Wednesday, February 11, 2009
Cochrane Collaboration Releases Two New Reviews* of Breast Cancer Research
Post-operative radiotherapy for ductal carcinoma in situ of the breast (Radiation Benefits Women With Early Breast Cancer):
Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery:
* What is a systematic review?
Pregnancy Has No Impact on Breast Cancer Survival, Delays Treatment & Diagnosis
When Informed, All Women Do Not Prefer Breast Conservation
New Genomic Test Can Personalize Breast Cancer Treatment
"Unlike a widely used genomic test that applies only to lymph-node negative, estrogen-receptor positive breast cancer, this new genomic test is broadly applicable for all women diagnosed with breast cancer," says breast cancer specialist Matthew Ellis, M.D., Ph.D., a member of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University.
"They found that luminal A was not sensitive to the chemotherapy, suggesting that patients with this good-prognosis type can forgo chemotherapy in favor of hormone-based therapy. They showed that among the poor-prognosis tumor types, basal-like breast cancer was the most sensitive to the chemotherapy and luminal B the least."
Editorial: Barriers to Delivery of Psychosocial Care for Cancer Patients
Predictors of Referral for Psychosocial Services: Recommendations From the Institute of Medicine Report—Cancer Care for the Whole Patient
Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
Pathway for cancer chemotherapy unveiled
Tuesday, February 10, 2009
The editorial points out the most likely outcome of this change will be higher costs for Medicare without additional benefit to patients. In addition, there are concerns that treating patients with drugs not approved for their specific cancer could raise safety risks.
NYT Editorial Link
Current data for the drugs included in this rule change were reviewed by the Agency for Healthcare Research and Quality and found there was no evidence of benefit for their use for cancers other than the ones FDA has approved .
"That might be fine if one could be confident that the compendiums were
authoritative and unbiased, but analysts have found that compendium
recommendations are often supported by little clinical evidence and are
by experts with financial ties to the drug industry.
Off-label uses are vitally important in cancer care and probably
constitute a majority of cancer drug treatments. But the danger in expanding
usage without strong evidence of safety and effectiveness is that patients
be harmed — and costs may be driven up
The solution — and an essential component of
health care reform — is to
establish centers for comparing the effectiveness
of drugs and treatments and
the cost-effectiveness of using them. That would
help make coverage decisions
more rational for all patients."
Breast cancer patients considering the use of off label drugs for treatment should have a thorough discussion with their oncologist about the potential benefits and risks of doing so.
Monday, February 9, 2009
Managing the Cost of Cancer Care
United Health & IBM recently announced a new pilot program for the model, according to this article in the New York Times.
"UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them more for the overall quality of care patients receive.
The new approach, which is also being tested in various guises by other insurers around the country, is known as the “medical home” model of health care. Many experts hope it will prove one of the best ways to rein in the nation’s runaway medical costs, while making people healthier. The theory is that by providing a home base for patients and coordinating their treatment, doctors can improve care, prevent unnecessary visits to the emergency room, reduce hospitalizations and lower overall medical spending. "
The plan seems short on details and some policy experts see it as just another fad. It may reduce costs for employers in the short term, but likely to not yield long term results.
What does this mean to breast cancer survivors?
- Cancer coverage - Many insurers these days sell "cafeteria" plans - health plans that cover only a few health care services and may exclude coverage for chemotherapy, breast reconstruction, etc. Will the "medical home" model of health care reform include coverage for all types of health care services, or just primary care - the area of medical care they focus on?
- Uninsured - The "medical home" model does nothing to provide coverage for those who have no health insurance. How does it make insurance available to workers whose employers don't offer it or to self-employed individuals who can't afford individual insurance?
- Underinsured - What about medical co-payments, prescription coverage and pre-existing condition exclusions - problem areas that increasingly make cancer treatment unaffordable even for those with insurance?
- Choice - The model described contracts with primary care physicians, restricting patients to a list of providers. How will this work for specialists, especially for cancer care?
I've just listed a few concerns, I'm sure there are others. Many of the solutions being proposed for health care reform are vague on details about how much health care coverage patients will receive when it comes to cancer care. Breast cancer diagnostic and treatment are highly specialized areas of medical care that aren't provided through community clinics and primary care practices. Beware of proposals that focus only on those areas.