TAP Vol 2 Issue 1

Page 1

Cancer survivorship and QOL 8

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Head & neck cancer controversy 25

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VOLUME 2, ISSUE 1

FDA drug updates 34

JANUARY 1, 2011 ASCOPost.com

Editor-in-Chief, James O. Armitage, MD

52nd ASH Annual Meeting

Maintenance Rituximab Delays the Need for Chemotherapy or Radiotherapy in Asymptomatic Follicular Lymphoma

Health-care Reform and the Treatment of Metastatic Cancer

By Alice Goodman

I

(Rituxan) maintenance therapy can delay the time to treatment for patients with nonbulky disease. The results of an Intergroup randomized trial of rituximab vs a watch-and-wait strategy were presented at 1.0 a plenary session during 0.9 the 52nd Annual Meeting 0.8 of the American Society 0.7 of Hematology (ASH).1 “Rituximab mainte0.6 nance therapy significant0.5 ly delays time to treat0.4 ment in asymptomatic 0.3 patients. Delaying cheArm A 0.2 Arm B motherapy may become 0.1 Arm C a popular option for pa0.0 tients with asymptom18 24 42 48 30 36 0 6 12 atic follicular lymphoma Months from randomization and could become the Fig. 1: Time to initiation of new therapy. Arm A = watchful waiting, Arm B = rituximab induction thera- standard of care in the py; Arm C = rituximab maintenance therapy. Courtesy of Kirit M. Ardeshna, MD. Used with permission future,” stated lead author 1 Proportion of patients without initiation of new therapy

n a comparison of patients with asymptomatic stage II, III, or IV follicular lymphoma, results of a randomized trial demonstrated that rituximab

of American Society of Hematology (ASH), from Ardeshna KM et al. Permission conveyed through Copyright Clearance Center, Inc.

continued on page 4

Health-care Policy

The Sustainable Growth Rate’s Unsustainable Impact on Oncology Practice By Ronald Piana

T

he sustainable growth rate (SGR) is the method used by the Centers for Medicare & Medicaid Services (CMS) to control Medicare’s spending on physician services. Generally, the SGR was designed to ensure that the cost per Medicare beneficiary does not exceed the growth in real gross domestic product (GDP). If yearly expenditures exceed the SGR target amount, the conversion factor will decrease physician fee schedules accordingly for the following year. On March 1 of each year, the physician fee schedule is updated and adjusted to meet the SGR target, which can be suspended or adjusted by Congress, as has been done in the past. On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. During that period of sweeping reform, the

Editor’s note: As The ASCO Post went to press, both houses of Congress approved a measure to postpone the SGR-driven Medicare physician fee cuts scheduled for January 1st. Upward of 23%, the payment cuts would have had dire consequences for community oncology practices. According to Joseph S. Bailes, MD, the SGR game is not over, simply postponed. “The flawed formula remains and it will require substantial ‘pay for’ to fix. It will also require substantial political will.” Watch for continued coverage of this important issue in future editions of The ASCO Post.

T

By Nora Janjan, MD, MPSA, MBA, and John Goodman, PhD

he discussion about cancer treatment in the United States has changed from the hope and promise of new innovations to considerations of whether a treatment is worth the personal and societal cost. This philosophical shift coincides with the aggressive application of comparative effectiveness evaluations of cancer care under the American Recovery and Reinvestment Act (ARRA, 2009) and the Affordable Care Act (ACA, 2010), which are the cornerstones of U.S. health-care reform. To meet cost-containment criteria, the Affordable Care Act included $500 billion of cuts to Medicare over 10 years. In 2012, the Affordable Care Act will create the Independent Payment Advisory Board to “recommend payment policy revisions to contain Medicare cost growth” while the Medicontinued on page 2

Dr. Janjan is Senior Fellow in Healthcare Policy and Dr. Goodman is President and CEO, National Center for Policy Analysis, Dallas. The National Center for Policy Analysis is a nonprofit conservative think tank established in 1983 and headquartered in Dallas, Texas. Disclosure: Dr. Janjan served as a consultant to Dendreon prior to the Medicare Evidence Development & Coverage Advisory Committee meeting on sipuleucel-T (Provenge).

MORE IN THIS ISSUE Oncology Meetings Coverage

52nd ASH Annual Meeting ����������������1, 12 52nd ASTRO Annual Meeting �����������3, 10 Chemotherapy Foundation   Symposium XXVIII �������������������������������� 6 35th ESMO Congress ������������������������������� 21 Direct from ASCO �������������������������������������� 14 MRI-based screening for breast cancer ������� 32

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