Countering the Misincentivization of Cancer Medicine by Real-Time Personal Professional Education (febrile neutropenia medications)

Countering the Misincentivization of Cancer Medicine by Real-Time Personal Professional Education [Cancer Center Business Summit]:

Purpose:
In the United States, public and private payer misincentivization of medical care and the invisibility of costs to the consumers of that care have conspired to create unsustainable growth in health care expenditure that undermines our economy, diminishes our productivity, and limits our international competitiveness. Cancer medicine provides a small yet salient example. On average, Medicare reimburses oncologists 6% above the average acquisition price for essential anticancer agents and supportive therapies. The costs of these agents vary across a stunning five orders of magnitude, from a few dollars to more than $400,000 per course of treatment. The profitability to providers varies across approximately four orders of magnitude, from cents to thousands of dollars per treatment. National guidelines (National Comprehensive Cancer Network [NCCN], American Society of Clinical Oncology [ASCO]) help providers select the most effective therapies without regard for cost.

Methods:
We created an oncologist-to-oncologist professional education program to help cancer physicians optimally use expensive long-acting white blood cell growth factors, in accordance with these national guidelines.

open access: A systematic review of the effectiveness of qigong exercise in supportive cancer care

Attitudes of Patients With Gynecological and Breast Cancer Toward Integration of Complementary Medicine in Cancer Care

Conclusion:
Although patients with gynecological malignancies use CAM significantly more than patients with breast cancer, both groups share similar conceptions regarding the active role of their gynecologist oncologists in the process of CAM integration within supportive care and expect CAM consultation to focus on improving their well-being.

full free access: Personalized Medicine and Cancer Supportive Care: Appropriate Use of Colony-Stimulating Factor Support of Chemotherapy

"Unfortunately, patients in RCTs (randomized clinical trials) are often highly selected, and toxicities, including FN, are frequently underreported (18). In addition, chemotherapy dose intensity and the use of prophylactic CSF or antibiotics are infrequently reported in RCTs, making it difficult to assess the true burden of neutropenic complications associated with a chemotherapy regimen (18)." "....Although there is little debate that both underuse and overuse of the CSFs occur in clinical practice, accurate estimates of the true magnitude and impact of such considerations remain elusive. What is clear is that there is a need for greater attention to chemotherapy-associated toxicities along with accurate prediction tools for the assessment of individual patient risks, including FN (febrile neutropenia) and its complications. Such tools could improve the evidence base for practice guidelines and aid clinicians in the selection of patients with cancer who are at an individual increased risk for FN, and therefore, appropriate candidates for the clinically effective and cost-effective use of the CSFs (40)."

Association Between a Name Change from Palliative to Supportive Care and the Timing of Patient Referrals -- The Oncologist

"....Because of the nature of our institution as a comprehensive cancer center
with a large patient volume, the results might not be generalizable to smaller cancer centers and oncology programs in other areas. However, the findings 
of our study regarding a higher overall number of referrals and earlier
referrals in the outpatient setting confirm the findings of our previous
survey study on the attitudes and beliefs of medical oncologists and
midlevel providers regarding the term palliative care. We believe
that these findings and the difference in referral pattern after the
name change are not center specific but rather reflect perceptions
among health care professionals in the U.S. regarding the strong
associations among palliative care, hospice, and end of life."


Conclusion The name change to supportive care was associated with more inpatient referrals and earlier referrals in the outpatient setting. The outpatient setting facilitates earlier access to supportive/palliative care and should be established in more centers.

Supportive care: new trends and new needs : Current Opinion in Oncology

Identifying supportive care needs of women with ovarian cancer (abstract)

abstract:
Women diagnosed with ovarian cancer may experience many shortterm and long-term effects from cancer and its treatment. Cancer has more than a physical impact, yet there is a lack of information about the types of needs these women have and whether they want help in meeting their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, informational, spiritual, psychological and practical) of women with ovarian cancer who attended a comprehensive, outpatient cancer centre. A further purpose was to determine if women wanted assistance in meeting those needs. A total of 50 women diagnosed with ovarian cancer participated in this study by completing a self-report questionnaire (The Supportive Care Needs Survey). The data indicated that a range of supportive care needs remained unmet for this patient group. Eight of the top 10 most frequently reported needs were psychosocial, such as fears about the cancer returning or spreading. The women also expressed a range of difficulty in managing their needs. However, despite this reality, significant numbers of women indicated they did not wish to have assistance from the clinic staff with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing care to these women.

Hospice enrollment for terminally ill patients with gynecologic malignancies: Impact on outcomes and interventions

CONCLUSIONS: While retrospective reviews evaluating hospice are challenging, our data suggest no detrimental impact on survival for hospice patients (vs non hospice). Continued evaluation for patients at the end-of-life is necessary in order to optimize resource utilization.

New supportive care assessment guideline available | Canadian Partnership Against Cancer

Note: search results show there is no reference either in the body of the paper nor in the references section to ovarian cancer

"Conclusion
Despite limitations in the research, there is reasonable evidence that psychosocial
and supportive care needs are under-addressed, that assessment improves patient
outcomes, and that some screening for distress and psychosocial assessment tools
have effective psychometric properties that help to “red flag” patients and support
comprehensive assessment. The recommendations in this guideline have been
designed to explain, ignite, and support the need for quality psychosocial health care
needs assessment and screening for distress in persons living with cancer. Using an
evidence base that is grounded in research and clinical practice, they stress the
importance of assessment as a first step in the explication of need and the
implementation of appropriate interventions. At the same time, this document has
suggested a range of important considerations as the field moves forward – from
needs assessment, clinical service provision, resource allocation, intervention, followup,
and outcome evaluation, to related research, and more. We believe the adoption
of these recommendations into cancer practice will bring us one step closer to a
person-focused cancer system that can improve patient and family experience of
living with cancer."

Intraperitoneal VEGF Inhibition Using Bevacizumab: A Potential Approach for the Symptomatic Treatment of Malignant Ascites? -- The Oncologist

"Despite the very strong preclinical evidence for an obligatory role of VEGF in the formation of malignant ascites and for a possible therapeutic efficacy of anti-VEGF therapies in the setting of malignant effusions, there are currently no reports from clinical studies addressing this point in cancer patients..........To date, only very few patients with malignant ascites have received i.p. bevacizumab and, therefore, this route of administration as well as this particular patient population need to be examined stringently regarding the safety of the treatment. However, we believe that i.p. application might be the route of choice in this particular setting."

Evidence Updates: Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients (advanced cancer)

Evidence Updates: Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients
Girgis A, Breen S, Stacey F, et al. Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients with nonlocalized breast and colorectal cancers. J Clin Oncol. 2009 Dec 20;27(36):6180-90. Epub 2009 Nov 16. PMID: 19917842 (Original)
DISCIPLINE RELEVANCE TO PRACTICE IS THIS NEWS?
Oncology - Breast 3 / 7 3 / 7
Oncology - Gastrointestinal 4 / 7 4 / 7
Oncology - Palliative and Supportive Care 6 / 7 6 / 7

Abstract PURPOSE: Patients with cancer experience considerable symptom burden, psychological morbidity, and unmet psychosocial needs. Research suggests that feedback of patient-reported outcomes to clinicians or caseworkers, alongside management strategies, may result in improved patient functioning. Two intervention models were developed to test this effect in a randomized, controlled trial against usual care (UC): a telephone caseworker (TCW) model and an oncologist/general practitioner (O/GP) model. Primary end points included anxiety, depression, physical/emotional functioning, and unmet supportive care needs.  
PATIENTS AND METHODS: Participants with nonlocalized breast or colorectal cancers were surveyed by computer-assisted telephone interview (CATI) at three time points: baseline, 3 months, and 6 months. Data collected from participant CATIs in the supportive care models were used to generate feedback to either each participant`s designated TCW, or their nominated O/GPs. Data obtained from participants in the UC model were used only to assess the impact of supportive care models. In total, 356 participants consented to study participation, completed the baseline CATI, and were randomly assigned to the UC, TCW, or O/GP groups.  
RESULTS: No overall intervention effect was observed. Physical functioning was significantly improved at the third CATI for participants in the TCW model (P = .01), and there was a trend toward fewer participants with unmet needs (P = .07). TCW group participants also were more likely to have the following: identified issues of need discussed (P < .0001); referrals made (P < .0001); and strong agreement that the intervention improved communication with their health care team (P = .0005).  
CONCLUSION: The TCW model holds some promise; however, additional work in at-risk populations is required before we recommend implementation.