Oncology

Expert panel convened by the American Journal of Managed Care provides insight into the challenges faced by clinicians and payers when administering cutting-edge cancer medications.

Since the rise of genetics and advanced molecular biology, cancer research is a field that has become almost as obsessed with understanding aberrant metabolism as it is with devising therapies.

In order to deliver quality and cost-effective cancer care, Michael Kolodziej, MD, Aetna's national medical director for oncology strategies, says that providers need to get better connected with payers.

Methods for better identifying malignant versus benign disease before nephrectomy could provide significant benefits to patients and payers.

In an effort to offset cost increases associated with the Affordable Care Act (ACA), the Obama administration intends to expand hospitals' access of the 340B discount drug plan. While the expansion may sound promising to some, many others worry that the program will threaten the quality of care, as increased participation risks higher potential for abuse. Even worse, the 340B program will likely rise the cost of cancer care.

For patients with early-stage lung adenocarcinomas, the histological pattern of the tumor predicts the risk of recurrence and might help guide surgical decisions.

Oncologists have a reputation to maintain - and according to the latest report from ZS Associates, when it comes to fortifying against pharmaceutical sales representatives, the specialty remains characteristically hardboiled for the second year in a row.

For the first time, government advisers are recommending screening for lung cancer, saying certain current and former heavy smokers should get annual scans to cut their chances of dying of the disease.

Panelists agreed that the cost of the new agents discussed to treat melanoma will be a challenge, just as the cost of healthcare as a whole in the United States is a major challenge.

Dr Fendrick asked panelists what they think about the idea of centers of excellence for specific cancers and an evidence-based steerage.

It's very, very complex to try to envision how you would come up with a single payment for an episode and not have a thousand different types of episodes in order to capture the heterogeneity of these diseases and the cost, said Dr Malin when asked to discuss the bundled payment method in oncology.

In this portion of the panel discussion, Dr Fendrick asked the panel whether or not they have noticed cost-related lack of access or nonadherence with the new agents being discussed.

Dr Weber said that despite all of the newer agents in development, the NCCN still offers comprehensive guidelines for the treatment of melanoma.

Dr Ribas opened this segment by discussing the new immunotherapy agents used in the treatment of metastatic melanoma. Specifically, he discussed the agents vemurafenib (Zelboraf), dabrafenib (Taflinar), and trametinib (Mekinist).

Panel moderator and AJMC co-editor-in-chief Dr Mark Fendrick introduced panelists Jennifer Malin, MD, PhD, manager and medical director of oncology, WellPoint; Jeffrey Weber, MD, PhD, senior member, H. Lee Moffitt Cancer Center Director, Donald A. Adam Comprehensive Melanoma Research Center; and Antoni Ribas, MD, PhD, Jonsson Comprehensive Cancer Center, UCLA.

In a study of older men who had died from causes other than prostate cancer, almost half were found to have prostate tumors. And up to half of those tumors detected on autopsy would have qualified for treatment had doctors known about them while the men lived, though none had been the cause of death.

Using low-dose CT scans to screen high-risk patients for lung tumors is far more effective at preventing lung cancer deaths than scanning those at low risk, according to a new analysis of over 53,000 volunteers.

In the final segment, panelists examine the use of companion diagnostics to determine proper patient utilization. Dr. Chernew asks if the required diagnostic testing is being appropriately used and if they are being covered by payers.

This segment of the panel discussion takes a closer look at the episode of cost for a patient going to a hospital versus a private office setting. Panelists agree that the cost of hospital care is not that much greater than in the office.

Dr. Chernew asks the panelists how payers address the value of these costly combination therapies when there are less expensive options available. Dr. Newcomer says that the drugs being discussed are, in fact, having a significant clinical effect.

In this clip, Dr. Swain and Dr. Newcomer discuss the results from the EMILIA trial. Dr. Swain notes that the survival benefit with the use of TDM-1 was five months.

Moderator and AJMC co-editor-in-chief, Dr. Michael Chernew delivers a brief overview of the discussion. The discussion focuses on the use of trastuzumab emtansine (Kadcyla) and pertuzumab (Perjeta). Panelists address the patient populations for the two agents and identify which are eligible to take the targeted therapy.

A new bill, Cancer Patient Protection Act of 2013 (HR 1416), is aiming to restore Medicare reimbursements for anti-cancer drugs and biologicals to pre-sequester levels