Tablet is better all round for cancer patients

[Dross]

A drug to treat colon cancer is proving much more convenient than traditional chemotherapy, has fewer side effects - and a study of almost 2,000 patients has shown it is giving them a better chance of surviving the disease.

Standard chemotherapy can be incredibly disruptive to people"s lives, said Prof Professor Chris Twelves of the University of Leeds, who led the research. Patients visit hospital five days a week for the injections and then have three weeks off before returning to hospital for the next course and the side effects can be unpleasant.

The oral chemotherapy drug Xeloda (capecitabine) offers fewer side-effects and less time in hospital and the trial has shown that patients given the drug were at least as likely to be alive and free of their disease as those on standard chemotherapy (the Mayo Clinic regimen).

The research showed that about 71 percent of patients given Xeloda were still alive after five years, compared to 68 percent of patients treated with standard chemotherapy injections.

Prof Twelves' study followed 1,987 patients who had undergone colon cancer surgery. It found that patients treated with Xeloda spent 85 percent less time with their doctor or at the hospital, and experienced fewer side effects. The new results, showing patients five-year survival rates, confirm the effectiveness of the treatment.

We now have long-term evidence now that clearly supports Xeloda's superiority over the Mayo Clinic regimen,� said Prof Twelves. There is now no reason why we should ask colon cancer patients to endure the burdens associated with that older treatment.�

[gdpawel]

Would a clinical trial to show when drugs are selected with and without the presence of profit differential (which would include oral-dose drugs), clinical outcomes would be the same?

Dr. Neil Love's "Patterns of Care" reported a survey of breast cancer oncologists based in academic medical centers and community based, private practice medical oncologists. The former oncologists do not derive personal profit from the administration of infusion chemotherapy, the latter oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.

The results of the survey could not have been more clear-cut. For first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists (who are motivated to keep off-protocol patients out of their chemotherapy infusion rooms to reserve these rooms for on-protocol patients) prescribed oral-dose drug Xeloda (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug Taxotere (docetaxel).

In contrast, among the commuity-based oncologists, only 18% prescribed the non-remunerative oral-dose drug Xeloda (capecitabine), while 75% prescribed remunerative infusion drugs, and about 40% prescribed the expensive, highly remunerative drug docetaxel.

ASCOs President says that we go by the literature, which has defined which are the best regimens. Well, how does he explain why the academics prescribe oral dose Xeloda to their metastatic breast cancer patients who aren't on their protocols, which keeps them from clogging up their chemo rooms and resources, which they want to use for the patients on their clinical trials, while the community oncologists almost universally prescribe infusion therapy, with the most popular drug being the still on patent Taxotere (docetaxel), which I do surmise has one of the best "spreads" between acquisition costs and average reimbursement.

The academic center-based oncologists are not without collective guilt. They are misguided in not recognizing that they continue to try and mate a notoriously heterogeneous disease into "one-size-fits-all" treatments. They predominately devote their clinical trial resources into trying to identify the best treatment for the "average" patient, in the face of evidence that this approach is non-productive. However, such unsuccessful experiments will never be viewed as such by the people whose careers are supported by these kinds of experiments.

What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.

[url]http://patternsofcare.com/2005/1/editor.htm (figure 37, volume 2, issue 1, 2005)

[url]http://www.nytimes.com/2006/03/08/health/08docs.html?ex=1152158400&en=55fd0d687b5771de&ei=5 070

[url]http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page8#Section297

[url]http://content.healthaffairs.org/cgi/content/abstract/25/2/437

[gdpawel]

Infused Chemotherapy Use in the Elderly After Patent Expiration

Rena M. Conti, PhD, Meredith B. Rosenthal, PhD, Blase N. Polite, MD, Peter B. Bach, MD, MAPP and Ya-Chen Tina Shih, PhD

The University of Chicago, Chicago, IL; Harvard University School of Public Health, Boston, MA; and Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Rena M. Conti, PhD, The University of Chicago, 5841 S. Maryland, MC 6086, Chicago, IL 60637; e-mail: [email]rconti@uchicago.edu

Abstract

Purpose:

The use of anticancer drugs (chemotherapies) is an important determinant of national spending trends. Recent policies have aimed to accelerate generic entry among chemotherapies to generate cost savings.

Methods:

We examined the effects of generic entry on the choice of chemotherapy for the treatment of metastatic colorectal cancer (MCRC) between 2006 and 2009 using autoregressive-moving average modeling with case control. A nationally representative sample of oncologists and patients with cancer (age ≥ 65 years) was employed to estimate the magnitude and significance of the impact of the generic entry of irinotecan in February 2008 on the number of administrations of irinotecan compared with oxaliplatin.

Results:

The generic entry of irinotecan resulted in a 17% to 19% decrease (P < .001) in use among elderly patients with MCRC compared with oxaliplatin. The results were robust to multiple sensitivity checks.

Conclusion:

This study provides novel and robust estimates of the decline in use of a chemotherapy to treat a common cancer in the elderly after patent expiration. The results suggest estimates from a previous Office of the Inspector General report of the potential savings derived from the generic entry of irinotecan for public payers are an overestimate, likely confounded by oncologists' response to financial incentives, changes in scientific evidence, and promotional activities. As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types.

Am J Manag Care. 2012;18(5 Spec No. 2):e173-e178

[url]http://www.ajmc.com/articles/Infused-Chemotherapy-Use-in-the-Elderly-After-Patent-Expiration

[gdpawel]

As cancer treatment in pill form transforms how care is delivered, a new Michigan State University study underscores the challenges patients face in administering their own chemotherapy outside the supervised environment of a cancer clinic.

Chemotherapy pills can target specific cancers better than some traditional intravenous drugs, said Sandra Spoelstra, the MSU assistant professor of nursing who led the study. But they also can be difficult for patients to take.

"Prescriptions for some oral pills have complex instructions," she said. "Some of them require patients to take pills several times a day or cycle their doses, taking one pill a day for three weeks, then stopping for a week before starting again. And some patients take two types of pills to treat their cancer or have multiple medications for other chronic conditions. It can be very complicated."

In addition, side effects such as severe nausea, vomiting, diarrhea, fatigue, skin reactions and pain are common. Those symptoms can lead some patients to skip doses, which may render their cancer treatment ineffective.

During the study, published in the journal Cancer Nursing, more than 40 percent of participating patients took too many pills or missed doses with poor adherence more likely among those with complex treatment regimens.

The researchers randomly assigned the patients to one of three groups. Members of the first group only had help from an automated calling system, developed at MSU, to see if they were following their prescriptions and help them monitor and manage symptoms. The second group got the automated calls and follow-up calls from nurses with strategies for sticking to their pill regimen. The rest got automated calls and nurse advice on both adhering to their regimen and managing symptoms.

Patients in all three groups reported less severe symptoms at the end of the study. The automated calls were just as effective alone as when they were coupled with nurse guidance. That suggests the automated system could be a simple and inexpensive way to help some patients take their drugs properly, Spoelstra said.

The small study will be the springboard for more comprehensive research that may yield clearer lessons for health care professionals, said University Distinguished Professor Barbara Given, who co-authored the study and leads the College of Nursing's efforts to improve oral chemotherapy.

In the meantime, she said nurses should be attentive when explaining oral chemo regimens to be sure patients and their families understand how to take the drugs as prescribed.

"It's cutting-edge treatment, but we don't know enough about it yet," she said. "People think if they had a life-threatening disease and their doctor recommended treatment, they'd follow the recommendations. But it's really not that simple."

Michigan State University. "The Drawbacks Of Oral Chemotherapy." Medical News Today. MediLexicon, Intl., 14 Jan. 2013