Interviews

Population health models that include social determinants of health can help employers design more strategic benefits that will provide an effective solution for all individuals who receive that insurance, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

While ibrutinib is a major breakthrough in treating chronic lymphocytic leukemia, it is associated with financial burdens and medical concerns for the older patients being treated, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Diabetes Can Break Your Heart is an important initiative that highlights the vital need for heightened education on the link between diabetes and heart failure, especially with American Heart Month looming, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.

Research has shown that fedratinib favorably impacts health-related quality of life for patients with myelofibrosis across the board, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Making benefit design more nuanced through the inclusion of employee variables could help increase the impact of value-based insurance design for employers, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

As a result of the opioid epidemic, there have been instances where it has been difficult to treat patients with pain related to their sickle cell disease because of new policies in place intended to curb addiction and overdoses, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia, highlights the coming advances in pediatric acute myeloid leukemia (AML) that she is the most excited for.

While minimal residual disease (MRD) has been a topic of research for at least a decade, right now it is more top of mind than ever before for people treating cancer, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Quality of life is an important end point in clinical trials, and it is important to discuss that with regulatory agencies, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

There are numerous conditions, including many rare and difficult to recognize disorders, which can be mistaken for MS, said Andrew Solomon, MD, associate professor of neurological sciences and division chief of multiple sclerosis at Larner College of Medicine, The University of Vermont, Burlington, Vermont.

Since there are aspects of care in clinical trials that might not be mandated, research is being done to see whether there are socioeconomic disparities for things like supportive care for children with cancer, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

In research presented at the 61st American Society of Hematology Annual Meeting and Exposition, Abby Statler, PhD, MPH, MA, research associate, Cleveland Clinic, and her colleagues found that African Americans with acute myeloid leukemia (AML) may be excluded from clinical trials due to renal dysfunction, despite it having no impact on AML outcomes.

Employers’ decisions around purchasing healthcare plans should focus on a broader measure of value, including employee productivity, not just cost, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Thomas Frisell, PhD, coordinator of the Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden, discusses whether patients with multiple sclerosis (MS) have an elevated risk for cardiovascular disease.

So far, minimal residual disease (MRD) has not been used much outside of clinical trials, but researchers are testing how it might be used to guide decisions in clinical practice, said Lindsey Roeker, MD, clinical fellow at Memorial Sloan Kettering Cancer Center.

Symptoms are not random chance—they have a real link to biological drivers of the disease and understanding them is important, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

The significant findings of the DAPA-HF data have been well received in both the scientific and payer communities, but we also need to ensure that patients with diabetes are educated on the signs, symptoms, and risk factors linked with heart failure, said Kiersten Combs, BS, US vice president of Cardiovascular Metabolism at AstraZeneca.

The next era in treating mantle cell lymphoma will use precision medicine to target therapies in a personalized way, said Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at MD Anderson.

The terminology for smoldering myeloma has been around for decades, but more discussion over what it means and who it really applies to is needed, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco, explains how her research into disparities in pediatric acute myeloid leukemia (AML) may help identify the cause of those disparities and how best to intervene in order to improve outcomes for these patients.

Alberto Ascherio, MD, DrPh, professor of epidemiology and nutrition at the Harvard T. H. Chan School of Public Health and professor of medicine at the Harvard Medical School, discusses the fact that, in addition to other modifiable factors linked with progression of multiple sclerosis (MS), dietary factors are also emerging as potentially related to outcomes.

The introduction of novel agents has really revolutionized the care of patients with chronic lymphocytic leukemia to the point where chemotherapy is rarely used, said Lindsey Roeker, MD, clinical fellow at Memorial Sloan Kettering Cancer Center.

We are in the regulatory process to get an indication for the treatment of heart failure in both type 2 and non-type 2 diabetic patients, and this serves as just the start of the scientific investment that we have made with dapagliflozin, said Kiersten Combs, BS, US vice president of Cardiovascular Metabolism at AstraZeneca.

Progress toward value-based payment models is moving slowly, so employers and healthcare systems need to recognize the value of taking on risk and encourage surrounding entities in their communities to do the same, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

One of the challenges with treating children with acute myeloid leukemia is that many of the novel drugs are not available in children. Current treatment with chemotherapy really requires balancing increasing doses with the short-term and long-term toxicities, said Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia.

To avoid the toxicities associated with use of chemotherapy, there has been progress in developing and utilizing chemotherapy-free therapies to treat mantle cell lymphoma, said Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at MD Anderson.

Although the pembrolizumab 8 arm of I-SPY2 did not have strong enough results to continue onto phase 3, it does provide some insights and highlights the need for precision medicine to tailor approaches to treatment, said Rita Nanda, MD, associate professor, medicine, The University of Chicago Medicine.