Value-Based Cancer Care Issues


March 2014, Vol 5, No 2

Virtual Patients Help Identify Opportunities for Cost-Savings

Charles Bankhead

Pathways

San Diego, CA—The use of virtual patient vignettes to improve adherence to a breast cancer clinical pathway identified correctable variances from a breast cancer clinical pathway with the potential to reduce the cost of care by several million dollars, according to the results of a pilot study reported at the 2013 American Society of Clinical Oncology Quality Care Symposium. [ Read More ]

Outpatient Chemoradiation Regimen Matches Inpatient Care Outcomes, at Lower Costs

Charles Bankhead

Head and Neck Cancer

Scottsdale, AZ—Definitive chemoradiation with single-agent outpatient chemotherapy for head and neck cancer led to disease control and survival equivalent to that of inpatient multi-agent therapy, at an annualized savings of almost $650,000, according to results of a small randomized trial presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium. [ Read More ]

Genetic Test for Breast Cancer Screening Cost-Effective for Women at Intermediate Risk

Eileen Koutnik-Fotopoulos

Economics of Cancer Care

The American Cancer Society has recommended annual magnetic resonance imaging (MRI) as an adjunct to mammography for breast cancer screening in women who have a lifetime risk of breast cancer of approximately 25% to ?50%, as determined by models such as the Gail risk test. A new simulated clinical trial evaluated the cost-effectiveness of using 7 single-nucleotide polymorphisms (7SNPs) in combination with the Gail test to assess the cost-benefit of annual MRI screening in women at risk for breast cancer (Folse HJ, et al. Cancer Prev Res [Phila]. 2013;6:1328-1336). [ Read More ]

Is the Promise of Health Information Technology More than a Hope and a Prayer? This Year at HIMSS

Craig Deligdish, MD

From the Editor

At the end of February, I had the opportunity to attend the Healthcare Information and Management Systems Society (HIMSS)14 Annual Conference, which was held in Orlando, FL. Attended by more than 30,000 committed vendors, healthcare administrators, providers, politicians, scientists, and others, the meeting provided a great deal of insight into the health information community’s past accomplishments, the present state of the art, and expectations for the future. [ Read More ]

Value Propositions

Jayson Slotnik, JD, MPH

Value Propositions

New Evidence Confirms Value of Yoga for Women with Breast Cancer A new study from M.D. Anderson has shown that patients with breast cancer who participated in yoga exercises that incorporated controlled breathing, meditation, and relaxation techniques into their treatment [ Read More ]

Switching from Intravenous to Subcutaneous Rituximab Saves Staff Time and Money

Wayne Kuznar

Economics of Cancer Care

New Orleans, LA—The efficiency of rituximab (Rituxan) and the associated cost can be improved by switching from intravenous (IV) to subcutaneous (SC) administration. Such a switch led to a substantial reduction in patient chair time and in active healthcare professional time, said Christof Wiesner, PhD, MPH, of the Market Access Department, Genentech, San Francisco, CA, at the ASH 2013 meeting. [ Read More ]

Previous Docetaxel Therapy Thwarts Enzalutamide Activity in CRPC

Charles Bankhead

Prostate Cancer

San Francisco, CA—Men with castration-resistant prostate cancer (CRPC) had inferior time duration to prostate-specific antigen (PSA) progression and of progression-free survival (PFS) if they received the androgen receptor agonist enzalutamide (Xtandi) after the taxane docetaxel (Taxotere) rather than before, according to data from a retrospective study presented at the 2014 Genitourinary Cancers Symposium. [ Read More ]

QOL Improved with 18 versus 36 Months of Hormonal Therapy in Patients with High-Risk Prostate Cancer, Confirming Earlier Efficacy Evidence

Alice Goodman

Prostate Cancer

San Francisco, CA—Longer-term follow-up of a large randomized phase 3 trial suggests that quality of life (QOL) is improved when patients with high-risk prostate cancer have a shorter versus longer course of androgen- deprivation therapy (ADT) plus radiotherapy as primary treatment. In this follow-up study, 18 months of ADT were found to improve QOL versus 36 months of ADT when added to radiotherapy. [ Read More ]

Encouraging Long-Term Safety Data for Radium-223

Phoebe Starr

Prostate Cancer

San Francisco, CA—The safety and efficacy of radium Ra 223 dichloride (Xofigo, formerly Alpharadin) injection in men with castration-resistant prostate cancer (CRPC) and bone meta­stases have held up over the longer- term follow-up of the phase 3 Alpha­radin in Symptomatic Prostate Cancer Patients (ALSYMPCA) trial. Results of a study reported at the 2014 Genitourinary Cancers Symposium showed that at 1.5 years after the last injection of this therapy, minimal myelosuppression and minimal nonhematologic adverse events were reported, and there were no reports of cancers of concern, including acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), and primary bone cancer. [ Read More ]

Understanding Molecular Subtypes Is Basis for Genomic Medicine in Prostate Cancer

Wayne Kuznar

Personalized Medicine

Boston, MA—Incorporating genomics into the practice of medicine requires the demonstration of the ability of biomarkers to impact clinical decision-making, and ensuring that patients receive the best therapy based on genomic findings. Scott A. Tomlins, MD, PhD, Assistant Professor of Pathology and Urology, University of Michigan Medical School, Ann Arbor, reviewed efforts to realize genomic medicine into prostate cancer diagnosis and management at the second Global Biomarkers Consortium annual conference. [ Read More ]

Bortezomib plus Thalidomide Maintenance Therapy Improves Overall Survival in Transplant-Ineligible Patients with Newly Diagnosed Myeloma

Jayson Slotnik, JD, MPH

In the Literature

Patients with multiple myeloma (MM) who are not fit to undergo stem-cell transplantation (SCT), typically receive melphalan (Alkeran) plus prednisone in combination with either thalidomide (Thalomid) or bortezomib (Velcade). Recent studies are exploring the clinical benefit of the 4-drug induction regimen of melphalan, prednisone, bortezomib, and thalidomide, followed by maintenance with bortezomib plus thalidomide (VMPT-VT). In a recent phase 3 clinical trial, a total of 511 patients with newly diagnosed MM who were not candidates for SCT were randomized to receive VMPT-VT (N = 254) or bortezomib, melphalan, and prednisone (VMP; N = 257). The patients’ median age was 71 years, and 27% of the patients were aged >75 years (Palumbo A, et al. J Clin Oncol. 2014;32:634-640). [ Read More ]

Nintedanib plus Docetaxel an Effective Combination in Patients with Advanced Non–Small-Cell Lung Cancer

Jayson Slotnik, JD, MPH

In the Literature

Currently, the US Food and Drug Administration–approved second-line treatments for non–small-cell lung cancer (NSCLC) include monotherapy with docetaxel (Taxotere), erlotinib (Tarceva), or pemetrexed (Alimta). A recent phase 3 clinical trial explored the safety and efficacy of nintedanib (Vargatef)—a potent oral angiokinase inhibitor—in combination with do­cetaxel, as a second-line treatment in patients with NSCLC (Reck M, et al. Lancet Oncol. 2014;15:143-155). [ Read More ]

Implications of the Affordable Care Act for Adult Survivors of Childhood Cancer

Jayson Slotnik, JD, MPH

In the Literature

Among adult survivors of childhood cancer, the lack of health insurance is a major obstacle to obtaining the recommended follow-up care. The goal of the Patient Protection and Affordable Care Act (ACA) enacted in 2010 was to broaden insurance coverage for all Americans. A new commentary by Mueller and several health policy experts addressed the questions regarding how several provisions in the ACA could help adult survivors of childhood cancers overcome insurance-based barriers to receiving the recommended follow-up care for patients with cancer (Mueller EL, et al. J Clin Oncol. 2014;32:615-617). [ Read More ]

Gazyva for Chronic Lymphocytic Leukemia: First FDA-Approved Breakthrough Therapy in Oncology

Lisa A. Raedler, PhD, RPh

Drug Updates

Chronic lymphocytic leukemia (CLL), a monoclonal disorder characterized by progressive accumulation and proliferation of functionally incompetent B-cells, is the most frequently diagnosed leukemia in the United States. The American Cancer Society has estimated that 4580 Americans will die from CLL in 2013, which represents approximately 19% of all leukemia deaths. Because it can have an insidious onset, CLL is often discovered incidentally after blood work is conducted for another reason. Between 25% and 50% of patients with CLL are asymptomatic at the time of presentation. [ Read More ]