Value-Based Cancer Care Issues


September 2013, Vol 4, No 7

ASCO Adds Aromatase Inhibitor to Breast Cancer Prevention Options in Postmenopausal Women

Charles Bankhead

Breast Cancer

An aromatase inhibitor has joined tamoxifen (Nolvadex) and the selective estrogen receptor (ER) modulator raloxifene hydrochloride (Evista) as chemoprevention for women who are at an increased risk for breast cancer, according to the recent update of the American Society of Clinical Oncology (ASCO) practice guideline (Visvanathan K, et al. J Clin Oncol. 2013;31:2942-2962).

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Balancing Cost and Quality in Oncology

Caroline Helwick

Economics of Cancer Care

Hollywood, FL—The goal of balancing cost and quality leaves no stakeholder without a challenge, said Grant D. Lawless, MD, RPh, Director, Healthcare Decision Analysis Program, and Associate Professor of Clinical Pharmacy, University of Southern California, Los Angeles.
“If one does not know to which port one is sailing, no wind is favorable,” and the United States is still struggling to chart a course for healthcare reform, Dr Lawless said.

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How Will We Pay for Cancer Care in 2018?

Craig Deligdish, MD

From the Editor

Just this month, the Institute of Medicine (IOM) published a report titled “Delivering High-Quality Can­cer Care: Charting a New Course for a System in Crisis.”1 This consensus report convened a committee of experts to examine the quality of cancer care in the United States and formulate recommendations for its improvement. The committee came to a number of conclusions and made 10 recommendations for the purpose of improving what it described as a system in “crisis,” which is associated with rising costs and growing demand.

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North Carolina Cuts Hospital Readmissions by 20%

Value Propositions

Hospital readmissions for chronic diseases, including cancer, are associated with a significant and often preventable financial burden in the United States. In 2008, North Carolina instituted a statewide transitional care model to prevent repeated hospitalizations in high-risk patients with Medicaid insurance who have multiple chronic conditions. The transitional care model comprises comprehensive medication management, self-management education sessions for patients and families, and outpatient follow-up with a medical home that is informed of the hospitalization. [ Read More ]

First Phase of ASCO’s Data-Sharing Standards Completed, Connecting Oncologists during Patient Care

Value Propositions

The completion of the Breast Cancer Treatment Plan and Summary Standard and Implementation Guide, the first phase in a set of interoperability standards, was announced at the 2013 annual meeting of the American Society of Clinical Oncology (ASCO). The new ASCO electronic data-sharing standards are aimed at facilitating information sharing among oncologists, patients, and researchers to enhance patient care. [ Read More ]

First-in-Class Drug, CFI-400945, Funded by Donor Grants Alone, Inhibits Growth of Several Cancers

Value Propositions

A group of scientists led by Tak Mak, MD, Director of the Princess Margaret Cancer Centre, and Dennis Slamon, MD, PhD, Director of Clinical/Translational Research, University of California, Los Angeles, and supported by funding from donor grants only, has filed a New Drug Application with the US Food and Drug Administration (FDA) for a drug developed based on the target enzyme PLK4, which plays a crucial role in cancer-cell division. [ Read More ]

Senate Approves $5.1 Billion for the National Cancer Institute in 2014

Value Propositions

The Senate Appropriations Committee approved a bill for fiscal year 2014 that provides $30.9 billion to the National Institutes of Health, of which one sixth—$5.1 billion—is designated for the National Cancer Institute (NCI). This bill constitutes an increase of $23 million in money provided to the NCI compared with 2012. However, the bill has yet to be approved by the House, which is more than likely to reduce these amounts, based on its previous actions related to scientific research. ASCO; July 24, 2013

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Mammography Screening Rates Enhanced by Copay Elimination

Wayne Kuznar

Economics of Cancer Care

Chicago, IL—Removing copays may help boost mammography screening rates for all age-groups above age 40 years. One insurer found a significant increase in screening rates with the removal of a copay, said Jeffrey M. Peppercorn, MD, MPH, Medical Oncologist at Duke Cancer Institute, Durham, NC.

A significant number of middle-aged women who live in rural locales do not pursue even biennial breast cancer screening, and cost may play a role, according to insurance claims data Dr Peppercorn presented at ASCO 2013.

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Poor Adherence to Oral Cancer Drugs a Growing Concern

Wayne Kuznar

Economics of Cancer Care

Chicago, IL—The number of oral oncolytic drugs has increased dramatically, but despite increased convenience, there is growing concern regarding adherence, said Winson Y. Cheung, MD, MPH, Assistant Professor, University of British Columbia Division of Medical Oncology, Vancouver, at a session on adherence at ASCO 2013. “Oral drugs shift the onus of treatment adherence from healthcare providers to patients,” Dr Cheung said.

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Causes for Hospital Readmissions of Patients with Cancer

Wayne Kuznar

Economics of Cancer Care

Chicago, IL—Hospitalizations and readmissions add substantial costs to healthcare. The annual cost of 30-day hospital readmissions in the United States is estimated to be $16 billion. In addition, bundled payment models may eliminate additional payment for readmissions in a specified period after discharge.

Several poster presentations at ASCO 2013 explored factors associated with readmission or unplanned hospitalizations in patients with cancer.

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Routine Surveillance CT Costly, Unnecessary in Lymphoma in Remission

Caroline Helwick

Economics of Cancer Care

Chicago, IL—Routine surveillance imaging is of little value in patients with diffuse large B-cell lymphoma (DLBCL) or classical Hodgkin lymphoma who are in remission, researchers from 2 institutions reported.

“DLBCL is clinically aggressive but potentially curable, even after relapse,” said Carrie A. Thompson, MD, Hematology Division, Mayo Clinic, Rochester, MN. “However, the optimal follow-up strategy is not clear.”

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Finasteride Does Not Affect Survival Rates in Prostate Cancer

In the Literature

Widespread adoption of prostate- specific antigen (PSA) screening has been associated with a 44% reduction in prostate cancer mortality. Although early detection of prostate cancer with PSA testing may lead to reduced mortality, it also leads to significant overdetection of cancer. Another approach that complements early detection is prostate cancer prevention. The use of finasteride, a 5-alpha reductase inhibitor, was evaluated in the Prostate Cancer Prevention Trial (PCPT).

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Industry-Funded Studies Receive Greater Prominence at ASCO Meetings

In the Literature

The American Society of Clinical Oncology (ASCO) revised its policy on financial conflicts of interest (FCOIs) in 2005, establishing for the first time certain types of financial relationships for clinical trial principal investigators. ASCO also clarified its requirement for those submitting research presentations at the annual ASCO meeting to disclose potential FCOIs with any entity having a commercial interest in the subject matter.

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Ibrutinib Shows Durable Remissions in Patients with Relapsed CLL

In the Literature

Treatment for chronic lymphocytic leukemia (CLL) has resulted in few cases of durable remissions. Bruton’s tyrosine kinase (BTK), an essential component of B-cell receptor signaling, mediates interactions with the tumor microenvironment and promotes the survival and proliferation of CLL cells. Ibrutinib, an oral covalent inhibitor of BTK designed for the treatment of B-cell cancers, has shown that treatment with this drug inhibits numerous processes. Ibrutinib also does not have toxic effects on normal T-cells. [ Read More ]

Abraxane Receives New Indication for Metastatic Pancreatic Cancer

FDA Approvals, News & Updates

The US Food and Drug Administra­tion (FDA) approved a new indication for paclitaxel protein-bound particles for injectable suspension, albumin-bound (Abraxane; Celgene) for the treatment of patients with metastatic pancreatic cancer. Removal of the pancreas by surgery is the only curative option in pancreatic cancer, but this option is no longer useful by the time this type of cancer is diagnosed, when the cancer has metastasized.

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NCCN/National Business Group on Health Collaboration Produces Guide for Employers

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—A collaboration between the National Comprehensive Cancer Network (NCCN) and the National Business Group on Health can help employers navigate the confusing landscape of employee benefits. Patricia J. Goldsmith, Executive Vice President and Chief Operating Officer of the NCCN, described the project, and the needs of employers that helped shape the project, at the Third Annual Conference of the Association for Value-Based Cancer Care.

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Bracing for Change in Healthcare Coverage with Medicaid Expansion: What This Means for Cancer Care Delivery

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—As part of the Affordable Care Act (ACA), Medicaid expansion necessitates that states soon come to grips with massive change in healthcare coverage. Matthew E. Brow, Vice President, Public Policy and Reimbursement Strategy, McKesson Specialty Health and the US Oncology Network, updated attendees at the Third Annual Conference of the Association for Value-Based Cancer Care on progress in this area.

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Ponatinib Given Early May Suppress New Mutations in Patients with CML

Alice Goodman

Personalized Medicine

Chicago, IL—A new analysis of mutations at baseline and at the end of treatment provides information about the response to ponatinib (Iclusig) in patients with chronic myeloid leukemia (CML) and Philadelphia chromosome–positive acute lymphocytic leukemia (ALL) enrolled in the phase 2 PACE study. The results were presented at the 2013 annual meeting of the American Society of Clinical Oncology.

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New Technologies Bring No Upward Shift in Treatment of Local Prostate Cancer

Wayne Kuznar

Prostate Cancer

Chicago, IL—The rate of therapy for localized prostate cancer does not increase in markets with higher penetration of robotic surgical technology and intensity-modulated radiation therapy (IMRT), according to an examination of trends using the Surveillance, Epidemiology and End Results (SEER)-Medicare–linked data­base, according to a poster presentation at the 2013 American Society of Clinical Oncology meeting by lead investigator Florian Rudolf Schroeck, MD, MS, Clinical Lecturer, Urology, University of Michigan, Ann Arbor.

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Yet Another Blow to the Medicaid Expansion

Ross D. Margulies, JD, MPH; Igor Gorlach, JD, MPH

Health Policy

The Affordable Care Act extends and simplifies Medicaid eligi­bility beginning January 1, 2014, by replacing Medicaid’s previous multiple categorical groupings and limitations with one simplified overarching rule: all individuals aged <65 years with incomes less than 138% of the federal poverty level ($15,415 for an individual or $26,344 for a family of 3 in 2012) who meet citizenship/lawful US status and state residency requirements are entitled to Medicaid benefits.

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Chemotherapy-Induced Neuropathy Can Persist a Decade after Stopping Treatment for Colorectal Cancer

Wayne Kuznar

Drug Updates

Symptoms of neuropathy may be evident a decade or more after completion of chemotherapy regimens that had been for the treatment of patients with colorectal cancer (CRC), reported researchers from Tilburg University in the Netherlands. Their recent study (Mols F, et al. J Clin Oncol. 2013;31:2699-2707) was supported by the Netherlands Organization for Scientific Research and the Dutch Cancer Society.

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Emerging Therapies and New Approaches in the “Double-Refractory” Setting in Myeloma

Wayne Kuznar

Drug Updates

Chicago, IL—Advances in the understanding of the biology of multiple myeloma and the identification of new drugs have resulted in improved management of myeloma, including for disease refractory to the recent proteasome inhibitors and immunomodulatory agents that have been added to the treatment of patients with myeloma.

New therapeutic strategies are needed in this challenging population, said Robert Z. Orlowski, PhD, MD, Professor, Department of Lymphoma/Myeloma, M.D. Anderson Cancer Center, Houston, TX, at the 2013 American Society of Clinical Oncology annual meeting.

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High Marks for Nutritional Supplement in Patients with Localized Prostate Cancer

Alice Goodman

Cancer Prevention

Berlin, Germany—A food supplement containing pomegranate seeds, green tea, broccoli, and turmeric—called Pomi-T (natureMedical)—taken twice daily significantly lowered prostate-specific antigen (PSA) levels versus placebo in men with localized prostate cancer, according to the results of a double-blind, placebo-controlled clinical trial. Use of the supplement allowed more men to remain on observation alone, according to results of a new study presented at the 2013 meeting of the Multinational Association of Supportive Care in Cancer.

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Including Caregivers in the Care of Patients with Cancer Improves Quality of Life

Alice Goodman

Survivorship

Washington, DC—Real-life experience translated into a research interest for Fedricker D. Barber, RN, MSN, of the M.D. Anderson Cancer Center, Houston, TX. At the 38th Annual Congress of the Oncology Nursing Society, Ms Barber presented a poster about the relationships between adult cancer survivors’ and caregivers’ social support, self-efficacy for physical activity, and quality-of-life (QOL) issues.

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Tafinlar and Mekinist: Two Oral Targeted Kinase Inhibitors for the Treatment of Patients with Metastatic Melanoma and BRAF Mutations

Lisa A. Raedler, PhD, RPh

Drug Updates

Cutaneous melanoma, although not the most common skin cancer, is the most deadly.1 Based on data collected between 2003 and 2009, the 5-year survival rate for Americans with metastatic melanoma remains very low—only 16%—for all disease stages and for both sexes.2 The National Cancer Institute has estimated that approximately 1 in 49 people will be diagnosed with melanoma in the United States, and more than 9450 people will die of this disease in 2013.2

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