August 2016 Vol 9, Special Issue: Payers' Perspectives in Oncology

In her presidential address, Julie M. Vose, MD, MBA, Chief of the Oncology/Hematology Division, University of Nebraska Medical Center, Omaha, highlighted the importance of multimodal care and its effect on the quality of care and enhancement of clinical trial participation among patients with cancer.

Access and adherence to long-term cancer therapies are emerging as major public health issues around the world, as high out-of-pocket costs for oral oncolytics are linked to nonadherence that can directly affect patient outcomes, said Dawn L. Hershman, MD, MS, Professor of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, at ASCO 2016.

The first-in-class antibody-drug conjugate rovalpituzumab tesirine (Rova-T) may be a new treatment option for patients with small-cell lung cancer (SCLC), which has a very poor prognosis and few treatment options. Rova-T is particularly promising in SCLC tumors that overexpress the delta-like (DLL) 3 protein, according to first-in-human study results presented at ASCO 2016.

Oral and poster presentations of several promising agents in early- and late-phase clinical trials dotted the program at ASCO 2016. The presentations included studies with positive findings associated with many investigational therapies, including first-in-class therapies such as chimeric antigen receptor (CAR) T-cells for the treatment of patients with B-cell malignancies or acute myeloid leukemia (AML); a vaccine (galinpepimut-S) for the treatment of patients with AML; and a chimeric monoclonal antibody against claudin 18.2 for the treatment of patients with advanced gastric cancers.

Aggressive end-of-life care for patients with terminal cancer and other illnesses is costly and not recommended.

An economic analysis of oncology regimens that were previously evaluated in trials conducted by the Canadian Cancer Society Research Institute has shown that the transition from branded to generic drug costs has a considerable impact on the cost-effectiveness and cost-utility of treatment.

In addition to affecting patient well-being and quality of life, financial toxicity has been shown to worsen survival outcomes because of nonadherence to drug therapy. Although policy interventions, improvements in benefit designs, and adjustments to reimbursement may help reduce costs for patients in the long-term, immediate changes are needed to alleviate financial burden, said Yousuf Zafar, MD, MHS, of the Duke Cancer Institute, Durham, NC, at ASCO 2016.

The cost of care varies widely across breast cancer chemotherapy regimens, even among treatments of comparable efficacy, according to a retrospective study presented at ASCO 2016. Some of the most costly regimens, such as docetaxel plus doxorubicin and cyclophosphamide, were found to be the most expensive and were associated with the highest risk for hospitalization.

The results of 2 phase 3 trials on treatment-related adverse events (AEs) in patients with non–small-cell lung cancer (NSCLC) showed that their frequency and associated costs were significantly higher with docetaxel than with nivolumab. The results were presented at ASCO 2016.

Evidence-based treatment protocols and clinical pathways for delivering quality cancer care have been developed for virtually all tumor types and stages, but questions remain regarding patient access, care quality, and transparency in their development and implementation.

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  •  Association for Value-Based Cancer Care
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  • Rheumatology Practice Management
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