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AVOIDING TOXIC GynecologicTHE Cancer Pg. 12 COST OF CANCER CARE

Shannon Sweeney

Oncology Patient MULTIPLE MYELOMA Navigator−Certified Generalist: Learning IN FOCUS

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FEBRUARY 2016

VOLUME 5 • NUMBER 1

By Karen Gregory, RN

New Look, Same Great ContentFEBRUARY 2016

NAVIGATING PATIENTS ACROSS THE CONTINUUM OF CANCER CARETM www.AONNonline.org

www.TheOncologyPharmacist.com

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LMWH Protocol for Thrombocytopenia Validated in Study

ASHP Foundation Forecast Provides Actionable Recommendations for Pharmacy Leaders

Caroline Helwick

Meg Barbor

new study suggests that boosting the consumption of flavonoid-containing foods, such as blueberries, may help stave off erectile dysfunction (Cassidy A, et al. Am J Clin Nutr The questionnaire-based study of more than 25,000 men participating in the Health Professionals Follow-Up Study indicated a 9% lower risk for erectile dysfunction among men who had a higher intake of flavones and an 11% lower risk with a higher intake of flavanones. “This is a large observational study and provides some novel and interesting as

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Orlando, FL—Guidelines for enoxaparin dose reduction when treating chemotherapy-induced thrombocytopenia (CIT) have been validated by a quality assessment study conducted at Memorial Sloan Kettering Cancer Center (MSKCC) in New York. “Our quality assessment project supports the safety and efficacy of our guidelines for therapeutic dose modifications of low-molecular-weight heparin (LMWH) in the setting of CIT,” said Gerald A. Soff, MD, Chief, Hematology Service, MSKCC, who discussed the study at a press briefing during the 57th American Society of Hematology

Alice Goodman

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responders can safely stop TKI treatment without remission. It has, however, become evident that about 1 in 4 patients who stop treatment with a TKI experience musculoskeletal pain (ie, TKI withdrawal syndrome [WS]). A study reported at the recent American Society of Hematology (ASH) annual Continued on page 7

Darzalex First Monoclonal Antibody Approved by the FDA for Multiple Myeloma

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ovember 2015 may be remembered as the “multiple myeloma month” in the annals of the FDA. On November 16, 2015, the FDA approved daratumumab (Darzalex; Janssen Biotech) injection for the treatment of patients with multiple myeloma who have received ≥3 previous treatments for this condition. Daratumumab is the first monoclonal antibody approved by the FDA

FOR RHEUMATOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS

www.RheumatologyPracticeManagement.com

By Karen Gregory, RN Director, Compliance and Education, Total Medical Compliance

MSKCC Guidelines for LMWH Dosing Thrombosis is the second leading cause of death in patients with cancer. It is commonly treated with anticoagulation, but this carries an increased risk of bleeding. In 2011, MSKCC implemented guidelines for LMWH dose modifications in the thrombocytopenia setting: adminisContinued on page 11

And other news from ASH, ASTRO, and SABCS yrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), and dramatically improved survival for these patients. Many patients with CML treated with a TKI have deep, sustained remissions. Clinical trials have shown that some good

Annual Meeting & Exposition. “With appropriate adherence to our guidelines, we saw gratifying safety and efficacy results,” Dr Soff said. “I think this will have an impact in reassuring practitioners.”

FDA NEWS

Continued on page 13

Pain Syndrome After Stopping Treatment with Tyrosine Kinase Inhibitors

serves to improve the effectiveness of leaders in hospital and health-system pharmacy practice. The Pharmacy Forecast 2016-2020, which predicts

CONFERENCE NEWS

RHEUMATOLOGY PRACTICE

A Practical Safety Checklist for Practice Managers

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Mastering the Crucial Conversation

and education for Nick Englezos

MANAGEMENT MARCH 2016 8

Continued on page 6

And other concise reviews of recently published studies n analysis of 2 double-blind phase 3 trials (MEASURE 1 and MEASURE 2) shows that secukinumab significantly reduced

Overprescribing of barbiturates and opioids

EPILEPSY & SEIZURES

Emily L. Graham

Bellevue, WA—Mandated by the Affordable Care Act and first applied on January 1, 2015, to large group practices, the Value Modifier (VM) provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS), based on the quality of care furnished compared with cost during a performance period.

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he date of the implementation of the International Classification of Diseases, Clinical Modification (ICD-10-CM, henceforth “ICD-10”), has come and gone, and we have survived what is arguably the most significant change for providers in the history of reporting healthcare services. As the dust settles, a postimplementation assessment is recommended. This is a time to acknowledge the success, reward the hard work, and ensure that Continued on page 14

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Episode-of-Care Reimbursement Model in Oncology: Benefits and Challenges

Deborah Korenstein, MD

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By Corbin Davis

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new paradigm of survivorship care is needed that attempts to balance the patient’s total well-being against the often toxic treatment of the disease, suggests Deborah Korenstein, MD, Director of Clinical Effective-

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iven the high cost of care for acute leukemia, innovative payment strategies that reward longitudinal care and create economic incentives for data-driven care delivery are needed, according to Joseph Alvarnas, MD, Director of Value-Based Analytics, and Associate Clinical Professor of Hematology and HematopoiContinued on page 28

March 2016 • Volume 5 • Number 2

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Personalized Medicine in Oncology

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FOR RHEUM

DECEMBER

®

A Pra Safet for Pr Man

COLORECTAL CANCER JANUARY 2016 Volume 3 • Number 1

Checkpoint Inhibition: A Promising Immunotherapeutic Approach for Colorectal Cancer..............................Page 8

By Karen Gre

MELANOMA

Director, Com Total Medica

Pembrolizumab Combination Shows Robust Antitumor Activity.................................................Page 13

VALUE-BASED CANCER CARE A Century of Medical Product Regulation: The Historic Framework for Personalized Medicine in Oncology.....................................................Page 66

SOCIETY FOR IMMUNOTHERAPY OF CANCER

GENETIC COUNSELING

Certain Types of T-Cells Show Clinical Benefit in Patients with Glioblastoma.................................................Page 14

The Evolving Phenotype of Li-Fraumeni Syndrome.............................................................Page 72

STAKEHOLDER PERSPECTIVE

The Coming Government Takeover of Drug Pricing..................................................................Page 20

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Case: Biomarkers in Multiple Myeloma..............Page 74

Your Source for Information and Education Solutions Phil Pawelko

Across the Continuum of Care

Senior Vice President 732.992.1887 ppawelko@the-lynx-group.com

the-lynx-group.com 1249 South River Road, Suite 202A, Cranbury, NJ 08512 Lynx Gatefold Lynx_051718

the-lynx-group.com

NATURAL KILLER CELLS

PANCREATIC CANCER

Using Natural Killer Cells in Immunotherapy: What Is Known, and Where to Next...............................Page 22

Immunotherapies in Development for Pancreatic Cancer.................................................................Page 76

THE LAST WORD Regulation and Reimbursement Policies Will

Determine the PMI’s Legacy.............................. Page 94 GLOBAL BIOMARKERS CONSORTIUM Clinical Approaches to Targeted Technologies ™

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Implementation of ICD-10—Is That It?

From the publishers of

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CONTINUUM

CHRONIC PAIN . . . . . . . . . . . . . . . . . 17 Sex differences in response to tramadol

Continued on page 21

BIOMARKERS • TARGETED THERAPIES • DIAGNOSTICS

Russ Hennessy

CONQUERING THE CANCER CARE

Increased use of sodium channel blockers may reduce cost

By Chase Doyle

ment recommendations.1 The US patent protection for Humira (adalimumab), the primary TNFi used in PsA, will expire at the end of this year, and biosimilars are poised to potentially take a significant share

RHEUMATOLOGY UPDATE . . 19 Patients with RA and OA Have Excellent Outcomes After Total Knee Replacement

A Peer-Reviewed Journal

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Senior Vice President 732.992.1886 jhennessy2@the-lynx-group.com

Value Modifier Policy for 2017: How Does Your Practice Measure Up?

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Lacosamide reduces seizures in partial epilepsy

Patient’s Priorities

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FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

Antipsychotics increase mortality risk in Parkinson’s disease

Updated Recommendations for A New Paradigm for Survivorship Pharmacologic Treatment of Patients with Psoriatic Arthritis Care: Assessing the

VALUE PROPOSITIONS . . . . . . . 4 FIBROMYALGIA . . . . . . . . . . . . . 22 Bariatric Surgery Before Knee Headaches, Persistent Back and Arthroplasty Neck Pain Predictors of Fibromyalgia Symptoms RHEUMATOID ARTHRITIS . . . 5 High Risk for Chronic Infections Linked to Q Fever in Patient with Rheumatoid Arthritis S

John Hennessy

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the signs and symptoms of ankylosing spondylitis. Results suggest that secukinumab is effective in patients naive to anti–tumor necrosis factor

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Senior Vice President 732.992.1884 nenglezos@the-lynx-group.com

David C. Sheridan, MD

ONCOLOGY PRACTICE

PSORIATIC ARTHRITIS drugs, but in the last 1 to 2 decades, biologic DMARDs—consisting of several cytokine inhibitors and other immune modulators—have been added © 2015 Engage Healthcare Communications, LLC to this list.1 Because of the costliness of biologic DMARDs, identifying nonresponders, anti-drug antibodies, and

Secukinumab Effective in Ankylosing Spondylitis

Bellevue, WA—Although the link between leadership and effective communication has long been acknowledged, developing the latter is still easier said than done. At the 2015 annual meeting of the National Organization of Rheumatology Managers, Tracy L. Spears, CEO of the Exceptional Leaders Lab, discussed the importance of this seem-

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raditionally, patients with rheumatoid arthritis (RA) have been treated with immunosuppressive drugs, such as corticosteroids, disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), and nonsteroidal anti-inflammatory

Continued on page 8

How to increase teamwork and productivity

Sodium Valproate Reduces Pain in Pediatric Patients with Migraine

pain reduction after VPA infusion, according to David C. Sheridan, MD, Department of Emergency Medicine, Oregon Health & Science University, (VPA) was used in the second-line set- Portland, who presented the results at ting for the treatment of adolescent the 2015 American Academy of Pain San Diego, CA—An inhaled formula- phase 2 clinical trial. According to data patients with migraine. Patients Medicine annual meeting. out is a common painful best to manage it. tion of levodopa (CVT-301) eased and presented at thehow International Congress achieved an additional 44% average “There are really no true, FDA-apcondition in that The study suggested that most Continued on page 8 breakthrough motor symptoms pa-is manageable, of Parkinson’s Disease and also Movement anddisease treatment arepatients GPs are not the following all of the guidetients with Parkinson’s (PD)guidelines Disorders, using inhaled available. Despite stud- were lines for able management between standard levodopa doses this, in a several formulation better to bridge of gout. For ies suggest management is subopti- example, urate-lowering therapy Continued on page 14 mal. A recent survey that explored (ULT) is frequently delivered inapMULTIPLE SCLEROSIS . . . . . . . . . . 4 IN THE LITERATURE . . . . . . . . . . 11 barriers to optimal care found that propriately, and monitoringSwitching of uric to teriflunomide is safe Adolescent sleep variability may impair and effective brain development patients and general practitioners acid (UA) concentrations is irregular. FOR ONCOLOGISTS, PRACTICE MANAGERS, (GPs) who treat gout want to be bet- In addition, when initiating alloSTROKE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 PARKINSON’S DISEASE . . . . . . 14 ter educated about the condition and purinol as ULT, many GPs fail to pre-

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Continued on page 4

GOUT

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Continued on page 17

provider communication is of primary importance. Among patients with relapsingremitting multiple sclerosis who were surveyed online between November and December 2012, those who had

By Chase Doyle By Alice Goodman

By Sophie Granger

BREAST CANCER . . . . . . . . . . . . . . 11 MYELOFIBROSIS . . . . . . . . . . . . . . 17 Chemotherapy-Induced Alopecia Ruxolitinib Reduces Spleen Size and Improves Disease-Related Symptoms ASH CONFERENCE CORRESPONDENT . . . . . . . . . . . . .14 DRUG UPDATE . . . . . . . . . . . . . . . . 20 All-Oral Combination Shows Keytruda (Pembrolizumab) First PD-1 Promise in Patients with Inhibitor Approved for the Treatment Multiple Myeloma of Patients with Metastatic Non–SmallCell Lung Cancer Expressing PD-L1

VOLUME 3 • NUMBER 6

racial differences in poststroke ADL limitations were observed,” reported James F. Burke, MD, MS, Clinical Lecturer, Neurology, University of Michigan, Ann Arbor, and colleagues. “Therefore, it is unlikely that the observed racial differences in poststroke ADL limitations are accounted for by differences in prestroke function.” As Dr Burke explained to ValueBased Care in Neurology (VBCN), it has been well-documented that African

Inhaled Levodopa Provides Rapid IL-6, VEGF-A Show Potential National Harbor, MD—A retrospecUnderstanding of tive MotorBetter Improvements in Patients review of pediatric emergency deas Disease Markers in Patients data showed significant pain with Parkinson’s Disease Patients with Gout Needed partment reduction when sodium valproate with Long-Term RA

for multiple myeloma. Daratumumab was approved under the FDA’s priority review and was granted an orphan drug status. “Targeting proteins that are found on the surface of cancer cells has led to the development of important oncology treatments,” said Richard Pazdur, MD, Director of the FDA’s Office of Hematology and Oncology Products. “Darzalex provides another treatment

Continued on page 6

ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safetycentered practice. As a challenge, the next time you enter your

preliminary analysis of predictors of disease-modifying therapy (DMT) adherence, presented at the American Academy of Neurology 2015 annual meeting reinforces the notion that patient–

contemporary information

VOL 9, NO 1

CLINICAL GUIDELINE UPDATE

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Continued on page 5

DECEMBER 2015

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www.ValueBasedRheumatology.com

By Rosemary Frei, MSc

By Rosemary Frei, MSc Christine M. Friedenreich, PhD

acial disparities in poststroke activities of daily living (ADL) limitations are not a result of prestroke activity limitations. Instead, according to a recent study, differences appear largest in the first 2 years after stroke2016 (Burke JF, et al. J Stroke CerebroFEBRUARY VOL vasc 5 • Dis. NO2015;24:1636-1639). 1 “In this nationally representative study of over 500 stroke patients, there were no racial differences in prestroke ADL limitations. In contrast, marked

Predictors of outcomes in mild Continuedischemic on page 8stroke

For Clinical Pharmacists, Board Certified Oncology Pharmacists, Pharmacy Directors, and P&T Committee Members LEADERSHIP

ncreased levels of physical activity after a diagnosis of prostate cancer are associated with significantly better survival, according to the results of a new,

By Chase Doyle

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to provide pivotal and

ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safety-centered practice. As a challenge, the next time you enter your office, walk in the front door and

Boosting Blueberry Intake May Keep Erectile Dysfunction Risk at Bay

I

www.ValueBasedNeurology.com

Director, Compliance and Education, Total Medical Compliance

By Charles Bankhead

JULY 2015 • VOL 2 • NO 2

Predictors of Patient Adherence Racial Disparities in Daily Activities After Stroke: to Multiple Sclerosis Therapy By Rosemary Frei, MSc Why Are Outcomes Worse in African Americans?

business model, we strive

www.JONS-online.com

A Practical Safety Checklist for Practice Managers

Increased Physical Activity May Help Extend Survival After Prostate Cancer Diagnosis

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Executive Vice President 732.992.1899 ssweeney@the-lynx-group.com

Guides Are Here! Pg. 26

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www.ValueBasedNeurology.com

Predictors of Patient Adherence Racial Disparities in Daily Activities After Stroke: to Multiple Sclerosis Therapy By Rosemary Frei, MSc Why Are Outcomes Worse in African Americans?

RETRAIN YOUR MIND TO BE YOUR OWN BEST ADVOCATE Making Progress with Patient Navigation

Certification CLINICAL TRIALS: 10 WHAT’SPg.IN IT FOR ME?

By Chase Doyle

R

acial disparities in poststroke activities of daily living (ADL) limitations are not a result of prestroke activity limitations. Instead, according to a recent study, differences appear largest in the first 2 years after stroke2016 (Burke JF, et al. J Stroke CerebroFEBRUARY VOL vasc 5 • Dis. NO2015;24:1636-1639). 1 “In this nationally representative study of over 500 stroke patients, there were no racial differences in prestroke ADL limitations. In contrast, marked

racial differences in poststroke ADL limitations were observed,” reported James F. Burke, MD, MS, Clinical Lecturer, Neurology, University of Michigan, Ann Arbor, and colleagues. “Therefore, it is unlikely that the observed racial differences in poststroke ADL limitations are accounted for by differences in prestroke function.” As Dr Burke explained to ValueBased Care in Neurology (VBCN), it has been well-documented that African

Relationship Between

ENCOURAGING HEALTHYand Fear Illness Perception of Recurrence and BEHAVIORS Psychological INCancer CAREGIVERS Distress Among Survivors of

AVOIDING THE TOXIC Gynecologic Cancer 12 COST OFPg.CANCER CARE

Continued on page 6

preliminary analysis of predictors of disease-modifying therapy (DMT) adherence, presented at the American Academy of Neurology 2015 annual meeting reinforces the notion that patient–

provider communication is of primary importance. Among patients with relapsingremitting multiple sclerosis who were surveyed online between November and December 2012, those who had

www.ValueBasedRheumatology.com

Continued on page 4

Sodium Valproate Reduces Pain in Pediatric Patients with Migraine

Inhaled Levodopa Provides Rapid IL-6, VEGF-A Show Potential Harbor, MD—A retrospecUnderstanding of National MotorBetter Improvements in Patients tive review of pediatric emergency deas Disease Markers in Patients data showed significant pain with Parkinson’s Disease Patients with Gout Needed partment reduction when sodium valproate with Long-Term RA (VPA) was used in the second-line setBy Chase Doyle By Alice Goodman GOUT

By Chase Doyle

ting for the treatment of adolescent San Diego, CA—An inhaled formula- phase 2 clinical trial. According to data patients with migraine. Patients out is a common painful best to manage it. tion of levodopa (CVT-301) eased and presented at thehow International Congress achieved an additional 44% average condition in that The study suggested that most breakthrough motor symptoms pa-is manageable, of Parkinson’s Disease and also Movement anddisease treatment arepatients GPs are not the following all of the guidetients with Parkinson’s (PD)guidelines Disorders, using inhaled available. Despite stud- were lines for able management between standard levodopa doses this, in a several formulation better to bridge of gout. For ies suggest management is subopti- example, urate-lowering therapy Continued on page 14 mal. A recent survey that explored (ULT) is frequently delivered inapMULTIPLE SCLEROSIS . . . . . . . . . . 4 barriers to optimal care found that propriately, and monitoringSwitching of uric to teriflunomide is safe and effective patients and general practitioners acid (UA) concentrations is irregular. (GPs) who treat gout want to be bet- In addition, when initiating alloSTROKE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ter educated about the condition and purinol as ULT, many GPs fail to prePredictors of outcomes in mild

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By Sophie Granger

HEADACHE MANAGEMENT . .

raditionally, patients with rheumatoid arthritis (RA) have been treated with immunosuppressive drugs, such as corticosteroids, disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), and nonsteroidal anti-inflammatory

Overprescribing of barbiturates and opioids

PSORIATIC ARTHRITIS drugs, but in the last 1 to 2 decades, biologic DMARDs—consisting of several cytokine inhibitors and other immune modulators—have been added © 2015 Engage Healthcare Communications, LLC to this list.1 Because of the costliness of biologic DMARDs, identifying nonresponders, anti-drug antibodies, and Continued on page 6

ONCOLOGY PRACTICE

MANAGEMENT Continued on page 8

EPILEPSY & SEIZURES

Updated Recommendations for Pharmacologic Treatment of Patients with Psoriatic Arthritis

. . . . . . . .

Lacosamide reduces seizures in partial epilepsy

8

10

And other concise reviews of recently published studies n analysis of 2 double-blind phase 3 trials (MEASURE 1 and MEASURE 2) shows that secukinumab significantly reduced

the signs and symptoms of ankylosing spondylitis. Results suggest that secukinumab is effective in patients naive to anti–tumor necrosis factor

B

iosimilar tumor necrosis factor inhibitors (TNFis) were given the thumbs up in the European League Against Rheumatism (EULAR) 2015 update of its psoriatric arthritis (PsA) pharmacologic treat-

MARCH 2016

HEALTH ECONOMICS . . . . . . . . 16

www.OncPracticeManagement.com

Increased use of sodium channel blockers may reduce cost

CHRONIC PAIN . . . . . . . . . . . . . . . . . 17

A New Paradigm for Survivorship Care: Assessing the Patient’s Priorities

Sex differences in response to tramadol

Implementation of ICD-10—Is That It? By Karna W. Morrow, CPC, RCC, CCS-P, PCS Senior Consultant, CSI Coding Strategies Powder Springs, GA

Continued on page 21

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www.UroPracticeManagement.com

Increased Physical Activity May Help Extend Survival After Prostate Cancer Diagnosis By Charles Bankhead

VOLUME 5 • NUMBER 1 www.JONS-online.com

A Practical Safety Checklist for Practice Managers By Karen Gregory, RN

New Look, Same Great ContentFEBRUARY 2016

NAVIGATING PATIENTS ACROSS THE CONTINUUM OF CANCER CARETM www.AONNonline.org

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Episode-of-Care Reimbursement Model in Oncology: Benefits and Challenges

Deborah Korenstein, MD

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ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safety-centered practice. As a challenge, the next time you enter your office, walk in the front door and

A

new paradigm of survivorship care is needed that attempts to balance the patient’s total well-being against the often toxic treatment of the disease, suggests Deborah Korenstein, MD, Director of Clinical EffectiveContinued on page 12

G

iven the high cost of care for acute leukemia, innovative payment strategies that reward longitudinal care and create economic incentives for data-driven care delivery are needed, according to Joseph Alvarnas, MD, Director of Value-Based Analytics, and Associate Clinical Professor of Hematology and Hematopoi-

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A Peer-Reviewed Journal

March 2016 • Volume 5 • Number 2

PM O

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ncreased levels of physical activity after a diagnosis of prostate cancer are associated with significantly better survival, according to the results of a new, Continued on page 5

BIOMARKERS • TARGETED THERAPIES • DIAGNOSTICS

Personalized Medicine in Oncology Personalizing Oncology Care and the Quest for Companion Diagnostics: A Researcher’s Perspective. An Interview with Suso J. Platero, PhD, of Janssen Pharmaceuticals ..................................................Page 61

llin

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INTERVIEW WITH THE INNOVATORS

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COLORECTAL CANCER JANUARY 2016 Volume 3 • Number 1

Checkpoint Inhibition: A Promising Immunotherapeutic Approach for Colorectal Cancer..............................Page 8

Pembrolizumab Combination Shows Robust Antitumor Activity.................................................Page 13

A Century of Medical Product Regulation: The Historic Framework for Personalized Medicine in Oncology.....................................................Page 66

R KE AC TR

Certain Types of T-Cells Show Clinical Benefit in Patients with Glioblastoma.................................................Page 14

The Evolving Phenotype of Li-Fraumeni Syndrome.............................................................Page 72

STAKEHOLDER PERSPECTIVE

The Coming Government Takeover of Drug Pricing..................................................................Page 20

PMO LIVE Case: Biomarkers in Multiple Myeloma..............Page 74

NATURAL KILLER CELLS

I SIC PHY

PANCREATIC CANCER

Using Natural Killer Cells in Immunotherapy: What Is Known, and Where to Next...............................Page 22

Immunotherapies in Development for Pancreatic Cancer.................................................................Page 76

Orlando, FL—Guidelines for enoxaparin dose reduction when treating chemotherapy-induced thrombocytopenia (CIT) have been validated by a quality assessment study conducted at Memorial Sloan Kettering Cancer Center (MSKCC) in New York. “Our quality assessment project supports the safety and efficacy of our guidelines for therapeutic dose modifications of low-molecular-weight heparin (LMWH) in the setting of CIT,” said Gerald A. Soff, MD, Chief, Hematology Service, MSKCC, who discussed the study at a press briefing during the 57th American Society of Hematology

Alice Goodman

yrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), and dramatically improved survival for these patients. Many patients with CML treated with a TKI have deep, sustained remissions. Clinical trials have shown that some good

MANAGEMENT

responders can safely stop TKI treatment without remission. It has, however, become evident that about 1 in 4 patients who stop treatment with a TKI experience musculoskeletal pain (ie, TKI withdrawal syndrome [WS]). A study reported at the recent American Society of Hematology (ASH) annual Continued on page 7

Darzalex First Monoclonal Antibody Approved by the FDA for Multiple Myeloma

N

ovember 2015 may be remembered as the “multiple myeloma month” in the annals of the FDA. On November 16, 2015, the FDA approved daratumumab (Darzalex; Janssen Biotech) injection for the treatment of patients with multiple myeloma who have received ≥3 previous treatments for this condition. Daratumumab is the first monoclonal antibody approved by the FDA

FOR RHEUMATOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS

®

DECEMBER 2015

www.RheumatologyPracticeManagement.com

A Practical Safety Checklist for Practice Managers Director, Compliance and Education, Total Medical Compliance

MSKCC Guidelines for LMWH Dosing Thrombosis is the second leading cause of death in patients with cancer. It is commonly treated with anticoagulation, but this carries an increased risk of bleeding. In 2011, MSKCC implemented guidelines for LMWH dose modifications in the thrombocytopenia setting: adminisContinued on page 11

And other news from ASH, ASTRO, and SABCS

T

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Annual Meeting & Exposition. “With appropriate adherence to our guidelines, we saw gratifying safety and efficacy results,” Dr Soff said. “I think this will have an impact in reassuring practitioners.”

FDA NEWS

Continued on page 13

Pain Syndrome After Stopping Treatment with Tyrosine Kinase Inhibitors

LS ls 3 IA ria ith ..1 TR al T ts w er… AL nic tien nc IC Cli r Pa Ca fo te LIN C sta ™

serves to improve the effectiveness of leaders in hospital and health-system pharmacy practice. The Pharmacy Forecast 2016-2020, which predicts

CONFERENCE NEWS

RHEUMATOLOGY PRACTICE

SOCIETY FOR IMMUNOTHERAPY OF CANCER

GENETIC COUNSELING

New Orleans, LA—The American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Forecast, now in its fourth edition,

Continued on page 11

By Karen Gregory, RN

MELANOMA

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Caroline Helwick

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new study suggests that boosting the consumption of flavonoid-containing foods, such as blueberries, may help stave off erectile dysfunction (Cassidy A, et al. Am J Clin Nutr. 2016 Jan 13. Epub ahead of print). The questionnaire-based study of more than 25,000 men participating in the Health Professionals Follow-Up Study indicated a 9% lower risk for erectile dysfunction among men who had a higher intake of flavones and an 11% lower risk with a higher intake of flavanones. “This is a large observational study and provides some novel and interesting as-

Continued on page 28

From the publishers of

CLINICAL GUIDELINE UPDATE

LEADERSHIP

By Rosemary Frei, MSc Christine M. Friedenreich, PhD

VOL 9, NO 1

For Clinical Pharmacists, Board Certified Oncology Pharmacists, Pharmacy Directors, and P&T Committee Members

Continued on page 9

Boosting Blueberry Intake May Keep Erectile Dysfunction Risk at Bay

Joseph Alvarnas, MD

By Corbin Davis

www.TheOncologyPharmacist.com

Director, Compliance and Education, Total Medical Compliance

Continued on page 14

VALUE PROPOSITIONS . . . . . . . 4 FIBROMYALGIA . . . . . . . . . . . . . 22 Bariatric Surgery Before Knee Headaches, Persistent Back and Arthroplasty Neck Pain Predictors of Fibromyalgia Symptoms RHEUMATOID ARTHRITIS . . . 5 High Risk for Chronic Infections Linked to Q Fever in Patient with Rheumatoid Arthritis S

Cancers Pg. 42

FOR UROLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

FEBRUARY 2016

VOLUME 6 • NUMBER 3

he date of the implementation of the International Classification of Diseases, Clinical Modification (ICD-10-CM, henceforth “ICD-10”), has come and gone, and we have survived what is arguably the most significant change for providers in the history of reporting healthcare services. As the dust settles, a postimplementation assessment is recommended. This is a time to acknowledge the success, reward the hard work, and ensure that

By Chase Doyle

ment recommendations.1 The US patent protection for Humira (adalimumab), the primary TNFi used in PsA, will expire at the end of this year, and biosimilars are poised to potentially take a significant share

RHEUMATOLOGY UPDATE . . 19 Patients with RA and OA Have Excellent Outcomes After Total Knee Replacement

MANAGEMENT

conquer-magazine.com

FOR ONCOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

PARKINSON’S DISEASE . . . . . . 14 Antipsychotics increase mortality risk in Parkinson’s disease

INSIDE

Continued on page 17

Patient Navigation Success Varies Among Different Groups of Women with

Official patient magazine of Breast and Gynecologic ™

™

Adolescent sleep variability may impair brain development

Photo by © ASCO/Todd Buchanan 2016

Secukinumab Effective in Ankylosing Spondylitis

UROLOGY PRACTICE

IN THE LITERATURE . . . . . . . . . . 11

By Rosemary Frei, MSc

A

Guides Are Here!

Pg. 26 CANCERS KIDNEY

David C. Sheridan, MD

pain reduction after VPA infusion, according to David C. Sheridan, MD, Department of Emergency Medicine, Oregon Health & Science University, Portland, who presented the results at the 2015 American Academy of Pain Medicine annual meeting. “There are really no true, FDA-ap-

INSIDE

Continuedischemic on page 8stroke

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Oncology Patient MULTIPLE MYELOMA Navigator−Certified Generalist: IN Learning FOCUS

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Pat Killingsworth

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for multiple myeloma. Daratumumab was approved under the FDA’s priority review and was granted an orphan drug status. “Targeting proteins that are found on the surface of cancer cells has led to the development of important oncology treatments,” said Richard Pazdur, MD, Director of the FDA’s Office of Hematology and Oncology Products. “Darzalex provides another treatment Continued on page 8

I N S I D E BREAST CANCER . . . . . . . . . . . . . . 11 MYELOFIBROSIS . . . . . . . . . . . . . . 17 Chemotherapy-Induced Alopecia Ruxolitinib Reduces Spleen Size and Improves Disease-Related Symptoms ASH CONFERENCE CORRESPONDENT . . . . . . . . . . . . .14 DRUG UPDATE . . . . . . . . . . . . . . . . 20 All-Oral Combination Shows Keytruda (Pembrolizumab) First PD-1 Promise in Patients with Inhibitor Approved for the Treatment Multiple Myeloma of Patients with Metastatic Non–SmallCell Lung Cancer Expressing PD-L1

VOLUME 3 • NUMBER 6

LEADERSHIP

Mastering the Crucial Conversation

How to increase teamwork and productivity By Chase Doyle

Bellevue, WA—Although the link between leadership and effective communication has long been acknowledged, developing the latter is still easier said than done. At the 2015 annual meeting of the National Organization of Rheumatology Managers, Tracy L. Spears, CEO of the Exceptional Leaders Lab, discussed the importance of this seemContinued on page 6

W

ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safetycentered practice. As a challenge, the next time you enter your Continued on page 17

Value Modifier Policy for 2017: How Does Your Practice Measure Up? Emily L. Graham

Bellevue, WA—Mandated by the Affordable Care Act and first applied on January 1, 2015, to large group practices, the Value Modifier (VM) provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS), based on the quality of care furnished compared with cost during a performance period. Continued on page 7

THE LAST WORD Regulation and Reimbursement Policies Will

In partnership with

Determine the PMI’s Legacy.............................. Page 94 GLOBAL BIOMARKERS CONSORTIUM Clinical Approaches to Targeted Technologies ™

The official publication of

Nat ion al O r gan iz at ion of o R he u m atolo g y Man a ge rs

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The Lynx Group philosophy utilizes our branded publications and full-service medical communications capabilities to provide customized and targeted programs for those involved in the spectrum of healthcare. Through our network and brands, we have the capability to engage the most appropriate thought leaders for your specific needs.

Nurses & Navigators Real Time Market Intelligence (RTMi) powered by The Lynx Group offers double-blind, real time access to our precontracted advisors across the healthcare continuum. Our comprehensive database along with our proprietary technology platform allow for virtual access in real time to all key influencers and decision makers in the healthcare community. The flexibility and nimble nature of RTMi allow for a wide range of applications with outcomes that ensure market optimization. The convenience that the virtual platform offers to our advisors ensures high participation rates with deep, qualitative responses that empower our clients with fresh, actionable insights.

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On-demand access to communicate to a wide reach of key stakeholders:

ASSOCIATIONS/CONFERENCES

patients, caregivers, nurse navigators, HCPs, and other customer groups Weekly recaps for timely feedback and monthly detailed executive summaries to evaluate real time market dynamics

The Lynx Group is the official association management and marketing company of the Academy of Oncology Nurse & Patient Navigators, and the Association for Value-Based Cancer Care. Through our association and conference management division, we have access to key thought leaders and target audiences throughout the spectrum of healthcare providers.

Recommendations on additional

to enhance, shape, and further launch strategy and goals

Multistakeholder Summits Market Research/Survey/Analytics

Campaign/Logo Development

responses as needed to obtain insightful

sales reps and field-based clinical teams

Congress Coverage/CI

Scientific Planning

Opportunities to probe on specific

Key insights to complement efforts of

Live Thought Leader Engagements

(Branded/Unbranded)

utilization

challenges/experiences

Peer-to-Peer Engagements

Content Development/Refresh

resources that will assist in clinical trial

feedback on clinical and operational

Strategix is a full-service, boutique-style strategic consulting, medical education, and communications agency that provides personalized service, flexibility, and individualized attention, while being backed by the infrastructure and shared professional resources of The Lynx Group. Strategix’s unique offerings include custom solutions that place senior-level staff with the unique experiences of launching and growing brands directly on their day-to-day work, as well as the capacity to engage a vast network of community and thought leaders. Strategix offers a wide range of strategies and services tailored to meet your specific needs.

Led by Lillie D. Shockney, RN, BS, MAS, ONN-CG, the Academy of Oncology Nurse & Patient Navigators (AONN+) is the largest professional organization dedicated to advancing the role of patient navigation in cancer care and survivorship care planning by providing a network for collaboration and development of best practices for the improvement of patient access to care, evidence-based cancer treatment, and quality of life during and after cancer treatment.

AONNonline.org

The Association for Value-Based Cancer Care (AVBCC) is one of the fastest growing national specialty organizations dedicated to improving the care of cancer patients and their quality of life, by discussing, considering, and evaluating the value equation as it relates to new and existing cancer therapies. We provide a forum for payers, providers, and the entire oncology team to consider and evaluate the cost–value issues particular to cancer treatments and its impact on patient care and outcomes. This unique focus is achieved through discussions and collaborations with those involved in evaluating therapies, treating patients, and paying for care.

AVBCConline.org

Brand Strategy Launch POA Meetings Advocacy Partnerships Clinical Trial Recruitment Strategy/Branding

CUSTOMER ENGAGEMENT

JOURNALS AND ADVERTISING

AGENCY

The Lynx Group philosophy utilizes our branded publications and full-service medical communications capabilities to provide customized and targeted programs for those involved in the spectrum of healthcare. Through our network and brands, we have the capability to engage the most appropriate thought leaders for your specific needs.

Nurses & Navigators Real Time Market Intelligence (RTMi) powered by The Lynx Group offers double-blind, real time access to our precontracted advisors across the healthcare continuum. Our comprehensive database along with our proprietary technology platform allow for virtual access in real time to all key influencers and decision makers in the healthcare community. The flexibility and nimble nature of RTMi allow for a wide range of applications with outcomes that ensure market optimization. The convenience that the virtual platform offers to our advisors ensures high participation rates with deep, qualitative responses that empower our clients with fresh, actionable insights.

Patients & Caregivers Payers

Physicians

THE PEER-REVIEWED FORUM FOR REAL-WORLD EVIDENCE IN BENEFIT DESIGN ™

FOR PAYERS, PURCHASERS, POLICYMAKERS, AND OTHER HEALTHCARE STAKEHOLDERS

Practice Managers ONCOLOGY PRACTICE

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WHY RTMi?

MANAGEMENT

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FOR RHEUMATOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS

For Clinical Pharmacists, Board Certified Oncology Pharmacists, Pharmacy Directors, and P&T Committee Members

Strategic Partnership

On-demand access to communicate to a wide reach of key stakeholders:

ASSOCIATIONS/CONFERENCES

patients, caregivers, nurse navigators, HCPs, and other customer groups Weekly recaps for timely feedback and monthly detailed executive summaries to evaluate real time market dynamics

The Lynx Group is the official association management and marketing company of the Academy of Oncology Nurse & Patient Navigators, and the Association for Value-Based Cancer Care. Through our association and conference management division, we have access to key thought leaders and target audiences throughout the spectrum of healthcare providers.

Recommendations on additional

to enhance, shape, and further launch strategy and goals

Multistakeholder Summits Market Research/Survey/Analytics

Campaign/Logo Development

responses as needed to obtain insightful

sales reps and field-based clinical teams

Congress Coverage/CI

Scientific Planning

Opportunities to probe on specific

Key insights to complement efforts of

Live Thought Leader Engagements

(Branded/Unbranded)

utilization

challenges/experiences

Peer-to-Peer Engagements

Content Development/Refresh

resources that will assist in clinical trial

feedback on clinical and operational

Strategix is a full-service, boutique-style strategic consulting, medical education, and communications agency that provides personalized service, flexibility, and individualized attention, while being backed by the infrastructure and shared professional resources of The Lynx Group. Strategix’s unique offerings include custom solutions that place senior-level staff with the unique experiences of launching and growing brands directly on their day-to-day work, as well as the capacity to engage a vast network of community and thought leaders. Strategix offers a wide range of strategies and services tailored to meet your specific needs.

Led by Lillie D. Shockney, RN, BS, MAS, ONN-CG, the Academy of Oncology Nurse & Patient Navigators (AONN+) is the largest professional organization dedicated to advancing the role of patient navigation in cancer care and survivorship care planning by providing a network for collaboration and development of best practices for the improvement of patient access to care, evidence-based cancer treatment, and quality of life during and after cancer treatment.

AONNonline.org

The Association for Value-Based Cancer Care (AVBCC) is one of the fastest growing national specialty organizations dedicated to improving the care of cancer patients and their quality of life, by discussing, considering, and evaluating the value equation as it relates to new and existing cancer therapies. We provide a forum for payers, providers, and the entire oncology team to consider and evaluate the cost–value issues particular to cancer treatments and its impact on patient care and outcomes. This unique focus is achieved through discussions and collaborations with those involved in evaluating therapies, treating patients, and paying for care.

AVBCConline.org

Brand Strategy Launch POA Meetings Advocacy Partnerships Clinical Trial Recruitment Strategy/Branding

CUSTOMER ENGAGEMENT

JOURNALS AND ADVERTISING

AGENCY

The Lynx Group philosophy utilizes our branded publications and full-service medical communications capabilities to provide customized and targeted programs for those involved in the spectrum of healthcare. Through our network and brands, we have the capability to engage the most appropriate thought leaders for your specific needs.

Nurses & Navigators Real Time Market Intelligence (RTMi) powered by The Lynx Group offers double-blind, real time access to our precontracted advisors across the healthcare continuum. Our comprehensive database along with our proprietary technology platform allow for virtual access in real time to all key influencers and decision makers in the healthcare community. The flexibility and nimble nature of RTMi allow for a wide range of applications with outcomes that ensure market optimization. The convenience that the virtual platform offers to our advisors ensures high participation rates with deep, qualitative responses that empower our clients with fresh, actionable insights.

Patients & Caregivers Payers

Physicians

THE PEER-REVIEWED FORUM FOR REAL-WORLD EVIDENCE IN BENEFIT DESIGN ™

FOR PAYERS, PURCHASERS, POLICYMAKERS, AND OTHER HEALTHCARE STAKEHOLDERS

Practice Managers ONCOLOGY PRACTICE

MANAGEMENT

FOR ONCOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS ™

™

UROLOGY PRACTICE

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Pharmacists

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FOR UROLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

RHEUMATOLOGY PRACTICE

WHY RTMi?

MANAGEMENT

CORE CAPABILITIES

™

FOR RHEUMATOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS

For Clinical Pharmacists, Board Certified Oncology Pharmacists, Pharmacy Directors, and P&T Committee Members

Strategic Partnership

On-demand access to communicate to a wide reach of key stakeholders:

ASSOCIATIONS/CONFERENCES

patients, caregivers, nurse navigators, HCPs, and other customer groups Weekly recaps for timely feedback and monthly detailed executive summaries to evaluate real time market dynamics

The Lynx Group is the official association management and marketing company of the Academy of Oncology Nurse & Patient Navigators, and the Association for Value-Based Cancer Care. Through our association and conference management division, we have access to key thought leaders and target audiences throughout the spectrum of healthcare providers.

Recommendations on additional

to enhance, shape, and further launch strategy and goals

Multistakeholder Summits Market Research/Survey/Analytics

Campaign/Logo Development

responses as needed to obtain insightful

sales reps and field-based clinical teams

Congress Coverage/CI

Scientific Planning

Opportunities to probe on specific

Key insights to complement efforts of

Live Thought Leader Engagements

(Branded/Unbranded)

utilization

challenges/experiences

Peer-to-Peer Engagements

Content Development/Refresh

resources that will assist in clinical trial

feedback on clinical and operational

Strategix is a full-service, boutique-style strategic consulting, medical education, and communications agency that provides personalized service, flexibility, and individualized attention, while being backed by the infrastructure and shared professional resources of The Lynx Group. Strategix’s unique offerings include custom solutions that place senior-level staff with the unique experiences of launching and growing brands directly on their day-to-day work, as well as the capacity to engage a vast network of community and thought leaders. Strategix offers a wide range of strategies and services tailored to meet your specific needs.

Led by Lillie D. Shockney, RN, BS, MAS, ONN-CG, the Academy of Oncology Nurse & Patient Navigators (AONN+) is the largest professional organization dedicated to advancing the role of patient navigation in cancer care and survivorship care planning by providing a network for collaboration and development of best practices for the improvement of patient access to care, evidence-based cancer treatment, and quality of life during and after cancer treatment.

AONNonline.org

The Association for Value-Based Cancer Care (AVBCC) is one of the fastest growing national specialty organizations dedicated to improving the care of cancer patients and their quality of life, by discussing, considering, and evaluating the value equation as it relates to new and existing cancer therapies. We provide a forum for payers, providers, and the entire oncology team to consider and evaluate the cost–value issues particular to cancer treatments and its impact on patient care and outcomes. This unique focus is achieved through discussions and collaborations with those involved in evaluating therapies, treating patients, and paying for care.

AVBCConline.org

Brand Strategy Launch POA Meetings Advocacy Partnerships Clinical Trial Recruitment Strategy/Branding

the patient voice APRIL 2016 • VOL 7, NO 3

OR AT

Pat Killingsworth AN INSPIRATIONAL MULTIPLE MYELOMA PATIENT ADVOCATE RETRAIN YOUR MIND TO BE YOUR OWN BEST ADVOCATE Making Progress with

global strategic alliance

President/CEO, The Lynx Group 908.510.5329 btyburski@the-lynx-group.com

of medical communication and education companies.

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Patient Navigation

Brian Tyburski

Certification CLINICAL TRIALS: Pg. 10 WHAT’S IN IT FOR ME?

Through our unique

Relationship Between

ENCOURAGING HEALTHY Illness Perception and Fear of Cancer Recurrence and BEHAVIORS IN CAREGIVERS Psychological Distress Among Survivors of

AVOIDING TOXIC GynecologicTHE Cancer Pg. 12 COST OF CANCER CARE

Shannon Sweeney

Oncology Patient MULTIPLE MYELOMA Navigator−Certified Generalist: Learning IN FOCUS

KIDNEY CANCERS

UROLOGY PRACTICE Patient Navigation Success Varies Among Different Groups of Women with Breast and Gynecologic Cancers Pg. 42

MANAGEMENT

conquer-magazine.com

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FOR UROLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

www.UroPracticeManagement.com

FEBRUARY 2016

VOLUME 5 • NUMBER 1

By Karen Gregory, RN

New Look, Same Great ContentFEBRUARY 2016

NAVIGATING PATIENTS ACROSS THE CONTINUUM OF CANCER CARETM www.AONNonline.org

www.TheOncologyPharmacist.com

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LMWH Protocol for Thrombocytopenia Validated in Study

ASHP Foundation Forecast Provides Actionable Recommendations for Pharmacy Leaders

Caroline Helwick

Meg Barbor

new study suggests that boosting the consumption of flavonoid-containing foods, such as blueberries, may help stave off erectile dysfunction (Cassidy A, et al. Am J Clin Nutr The questionnaire-based study of more than 25,000 men participating in the Health Professionals Follow-Up Study indicated a 9% lower risk for erectile dysfunction among men who had a higher intake of flavones and an 11% lower risk with a higher intake of flavanones. “This is a large observational study and provides some novel and interesting as

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New Orleans, LA—The American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Forecast, now in its fourth edition,

R KE AC TR

Orlando, FL—Guidelines for enoxaparin dose reduction when treating chemotherapy-induced thrombocytopenia (CIT) have been validated by a quality assessment study conducted at Memorial Sloan Kettering Cancer Center (MSKCC) in New York. “Our quality assessment project supports the safety and efficacy of our guidelines for therapeutic dose modifications of low-molecular-weight heparin (LMWH) in the setting of CIT,” said Gerald A. Soff, MD, Chief, Hematology Service, MSKCC, who discussed the study at a press briefing during the 57th American Society of Hematology

Alice Goodman

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responders can safely stop TKI treatment without remission. It has, however, become evident that about 1 in 4 patients who stop treatment with a TKI experience musculoskeletal pain (ie, TKI withdrawal syndrome [WS]). A study reported at the recent American Society of Hematology (ASH) annual Continued on page 7

Darzalex First Monoclonal Antibody Approved by the FDA for Multiple Myeloma

N

ovember 2015 may be remembered as the “multiple myeloma month” in the annals of the FDA. On November 16, 2015, the FDA approved daratumumab (Darzalex; Janssen Biotech) injection for the treatment of patients with multiple myeloma who have received ≥3 previous treatments for this condition. Daratumumab is the first monoclonal antibody approved by the FDA

FOR RHEUMATOLOGISTS, PRACTICE MANAGERS, FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS

www.RheumatologyPracticeManagement.com

By Karen Gregory, RN Director, Compliance and Education, Total Medical Compliance

MSKCC Guidelines for LMWH Dosing Thrombosis is the second leading cause of death in patients with cancer. It is commonly treated with anticoagulation, but this carries an increased risk of bleeding. In 2011, MSKCC implemented guidelines for LMWH dose modifications in the thrombocytopenia setting: adminisContinued on page 11

And other news from ASH, ASTRO, and SABCS yrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), and dramatically improved survival for these patients. Many patients with CML treated with a TKI have deep, sustained remissions. Clinical trials have shown that some good

Annual Meeting & Exposition. “With appropriate adherence to our guidelines, we saw gratifying safety and efficacy results,” Dr Soff said. “I think this will have an impact in reassuring practitioners.”

FDA NEWS

Continued on page 13

Pain Syndrome After Stopping Treatment with Tyrosine Kinase Inhibitors

serves to improve the effectiveness of leaders in hospital and health-system pharmacy practice. The Pharmacy Forecast 2016-2020, which predicts

CONFERENCE NEWS

RHEUMATOLOGY PRACTICE

A Practical Safety Checklist for Practice Managers

W

Mastering the Crucial Conversation

and education for Nick Englezos

MANAGEMENT MARCH 2016 8

Continued on page 6

And other concise reviews of recently published studies n analysis of 2 double-blind phase 3 trials (MEASURE 1 and MEASURE 2) shows that secukinumab significantly reduced

Overprescribing of barbiturates and opioids

EPILEPSY & SEIZURES

Emily L. Graham

Bellevue, WA—Mandated by the Affordable Care Act and first applied on January 1, 2015, to large group practices, the Value Modifier (VM) provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS), based on the quality of care furnished compared with cost during a performance period.

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Senior Consultant, CSI Coding Strategies Powder Springs, GA

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he date of the implementation of the International Classification of Diseases, Clinical Modification (ICD-10-CM, henceforth “ICD-10”), has come and gone, and we have survived what is arguably the most significant change for providers in the history of reporting healthcare services. As the dust settles, a postimplementation assessment is recommended. This is a time to acknowledge the success, reward the hard work, and ensure that Continued on page 14

W ab NE xim A Infli ded 9 FD ilar men l… sim om rova Bio Rec App for

Episode-of-Care Reimbursement Model in Oncology: Benefits and Challenges

Deborah Korenstein, MD

Joseph Alvarnas, MD

By Corbin Davis

A

new paradigm of survivorship care is needed that attempts to balance the patient’s total well-being against the often toxic treatment of the disease, suggests Deborah Korenstein, MD, Director of Clinical Effective-

G

iven the high cost of care for acute leukemia, innovative payment strategies that reward longitudinal care and create economic incentives for data-driven care delivery are needed, according to Joseph Alvarnas, MD, Director of Value-Based Analytics, and Associate Clinical Professor of Hematology and HematopoiContinued on page 28

March 2016 • Volume 5 • Number 2

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Personalized Medicine in Oncology

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INTERVIEW WITH THE INNOVATORS Personalizing Oncology Care and the Quest for Companion Diagnostics: A Researcher’s Perspective. An Interview with Suso J. Platero, PhD, of Janssen Pharmaceuticals..................................................Page 61

FOR RHEUM

DECEMBER

®

A Pra Safet for Pr Man

COLORECTAL CANCER JANUARY 2016 Volume 3 • Number 1

Checkpoint Inhibition: A Promising Immunotherapeutic Approach for Colorectal Cancer..............................Page 8

By Karen Gre

MELANOMA

Director, Com Total Medica

Pembrolizumab Combination Shows Robust Antitumor Activity.................................................Page 13

VALUE-BASED CANCER CARE A Century of Medical Product Regulation: The Historic Framework for Personalized Medicine in Oncology.....................................................Page 66

SOCIETY FOR IMMUNOTHERAPY OF CANCER

GENETIC COUNSELING

Certain Types of T-Cells Show Clinical Benefit in Patients with Glioblastoma.................................................Page 14

The Evolving Phenotype of Li-Fraumeni Syndrome.............................................................Page 72

STAKEHOLDER PERSPECTIVE

The Coming Government Takeover of Drug Pricing..................................................................Page 20

PMO LIVE

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oul of y You The way you the message o centered prac As a chall

Case: Biomarkers in Multiple Myeloma..............Page 74

Your Source for Information and Education Solutions Phil Pawelko

Across the Continuum of Care

Senior Vice President 732.992.1887 ppawelko@the-lynx-group.com

the-lynx-group.com 1249 South River Road, Suite 202A, Cranbury, NJ 08512 Lynx Gatefold Lynx_051718

the-lynx-group.com

NATURAL KILLER CELLS

PANCREATIC CANCER

Using Natural Killer Cells in Immunotherapy: What Is Known, and Where to Next...............................Page 22

Immunotherapies in Development for Pancreatic Cancer.................................................................Page 76

THE LAST WORD Regulation and Reimbursement Policies Will

Determine the PMI’s Legacy.............................. Page 94 GLOBAL BIOMARKERS CONSORTIUM Clinical Approaches to Targeted Technologies ™

The official publication of

In partnership with

From the publishers of

The offical publication of

WORLD CUTANEOUS MALIGNANCIES CONGRESS

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Implementation of ICD-10—Is That It?

From the publishers of

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Senior Vice President 732.992.1888 rhennessy@the-lynx-group.com

CONTINUUM

CHRONIC PAIN . . . . . . . . . . . . . . . . . 17 Sex differences in response to tramadol

Continued on page 21

BIOMARKERS • TARGETED THERAPIES • DIAGNOSTICS

Russ Hennessy

CONQUERING THE CANCER CARE

Increased use of sodium channel blockers may reduce cost

By Chase Doyle

ment recommendations.1 The US patent protection for Humira (adalimumab), the primary TNFi used in PsA, will expire at the end of this year, and biosimilars are poised to potentially take a significant share

RHEUMATOLOGY UPDATE . . 19 Patients with RA and OA Have Excellent Outcomes After Total Knee Replacement

A Peer-Reviewed Journal

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UNIQUE BRANDS

www.OncPracticeManagement.com

HEALTH ECONOMICS . . . . . . . . 16

in healthcare.

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In partnership with

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iosimilar tumor necrosis factor inhibitors (TNFis) were given the thumbs up in the European League Against Rheumatism (EULAR) 2015 update of its psoriatric arthritis (PsA) pharmacologic treat-

Senior Vice President 732.992.1886 jhennessy2@the-lynx-group.com

Value Modifier Policy for 2017: How Does Your Practice Measure Up?

. . . . . . . .

Lacosamide reduces seizures in partial epilepsy

Patient’s Priorities

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FINANCIAL COUNSELORS, AND REIMBURSEMENT SPECIALISTS™

Antipsychotics increase mortality risk in Parkinson’s disease

Updated Recommendations for A New Paradigm for Survivorship Pharmacologic Treatment of Patients with Psoriatic Arthritis Care: Assessing the

VALUE PROPOSITIONS . . . . . . . 4 FIBROMYALGIA . . . . . . . . . . . . . 22 Bariatric Surgery Before Knee Headaches, Persistent Back and Arthroplasty Neck Pain Predictors of Fibromyalgia Symptoms RHEUMATOID ARTHRITIS . . . 5 High Risk for Chronic Infections Linked to Q Fever in Patient with Rheumatoid Arthritis S

John Hennessy

By Chase Doyle

the signs and symptoms of ankylosing spondylitis. Results suggest that secukinumab is effective in patients naive to anti–tumor necrosis factor

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HEADACHE MANAGEMENT . .

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all stakeholders

Senior Vice President 732.992.1884 nenglezos@the-lynx-group.com

David C. Sheridan, MD

ONCOLOGY PRACTICE

PSORIATIC ARTHRITIS drugs, but in the last 1 to 2 decades, biologic DMARDs—consisting of several cytokine inhibitors and other immune modulators—have been added © 2015 Engage Healthcare Communications, LLC to this list.1 Because of the costliness of biologic DMARDs, identifying nonresponders, anti-drug antibodies, and

Secukinumab Effective in Ankylosing Spondylitis

Bellevue, WA—Although the link between leadership and effective communication has long been acknowledged, developing the latter is still easier said than done. At the 2015 annual meeting of the National Organization of Rheumatology Managers, Tracy L. Spears, CEO of the Exceptional Leaders Lab, discussed the importance of this seem-

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By Chase Doyle

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raditionally, patients with rheumatoid arthritis (RA) have been treated with immunosuppressive drugs, such as corticosteroids, disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), and nonsteroidal anti-inflammatory

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How to increase teamwork and productivity

Sodium Valproate Reduces Pain in Pediatric Patients with Migraine

pain reduction after VPA infusion, according to David C. Sheridan, MD, Department of Emergency Medicine, Oregon Health & Science University, (VPA) was used in the second-line set- Portland, who presented the results at ting for the treatment of adolescent the 2015 American Academy of Pain San Diego, CA—An inhaled formula- phase 2 clinical trial. According to data patients with migraine. Patients Medicine annual meeting. out is a common painful best to manage it. tion of levodopa (CVT-301) eased and presented at thehow International Congress achieved an additional 44% average “There are really no true, FDA-apcondition in that The study suggested that most Continued on page 8 breakthrough motor symptoms pa-is manageable, of Parkinson’s Disease and also Movement anddisease treatment arepatients GPs are not the following all of the guidetients with Parkinson’s (PD)guidelines Disorders, using inhaled available. Despite stud- were lines for able management between standard levodopa doses this, in a several formulation better to bridge of gout. For ies suggest management is subopti- example, urate-lowering therapy Continued on page 14 mal. A recent survey that explored (ULT) is frequently delivered inapMULTIPLE SCLEROSIS . . . . . . . . . . 4 IN THE LITERATURE . . . . . . . . . . 11 barriers to optimal care found that propriately, and monitoringSwitching of uric to teriflunomide is safe Adolescent sleep variability may impair and effective brain development patients and general practitioners acid (UA) concentrations is irregular. FOR ONCOLOGISTS, PRACTICE MANAGERS, (GPs) who treat gout want to be bet- In addition, when initiating alloSTROKE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 PARKINSON’S DISEASE . . . . . . 14 ter educated about the condition and purinol as ULT, many GPs fail to pre-

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Nat ion al O r ga n iz at ion of o R he u m atolo g y Man a gers

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GOUT

I SIC PHY

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provider communication is of primary importance. Among patients with relapsingremitting multiple sclerosis who were surveyed online between November and December 2012, those who had

By Chase Doyle By Alice Goodman

By Sophie Granger

BREAST CANCER . . . . . . . . . . . . . . 11 MYELOFIBROSIS . . . . . . . . . . . . . . 17 Chemotherapy-Induced Alopecia Ruxolitinib Reduces Spleen Size and Improves Disease-Related Symptoms ASH CONFERENCE CORRESPONDENT . . . . . . . . . . . . .14 DRUG UPDATE . . . . . . . . . . . . . . . . 20 All-Oral Combination Shows Keytruda (Pembrolizumab) First PD-1 Promise in Patients with Inhibitor Approved for the Treatment Multiple Myeloma of Patients with Metastatic Non–SmallCell Lung Cancer Expressing PD-L1

VOLUME 3 • NUMBER 6

racial differences in poststroke ADL limitations were observed,” reported James F. Burke, MD, MS, Clinical Lecturer, Neurology, University of Michigan, Ann Arbor, and colleagues. “Therefore, it is unlikely that the observed racial differences in poststroke ADL limitations are accounted for by differences in prestroke function.” As Dr Burke explained to ValueBased Care in Neurology (VBCN), it has been well-documented that African

Inhaled Levodopa Provides Rapid IL-6, VEGF-A Show Potential National Harbor, MD—A retrospecUnderstanding of tive MotorBetter Improvements in Patients review of pediatric emergency deas Disease Markers in Patients data showed significant pain with Parkinson’s Disease Patients with Gout Needed partment reduction when sodium valproate with Long-Term RA

for multiple myeloma. Daratumumab was approved under the FDA’s priority review and was granted an orphan drug status. “Targeting proteins that are found on the surface of cancer cells has led to the development of important oncology treatments,” said Richard Pazdur, MD, Director of the FDA’s Office of Hematology and Oncology Products. “Darzalex provides another treatment

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ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safetycentered practice. As a challenge, the next time you enter your

preliminary analysis of predictors of disease-modifying therapy (DMT) adherence, presented at the American Academy of Neurology 2015 annual meeting reinforces the notion that patient–

contemporary information

VOL 9, NO 1

CLINICAL GUIDELINE UPDATE

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DECEMBER 2015

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www.ValueBasedRheumatology.com

By Rosemary Frei, MSc

By Rosemary Frei, MSc Christine M. Friedenreich, PhD

acial disparities in poststroke activities of daily living (ADL) limitations are not a result of prestroke activity limitations. Instead, according to a recent study, differences appear largest in the first 2 years after stroke2016 (Burke JF, et al. J Stroke CerebroFEBRUARY VOL vasc 5 • Dis. NO2015;24:1636-1639). 1 “In this nationally representative study of over 500 stroke patients, there were no racial differences in prestroke ADL limitations. In contrast, marked

Predictors of outcomes in mild Continuedischemic on page 8stroke

For Clinical Pharmacists, Board Certified Oncology Pharmacists, Pharmacy Directors, and P&T Committee Members LEADERSHIP

ncreased levels of physical activity after a diagnosis of prostate cancer are associated with significantly better survival, according to the results of a new,

By Chase Doyle

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to provide pivotal and

ould the first impression a patient has of your practice send a safety message? You see, first impressions do count! The way your office appears will hopefully send the message of a well-organized, efficient, safety-centered practice. As a challenge, the next time you enter your office, walk in the front door and

Boosting Blueberry Intake May Keep Erectile Dysfunction Risk at Bay

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www.ValueBasedNeurology.com

Director, Compliance and Education, Total Medical Compliance

By Charles Bankhead

JULY 2015 • VOL 2 • NO 2

Predictors of Patient Adherence Racial Disparities in Daily Activities After Stroke: to Multiple Sclerosis Therapy By Rosemary Frei, MSc Why Are Outcomes Worse in African Americans?

business model, we strive

www.JONS-online.com

A Practical Safety Checklist for Practice Managers

Increased Physical Activity May Help Extend Survival After Prostate Cancer Diagnosis

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Executive Vice President 732.992.1899 ssweeney@the-lynx-group.com

Guides Are Here! Pg. 26

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