Turning the Tide Against Cancer: Patient-Centered Care and Value

On October 9, the Personalized Medicine Coalition, the American Association for Cancer Research, and Feinstein Kean Healthcare will be convening the second Turning the Tide Against Cancer Through Sustained Medical Innovation national conference in Washington, D.C., to continue the ongoing dialogue which began at the initiative’s inaugural conference in June 2012.

This year’s conference will bring together leaders from across the cancer community to help identify specific policy solutions to the challenges of supporting the shift to patient-centered research and care and addressing the value and cost of cancer care — two key themes that have emerged through the initiative’s ongoing work.

The Age of Personalized Medicine editorial team sat down with each of the initiative co-conveners to talk about the current cancer research and care landscape,  the upcoming conference, and what progress has been made since the start of the Turning the Tide Against Cancer initiative in 2011.

Our conversation with Edward Abrahams Ph.D., president of the Personalized Medicine Coalition can be viewed below. Stay tuned for additional video interviews with Margaret Foti, Ph.D., M.D. (h.c.), chief executive officer of the American Association for Cancer Research and Marcia A. Kean, M.B.A., chairman of Feinstein Kean Healthcare.

Visit the Turning the Tide Against Cancer website to register for the conference and learn more about ways you or your organization can support the ongoing initiative. The Age of Personalized Medicine will also be tweeting live from the conference on October 9.

Prescribe by Price, But at What Cost to Patients?

In recent months, there has been increased discussion about the cost and value of cancer care. These conversations are important, but it’s crucial to make sure the patient’s unique perspective on value isn’t lost in the mix. We must also be sure we are considering each patient’s unique diagnosis, as well as the heterogeneity of their disease.

It is clear that targeted therapies play an important role in delivering personalized care to patients, and in particular, those with many forms of cancer. A recent article in Newsweek profiled a patient who, through a new tumor identification method, was able to receive a highly-targeted treatment for his sarcoma. As noted in the article, “the slow and steady march of innovation in our understanding of cancer and the emergence of companies providing personalized treatments have not only saved Rose’s life but allowed him to turn his cancer from a death sentence into a chronic illness that simply needs regular managing.”

These stories are becoming more common, yet as new targeted treatments work through the regulatory pathways, we are faced with ongoing questions: How do we ensure patients have access to these life-saving drugs and the diagnostics used to select them? And how do we ensure the system incentivizes research and development broadly, so more people benefit from personalized medicine?

Recently, the American Society of Clinical Oncology (ASCO) announced that it will be developing a scorecard, slated to come out this fall, to evaluate cancer drugs based on their cost and value, as well as their efficacy and side effects. This signifies a potential shift in the way that physicians make decisions about their patients’ health, encouraging them to consider the financial implications of interventions alongside patients’ needs. As this framework is developed, it will be important to ensure that the full value of innovative interventions is recognized.

Scientific advances have the potential to provide earlier and better diagnoses, more effective treatments and even possible cures for patients. Personalized approaches to care could provide a patient with more or better quality time to spend with their family or friends, and overall greater long-term value.

As Edward Abrahams, president of the Personalized Medicine Coalition told The Washington Post, these targeted treatments also bring a greater long-term value to the healthcare system as a whole by cutting down the frequency of unnecessary treatments and procedures, and avoiding unnecessary side effects.

Still our continued focus must be on providing high-value care and creating a system that improves patient outcomes and does not place the focus on prescribing drugs based on cost or financial incentives. The Personalized Medicine Coalition, along with the American Association of Cancer Research and Feinstein Kean Healthcare, continues to engage the cancer community to address these questions of cost and value through the Turning the Tide Against Cancer initiative.

Through ongoing dialogue and discussion as part of this initiative, two key themes continually resurface as components that should be considered when defining value: advancing approaches that are patient-centered, and developing new approaches to value assessment that align with and incentivize scientific progress and innovation.

On October 9, 2014, the Personalized Medicine Coalition, the American Association of Cancer Research and Feinstein Kean Healthcare will re-convene the cancer community in Washington, D.C., for a second Turning the Tide Against Cancer national conference to advance the conversation on the value and cost, while supporting a shift to patient-centered cancer research and care.

From The ASCO Meeting In Chicago: A Focus On Cost, Value, And Financial Toxicity Of Cancer Care

In the following post, Dr. Leonard Lichtenfeld, Deputy Chief Medical Officer for the American Cancer Society, shares his thoughts on the discussion at the 2014 American Society of Clinical Oncology (ASCO) annual meeting regarding the cost and value of cancer care and treatment and mentions an article recently published in Clinical Cancer Research that he co-authored with other members of the Turning the Tide Against Cancer initiative.

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At the annual meeting of the American Society of Clinical Oncology (ASCO) here in Chicago, something vitally important is happening: there is an increasing recognition of something no one really wanted to talk about in polite company until now. It is the fact that the costs of many of the new treatments being developed are extraordinary.

The headlines about cost and value of cancer care greeted me when I walked into the McCormick Center in Chicago for the opening sessions of the meeting. This is the leading cancer meeting in the world, and what happens here makes news worldwide, significantly impacting the lives of patients with cancer wherever they may be.

Now there is an increasing recognition of the elephant in the room: the costs of these new treatments are extraordinary. No matter how one chooses to slice and dice the arguments, these drugs are expensive with costs per month of $8000 and upwards getting a lot of attention and increasing concerns, especially at this meeting.

For years, it was whispered in hallways, muttered about with reporters, but now it’s out in the open. The headlines say it, the lecturers say it, the attendees are talking about it. There is an increasing awareness surrounding the value, cost and toxicities–both medical and financial-of cancer treatment. Even as I write this I am sitting in a session devoted to the topic of how we make the choices so necessary for the welfare of our patients and how we should guide those choices.

Some say the costs of this brave new world of cancer care are justified by the advances they bring to the clinic and the lives of patients. The cost of the drug should reflect the value they provide to society says one company. Others say the costs are justified to allow continued research to advance new drugs. But increasingly, another voice is being heard: one that says the costs are unconscionable and not sustainable. Patients are going bankrupt and some of the drugs are quite toxic or don’t bring sufficient value to the patient (such as meaningfully extending life, or reducing side effects).

This argument and the facts behind it are not going to go away. And they shouldn’t. There are too many forces at work here to suggest that this discussion be tabled. Right now, camps are developing on either end of the spectrum, with many if not most cancer professionals are in a large undecided middle. This war of words includes pharmaceutical company press releases promoting drug development, lectures describing how organizations are trying to develop ways to measure the true value of particular treatments-not just the cost, but what the drug really brings to the table, how many side effects does it have, and what is its “financial toxicity” (the lecturer’s words, not mine) of the medication.

And as this debate rages, I can assure you it’s only the beginning. Listen to the experts and you hear that we are moving forward rapidly to develop new equipment to more rapidly analyze the cancer genome. Another expert exhorts us that we only have drugs to address 5% of the genetic abnormalities we have identified that make a cancer cell a cancer cell. We are looking at a future where literally thousands of drugs may potentially be available to treat the various genetic abnormalities we find in any one person’s cancer (each cancer has a number of these changes, and then with treatment the cell is smart enough to develop a “workaround” which would require a different drug).

One expert made the very appropriate comment that this level of individualization means we are moving toward a day when “every cancer is a rare cancer.” Imagine cancer cells being like fingerprints: each one an individual, except that unlike fingerprints, cancer cells can change their stripes. And we need to meet each of those changes wherever those cells reside in the body.

A couple of months ago I was privileged to be a coauthor on an article published in Clinical Cancer Research talking about these issues. The article was written by members of the Turning The Tide Against Cancer initiative, and described what we have to do to change the system. Refocusing on the entire ecosystem of research, translation of drugs from lab to bedside, clinical trials, clinical practice and how we care for patients was the topic, and all of those have to be addressed. It will be an immense effort that will require intense focus and commitment from many participants to reform what we do and how we do it and then make it work for our patients, wherever they may be. Ultimately, patients must be our focus and always be the center of our attention. Whatever we do must be through the lens of the patient and their families.

What bothers me about all of this? While it’s great this issue is finally getting some attention, I don’t yet see the passion I would expect to see given the serious barriers standing between us and our promised future. We have spent decades getting to this point. We need to get the new effective treatments to patients as quickly as possible, wherever that patient may be. We need new trial systems to evaluate drugs, and perhaps rethink how we study drugs to learn as much as we can from each patient.

And then we need to figure out how to pay for all of this, supporting our research enterprise, pay for the care, and afford the new drugs. Many people, organizations, and corporations have to rethink how they do business. Society must make this process work.

Here we sit, but is it on the edge of a precipice or the edge of an opportunity? Who will take the lead? Who will truly define value? Who will afford the costs?

So many questions, and hopefully some answers are coming. We need a new paradigm, we need a better future. Business as usual is not going to get us where we need to be. If we want to make this cancer’s last century we had best take hold of the opportunity and make it happen. We may not get another chance if we don’t act now, and make our future and our vision our reality.

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A version of this blog originally appeared in Dr. Len’s Cancer Blog at the American Cancer Society.