Health News - Enhanced data access to benefit cancer researchers and patients

Health News - Enhanced data access to benefit cancer researchers and patients

Effects of Funding Policy Changes and Health Warnings on the Use of Erythropoiesis-Stimulating Agents [Original Contributions]

Effects of Funding Policy Changes and Health Warnings on the Use of Erythropoiesis-Stimulating Agents [Original Contributions]

Purpose:
To characterize the effects of formulary changes and governmental safety warnings on use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.

Patients and Methods:
We conducted a cross-sectional time-series analysis using health administrative data from Ontario, Canada. From January 1997 to December 2009 we identified all ESA initiations among patients diagnosed with cancer. We explored the effects of two formulary changes that progressively liberalized coverage for ESAs, first by rescinding the requirement for blood transfusion in 2003 and then by removing all restrictions in 2007. We also explored the effect of US Food and Drug Administration and Health Canada warnings issued in the second quarter of 2007. To assess regional variability in ESA use, we determined prescription rates for each of Ontario's 14 regional cancer centers.

Results:
After the first formulary change, the ESA initiation rate increased to 1.66 new users per 1,000 patients with cancer, 374% more than predicted (P < .001). After the second formulary change, the initiation rate increased to 3.97 new users per 1,000 patients with cancer, 73% more than predicted (P < .001). After the safety warnings, this rate declined 81% by study end (P < .001). We found significant regional variation in ESA use.

Conclusion:
Formulary access and safety warnings had significant impacts on the new use of ESA drugs in patients with cancer. This suggests that both are effective means of influencing the use of these drugs. Variable ESA prescription rates across our region may reflect a lack of consensus regarding their utility.

abstract: Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling.

Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling

Genet Med. 2011 Dec;13(12):1045-50. doi: 10.1097/GIM.0b013e31822a8113.

Abstract

PURPOSE:

Coverage policies for genetic services for hereditary cancers are of interest because the services influence cancer risk reduction for both persons with cancer and their family members. We compared coverage policies for BRCA genetic testing and genetic counseling among selected payers in the United States to illuminate eligibility criteria variation that may explain differential access by insurance type. We compared these policies with policies for breast cancer screening with magnetic resonance imaging to consider whether payers apply a unique policy approach to genetic services.

METHODS:

We conducted a case study of large private and public payers selected on number of covered lives. We examined coverage policies for BRCA genetic testing, genetic counseling, and screening with magnetic resonance imaging and the eligibility criteria for each. We compared eligibility criteria against National Comprehensive Cancer Network guidelines.

RESULTS:

Eligibility criteria for BRCA testing were related to personal history and family history of cancer. Although private payers covered BRCA testing for persons with and without cancer, the local Medicare carrier in our study only covered testing for persons with cancer. In contrast, Arizona's Medicaid program did not cover BRCA testing. Few payers had detailed eligibility criteria for genetic counseling. Private payers have more detailed coverage policies for both genetic services and screening with magnetic resonance imaging in comparison with public payers.

CONCLUSION:

Despite clinical guidelines establishing standards for BRCA testing, we found differences in coverage policies particularly between private and public payers. Future research and policy discussions can consider how differences in private and public payer policies influence access to genetic technologies and health outcomes.

abstract: Survival Duration among Patients with a Noncancer Diagnosis Admitted to a Palliative Care Unit: A Retrospective Study

Abstract 

Background: 

Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources.

Purpose/Methods: 

To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time.

Results: 

We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36).

Discussion/Conclusion:
Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.

media: Elderly and ill patients connect to their doctors via broadband: Pilot Australian project

A study encourages people to take the doctor’s notes home after exams. - NYTimes.com

(U.S.) S. 1674: Improving Access to Clinical Trials Act of 2010 (GovTrack.us)

Text:
Summary
Status:

Occurred: Introduced Sep 15, 2009
Occurred: Referred to Committee View Committee Assignments
Occurred: Passed Senate Aug 5, 2010
Occurred: Passed House Sep 23, 2010
Not Yet Occurred: Signed by President ...
Having passed in identical form in both the House and Senate, this bill now awaits the signature of the President before becoming law. [Last Updated: Sep 29, 2010 9:33PM]
Last Action:
Sep 24, 2010: Presented to President.

Related:

See the Related Legislation page for other bills related to this one and a list of subject terms that have been applied to this bill. Sometimes the text of one bill or resolution is incorporated into another, and in those cases the original bill or resolution, as it would appear here, would seem to be abandoned.
Votes:

Aug 5, 2010: This bill passed in the Senate by Unanimous Consent. A record of each senator’s position was not kept.
Sep 23, 2010: This bill passed in the House of Representatives by voice vote. A record of each representative’s position was not kept.

Experts Call For End To Global Inequalities In Access To Pain Medication For Cancer Sufferers

AACR Hosts Cancer Disparities Conference in Miami, Fla. abstract online Sept

This year, the American Association for Cancer Research will host its third conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved at the Loews Miami Beach Hotel in Miami, Fla.

Findings presented at this year’s meeting will include:

• proven communication methods for reaching minority populations;
• strategies to increase enrollment in clinical trials;
• prognosis in lung cancer affected by race;
• breast cancer trends in Arab and Israeli Jewish women;
• the importance of social support and physical activity in survivors; and,
• socioeconomics and access to health care.
To help you plan your coverage of the conference, the program schedule is available online at
http://www.aacr.org/disparities2010

abstracts will be available on Sept. 22, 2010

full free access: Women's Constructions of the 'Right Time' to Consider Decisions about Risk-Reducing Mastectomy and Risk-Reducing Oophorectomy (B.C.)

Methods (abstract): 

In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. 

pdf file (free access):

A women-centred approach addresses issues beyond traditional
medical interventions, placing health in its broad social context, and also addresses barriers to access and respects women’s diversity [55]. Although risk-reducing surgery decisions are women’s decisions, women should not be saddled with the burden of tackling barriers to accessing health care services.
Health care professionals, health care organizations, and government must work hard to resolve these challenges.

 

Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI

"The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."

Labor's e-health plan misses patient safety mark say doctors | The Australian

The Big Flap About Pathway Genomics and Walgreen's: Topol on Genomics

A few weeks ago, Pathway Genomics, a consumer genomics company, had planned to have its saliva kits at all US Walgreen's drug stores. The FDA put a stop to it. Congress is now investigating the matter. What is going on here?
http://www.nytimes.com/2010/06/12/health/12genome.html?scp=1&sq=pathway%20genomics&st=cse

research: BRCA-Negative Ovarian Cancer Responds to Monotherapy With PARP Inhibitor | Cancer Survivors Network

Note: detailed article on PARP's/BRCA "....Interest in PARP inhibition was perhaps best reflected by the question an attendee at the packed session put to Dr. Gelmon.

"My problem is, as a practicing oncologist, I see these great, wonderful results, in a very difficult population of patients with ovarian cancer," he said. "I want to know when I can get my hands on some. There are patients dying today because of this lack of access.""

Patient Advocate Foundation :: 1-800-532-5274

help for solving insurance and access problems (U.S.):

Patient Advocate Foundation :: 1-800-532-5274

abstract: Understanding the support needs of patients accessing test results online. PHRs offer great promise, but support issues must be addressed to

Understanding the support needs of patients accessing test results online. PHRs offer great promise, but support issues must be addressed to ensure appropriate access.

Wednesday, December 23, 2009 E-health revolution; Island doctors and nurses first in B.C. to have instant access to patients' histories

Also see my short comment