NOVEMBER/DECEMBER 2010 VOL 1 NO 6
www.ValueBasedCancer.com
Significant Impact for New Prostate Cancer Therapy
Continued Pressures on Community Cancer Centers
By Charles Bankhead
By Colin Gittens
Milan—Men with castration-resistant prostate cancer (CRPC) gained 4 months in overall survival (OS) when treated with the novel antiandrogen abiraterone acetate, data from a large randomized trial showed. Treatment with abiraterone and prednisone led to a median OS of 14.8 months compared with 10.9 months for prednisone alone (P <.001). Although seemingly modest, the difference will likely have a practice-changing impact on the treatment of CRPC, lead investigator Johann de Bono, MBBS, PhD, an oncologist at the Royal Marsden Hospital in London, said at the 35th European Society for Medical Oncology Congress. “In the history of prostate cancer, only 4 drugs have ever shown a sur-
vival benefit,” said Dr de Bono. Some patients treated with the agent have had long-lived responses, including 2 of his own Johann de Bono, MBBS, PhD patients who have been treated continuously for more than 4 years. Abiraterone blocks androgen synthesis by inhibiting the CYP17 rate-limiting enzyme necessary for conversion of testosterone precursors into the male hormone. Laboratory and clinical evidence have suggested that some prostate cancer cells generate intratumoral androgens despite androgen Continued on page 14
Contralateral Prophylactic Mastectomy Improves Survival, Is Cost-Effective in Some By Caroline Helwick National Harbor, MD—Multiple benefits were observed for contralateral prophylactic mastectomy (CPM), including cost-effectiveness, in studies presented at the 2010 ASCO Breast Cancer Symposium by investigators from the Mayo Clinic, Rochester, MN. CPM not only reduced the risk of breast cancer in the opposite breast by 95% among high-risk women with breast cancer, it improved survival as well. In addition, in younger women undergoing mastectomy and deemed to be at average risk, CPM was cost-
effective when compared with routine surveillance aimed at early detection for cancer in the opposite breast. “CPM provides Judy Boughey, MD good value, ie, cost/outcome, for select patient groups,” reported Benjamin Zendejas, MD, of the Department of Surgery at the Mayo Clinic, who authored the cost-effectiveness study. Continued on page 10
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onsolidation and cost pressures remain key concerns for community cancer centers, according to Christian Downs, MHA, JD, the executive director of the Association of Community Cancer Centers (ACCC). Mr Downs presented additional results and analysis from the ACCC’s ongoing, 3-year member survey at the Managed Care Network Oncology Management Summit in Chicago, IL, on September 24. This survey traces the continued reaction of the community hospital cancer programs to legislative and economic changes that are reshaping community oncology practice. The survey data, which were collected in late 2009, show that community cancer center revenue is still largely tied to providing drugs to patients. In comparison to the physician office setting, where physicians are on the hook for drug costs, “drugs mean less to hos-
Christian Downs, MHA, JD
pitals,” Mr Downs pointed out. Hospitals are also beginning to contract with multiple group purchasing organizations as a means of controlling costs, and a large percentage of responContinued on page 8
Plan to attend the upcoming Association for Value-Based Cancer Care meeting. See page 29 for details.
CMS Releases Outpatient Payment Rules for Physicians and Hospitals Improved preventive coverage, continued payment concerns By Crystal Kuntz, MPA
O
n November 2, 2010, the Centers for Medicare & Medicaid Services (CMS) issued its Physician Fee Schedule and Hospital Outpatient Prospective Payment System final rules for 2011. These CMS regulations are important for all providers of care in the Medicare program, as they set the payment parameters for the upcoming year.
Payment to physicians under Medicare remains an unresolved and complicated issue. Under these new regulations, physicians would see a 24.9% overall pay cut beginning January 1, 2011 unless Congress takes action to stop it. The reasons for the payment cut are complex but stem from what is widely seen as flaws in the Continued on page 28
IN THIS ISSUE Building the VBCC reader community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Cancer pathway profile: A statewide program in Michigan . . . . . . . . . . . . . 8 Denise Pierce on cancer cost discussions . . . . . . . . . . . . . . . . . . . . . . . . . 26 Continuing education for pharmacists on non–small-cell lung cancer . . . 34 ©2010 Engage Healthcare Communications, LLC