Articles

In 2012 and 2013, the American Society of Clinical Oncology (ASCO) published 2 sets of 5 key opportunities to improve value in cancer care as part of a multispecialty project, called Choosing Wisely. As a supervisor for a process that reviewed more than 15,000 hematology and oncology treatment requests in 2013, we were able to observe oncologists who followed ASCO’s advice, and those who were either unaware of Choosing Wisely or who chose to disregard it. Although the recommendations were not universally followed, they were a tremendous step forward in advancing value-based oncology treatments.

We understand that the financial sustainability of cancer care is a serious issue as cancer diagnoses around the world continue to rise. We commend those organizations seeking to address the issue of value in cancer care, which is an incredibly difficult, multifaceted challenge.

The American Society of Clinical Oncology (ASCO) has introduced its conceptual framework to “Assess the Value of Cancer Treatment Options,” with the laudable objective to “assist physicians and patients in assessing the values of a new drug treatment.” As released, the ASCO framework has the potential to confound oncologists, in some instances, as follows.

There has been talk regarding pricing in healthcare for a number of years, so the recent move by the American Society of Clinical Oncology (ASCO) and by Memorial Sloan Kettering Cancer Center (MSKCC), discussed in this issue of Value­-Based Cancer Care, is certainly a big deal, but is hardly surprising.

In the face of escalating costs of cancer drugs, the American Society of Clinical Oncology (ASCO) rightly asks, what is the value of these new medicines?

Rising to a level of equal status with cancer providers is a tall order for patients with cancer, yet it is precisely the intent of the Meaningful Use Stage 3 proposed standards that are set to take effect in 2018 (ie, patient-reported outcomes), as well as the value-based care initiatives. Providers need to drop their resistance and contemplate the following benefits of patient centricity.

The FDA’s Oncologic Drug Advisory Committee (ODAC) reviewed necitumumab (Eli Lilly & Co) for use in patients with metastatic squamous non–small-cell lung cancer (NSCLC). Necitumumab is an immunoglobulin G1 monoclonal antibody that inhibits the interaction between the human epidermal growth factor receptor (EGFR) and its ligands. EGFR expression is elevated in NSCLC and affects >95% of squamous NSCLC tumors.

The American Society of Clinical Oncology (ASCO) new value framework abandons the Hippocratic Oath. No longer is the doctor’s first obligation to “apply, for the benefit of the sick, all measures which are required.” Instead, ASCO’s value framework has the potential to help insurers “evaluate the relative value of new treatments” as they develop “benefit structures, adjustment of insurance premiums, and implementation of clinical pathways and administrative controls."