Huge Progress in Palliative Care

A Q&A with Diane E. Meier, MD, FACP, Director, Center to Advance Palliative Care; Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai; New York, NY;

Originally published November 8, 2017

Q: You wrote in MedGenMed in 2007 that palliative care was the job of all hospitals. In October 2017 you were honored at the National Academy of Medicine for your achievements in this field. How fully has your charge to hospitals in 2007 been realized?

A: Palliative care is a fairly new medical specialty devoted to reducing suffering and improving quality of life for people living with serious illness-whether the disease is curable, chronic, or life threatening and progressive. Palliative care teams work alongside disease treatment specialists to provide an added layer of support in service of pain and symptom management, family support, attention to the social determinants of health, and skilled communication about what to expect and what matters most to the patient in the context of the reality of the illness. Multiple studies demonstrate palliative care’s contribution to achievement of the triple aim: better experience of care, better care outcomes (including survival in several studies), and as an epiphenomenon of better care, much lower unnecessary utilization of 911 calls, ED visits, and hospitalization. Continue reading…

ASCO Report Finds U.S. Cancer Care System Ill-Equipped to Deliver New Advances to Patients

“As the nation embarks on an ambitious ‘moonshot’ to accelerate progress against cancer, our system for delivering today’s cancer treatments must be better prepared to bring advances to all patients, warns a new report from ASCO.

The State of Cancer Care in America: 2016, published March 15 in the Journal of Oncology Practice and presented at a Congressional briefing in Washington, DC, is ASCO’s third annual assessment of national trends in cancer care delivery. The report highlights many promising cancer care developments, including new drugs and technologies, declining mortality rates, expanded access to healthcare generally, and a shift towards value-based care. But ASCO also highlights major challenges for patients and physicians, including uneven health insurance coverage, rapidly rising costs, and other barriers to accessing new treatments.”

Making Immunotherapy Available in the Community

“With immunotherapy fast becoming part of oncology practice, one group is taking measures to ensure that community cancer care is not left behind.

“Later this month the Association of Community Cancer Centers (ACCC) will launch the Institute for Clinical Immuno-Oncology (ICLIO), an initiative directed to preparing community cancer teams and centers to deal with the clinical as well as coverage and reimbursement aspects of the emerging therapy. Initial funding was provided through a contribution from Bristol-Myers Squibb.

“ICLIO is chaired by Lee S. Schwartzberg, MD, who spoke with MedPage Today about the program’s origins and goals.

“Schwartzberg, a professor of medicine who heads the Division of Hematology and Oncology at the University of Tennessee Health Science Center and who serves as medical director of the West Clinic in Memphis, said that ICLIO grew out of ACCC members’ concern about how to integrate immunotherapy into their practices, especially with the ‘remarkable outpouring of clinical data and drug approvals in immunotherapy,’ which Schwartzberg called an ‘almost new discipline of oncology.’ “

Geography Matters: Imaging Overuse Seen for Breast, Prostate Cancer in Certain Regions across the U.S.

“Where you receive medical care impacts many things — including whether or not you receive inappropriate medical tests, according to a new study.

“Researchers from NYU Langone Medical Center and its Laura and Isaac Perlmutter Cancer Center, in a new retrospective study publishing online March 12th in JAMA Oncology, conclude that patients with low-risk prostate or breast cancer were more or less likely to receive inappropriate imaging during treatment, depending on the region of the country in which they received medical care.

“They examined medical records from 2004-2007 of 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer, across 84 separate hospital referral regions (HRRs). They conclude that overuse of imaging occurred at a rate of approximately 44.4% for men and nearly 42% for women in the study.

“Equally important, inappropriate use of imaging was strongly linked to certain regions across the U.S. in which patients were treated. For example, HRRs in the Northeast reported higher use of imaging tests for low-risk patients, while other regions, such as the Northwest and Utah, demonstrated more appropriate use of imaging.

Genentech Distribution Shift for Cancer Meds Delays Patient Care: Survey

“A new survey of hospitals and academic medical centers finds that a recent move by Genentech to switch distribution of three widely used cancer treatments – Avastin, Rituxan and Herceptin – is resulting in higher costs, reduced access to the medications and delays in treating patients. And the institutions are hoping the results will prompt the drug maker, which says it’s unaware of such problems, to revert to its earlier distribution program.

“Here’s the background: Last fall, Genentech began using just a few distributors that specialize in handling such medicines. Until then, the Roche unit used dozens of wholesalers, although the specialty distributors are actually divisions of some of those same wholesalers. Genentech says the change was made to save money, but also make distribution more efficient and prevent the possibility of shortages.

“However, most of the institutions – 93% – say they had not experienced shortages, and the move has disrupted not only their finances, but patient care. The survey also found that 81% say the switch will have a moderate to significant impact on their expenses. Meanwhile, 63% say deliveries have been unreliable and 88% reported a delay in patient treatment because one of the drugs was unavailable.

“The institutions say they are forced to increase inventories to hedge against any supply disruptions that may occur because shipping can take longer, depending upon the location of the distributor. Some institutions say they cannot afford to keep large amounts of drug on hand, which can result in delays in treating new patients or unexpected events. And previous discounts may no longer be available.”

Breast Cancer Diagnoses, Survival Varies by Race, Ethnicity

The gist: A recent study found that a breast cancer patient’s race and ethnicity might affect whether they are diagnosed at an early stage. Race and ethnicity might also affect how long a patient survives after a stage I diagnosis.

“Among nearly 375,000 U.S. women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity, with much of the difference accounted for by biological differences, according to a study in the January 13 issue of JAMA.

“In the United States, incidence rates of breast cancer among women vary substantially by racial/ethnic group. Race/ethnicity and sociodemographic factors may influence a woman’s adherence to recommendations for clinical breast examination, breast self-examination, or screening mammogram and the likelihood of her seeking appropriate care in the event that a breast mass is noticed. A growing body of evidence suggests that biological factors may also be important in determining stage at diagnosis (i.e., the growth rate and metastatic potential of small-sized breast cancer tumors may vary between women due to inherent differences in grade and other or unknown pathological features), according to background information in the article…

“The authors write that much of the difference in diagnosis and survival could be statistically accounted for by intrinsic biological differences such as lymph node metastasis, distant metastasis, and triple-negative behavior of tumors…

” ‘Access to the use of genetic or molecular markers to guide choice of targeted therapy and reduce the costs of care can be made more equitable. For women with triple-negative disease, access to prompt diagnosis and initiation of chemotherapy can be lifesaving because these tumors metastasize early. Closing the survival gap will only occur once health care leaders initiate system changes that improve access to high-quality care along with a more comprehensive study of breast cancer biology through inclusion of a substantial number of minority patients in ‘omics’ research and in clinical trials.’ “

Geography May Limit Access to Cancer Clinical Trials

“Where advanced cancer patients live affects the likelihood that they can enroll in a treatment clinical trial, a new study found.

“Fewer than 10 percent of U.S. cancer patients participate in clinical trials, the authors note.

“ ‘Clinical trials are the basis for the vast majority of advances in cancer care, so, the only way to move the field forward is for patients to participate in clinical trials,’ said lead author Dr. Matthew D. Galsky of the Icahn School of Medicine at Mount Sinai in New York.

“ ‘In addition, participation in clinical trials may offer patients access to a novel treatment, that ultimately goes on to markedly change the outlook for patients with the disease, but is not otherwise available outside of the context of a trial,’ Galsky told Reuters Health by email.

“Some data has suggested that patients who participate in clinical trials may have better outcomes regardless of the treatment they receive, which could be due to the very close follow-up, and strict guidelines, for management of patients enrolled in trials, he said.”

Quality Cancer Care Still a Goal, Not a Reality, for Most Low-Income Americans

The American Society of Clinical Oncology (ASCO) today called for major reform of Medicaid to ensure access to life-saving screening, treatment and prevention services for low-income Americans with cancer.

“In the new ‘ASCO Policy Statement on Medicaid Reform,’ published today in the Journal of Clinical Oncology, the Society called for Medicaid expansion in all 50 states to close critical coverage gaps, to improve cancer screening and prevention services, and to end coverage restrictions that prevent Medicaid enrollees from receiving high-quality cancer care, among other recommendations.

“Currently, 67.9 million Americans — about one-fifth of the U.S. population — are enrolled in Medicaid, including those added under the Affordable Care Act expansion. Of these, an estimated 2.1 million are cancer patients or cancer survivors.* Yet studies show that Medicaid patients often do not receive the same quality of cancer care as patients with private insurance, and they are up to three times more likely to be diagnosed with cancer at a late stage, when treatment is less likely to be effective.[1]

” ‘Every patient should be able to receive high-quality cancer care, regardless of his or her financial circumstances,’ said ASCO President Peter Paul Yu, MD, FACP, FASCO. ‘Millions of Americans who rely on Medicaid won’t be able to take advantage of advances in cancer prevention and treatment unless meaningful reform occurs.’ “

Cancer Patients’ Access to Quality Health Care ‘Threatened’

“Increased cancer incidence will coincide with a decreasing number of oncologists and growing financial strain of community oncologic practices, according to ASCO’s ‘State of Cancer Care in America: 2014’ report…

“The report — the first comprehensive assessment of its kind — estimates the number of US cancer cases will increase 45% by 2030, partially due to an aging population and screening practices. The current number of 13.7 million cancer survivors also is expected to increase to about 18 million.”