to David Eagle, MD, Immediate Past President of Community Oncology Alliance (COA), Lake Norman Oncology, Mooresville/Huntersville, NC. At the 3rd Annual Conference of the Association for Value-Based Cancer Care, Dr Eagle described the seriousness of the plight faced by community oncology practices.

[ Read More ]

Community Oncology Care Improves Outcomes, Adds Value in the New Models of Cancer Care

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—As new models of oncology care evolve, they should not dismiss the importance of multi­discipline involvement, Thomas A. Marsland, MD, President, Integrated Community Oncology Network, Orange Park, FL, maintained in his talk at the 3rd Annual Conference of the Association for Value-Based Cancer Care. Dr Marsland is also Past President of the Florida chapter of the American Society of Clinical Oncology.

[ Read More ]

Practical Problems Must Be Overcome to Move Personalized Medicine Forward in Oncology

Wayne Kuznar

Personalized Medicine

Boston, MA—Incorporating personalized medicine into everyday oncology clinical practice will require new paradigms in an effort to match patients with cancer with the appropriate therapies, as well as attempts to treat solid tumors at an earlier stage with targeted agents, said Razelle Kurzrock, MD, Director, Center for Personalized Cancer Therapy, University of California, San Diego (UCSD) Moores Cancer Center, at the Second Global Biomarkers Consortium annual conference.

[ Read More ]

Gilotrif: Second-Generation Tyrosine Kinase Inhibitor Indicated for the First-Line Treatment of Patients with Non–Small-Cell Lung Cancer and EGFR Mutation

Lisa A. Raedler, PhD, RPh

Drug Updates

Lung cancer is one of the most frequently diagnosed cancers, as well as the leading cause of cancer-related mortality in the United States.1 The American Cancer Society has estimated that more than 159,000 Americans will die from lung cancer in 2013, representing approximately 27% of all cancer deaths.1 Non–small-cell lung cancer (NSCLC), the most common form of the disease, accounts for 85% to 90% of all cases of lung cancer.2

[ Read More ]

Physician-Focused Improvement in Patient Satisfaction at the Cleveland Clinic

Rosemary Frei, MSc

Patient Communication

Phoenix, AZ—The degree of patient satisfaction with healthcare is becoming paramount in the new era of value-based care, according to James Merlino, MD, Chief Experience Officer, and Associate Chief of Staff, Patient Experience Office, Cleveland Clinic Health System (CCHS), OH, who discussed high-value healthcare at the American Medical Group Association 2013 Institute for Quality Leadership conference.

[ Read More ]

Ten Steps to Achieving Value-Based Care at the Mayo Clinic

Rosemary Frei, MSc

Value in Oncology

Phoenix, AZ—The staff at the Mayo Clinic are working to “bend the cost curve” and optimize resource utilization efficiency while continuing to provide high-quality care to their large population of patients, said Kari Bunkers, MD, Chief Medical Information Officer, Mayo Clinic Health System, and Medical Director, Mayo Clinic Office of Population Health Management (OPHM) at the American Medical Group Association 2013 Institute for Quality Leadership conference.

[ Read More ]

The Cost of End-of-Life Care in Oncology

Craig Deligdish, MD

From the Editor

The recent Institute of Medicine report “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis” addressed the important issues of delivering high-quality cancer care, including end-of-life care.1 Given that for many patients cancer can be a terminal illness, the cost of end-of-life care in oncology has recently been a significant focus for public and private payers.

[ Read More ]