Oncology Practice Management Issues


February 2017, Vol 7, No 2

2017—the Year of the Huddle?

Dawn Holcombe, MBA, FACMPE, ACHE

From the Editor

In 2017, more than ever before, oncology practices of all sizes will ultimately be responsible for the quality and the continuity of the care that they provide to their patients. Notably, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-based Incentive Payment System (MIPS), Medicare will be tracking performance and scores that practices accumulate through self-reporting or Medicare claims tracking. These performance metrics include quality measures, resource utilization, Advancing Care Information under MIPS, and the Clinical Practice Improvement Activities of MACRA. Practices that are participating in the Medicare Oncology Care Model (OCM) are subject to the MIPS measures, as well as the requirements and expectations for practice transformation under the OCM, although some OCM activities may also facilitate performance for the MIPS measures. [ Read More ]

New Value Model Incorporates Long-Term Adverse Effects of Cancer Drugs

Chase Doyle

ASH 2016 Highlights

A new economic model suggests that overall survival and drug toxicity profiles are insufficient for assessing the value of a drug. According to a study that incorporated late adverse events in advanced Hodgkin lymphoma, a more comprehensive benefit-to-risk ratio of a drug requires an understanding of its long-term health implications, said Ohad Oren, MD, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, at the 2016 American Society of Hematology meeting. [ Read More ]

R-CHOP Prevails Over Dose-Adjusted EPOCH-R as Standard of Care for Diffuse Large B-Cell Lymphoma

Phoebe Starr

ASH 2016 Highlights

The CALGB/Alliance 50303 clinical trial failed to show that dose-adjusted treatment with the EPOCH-R (etoposide, phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride, and rituximab) regimen was superior to standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL). Both treatment regimens were equally effective for event-free survival and overall survival (OS), but dose-adjusted [ Read More ]

Updated ASCO Recommendations Support Early Palliative Care in Patients with Advanced Cancers

Jessica Miller

Palliative Care

Patients with advanced cancer should receive early palliative care concurrently with active standard disease treatment, according to the updated guidelines from the American Society of Clinical Oncology (ASCO), which were recently published in the Journal of Clinical Oncology. An expert panel convened by ASCO concluded that early palliative care in patients with advanced cancers reduces depression and improves satisfaction with care and quality of life. [ Read More ]

Leveraging Clinical Data Through Diagnosis Codes as a Successful Oncology Practice

Karna W. Morrow, CPC, RCC, CCS-P, PCS; Sheryl A. Riley, RN, OCN, CMCN

Practice Management

Strategizing patients by determining which patients and what volume of patients will require the most resources is essential to positioning your practice for a successful future. Any business model would identify the needs of a population before defining what services should be brought to a given area, and medical practices should follow suit. [ Read More ]

Select Ongoing Trials Currently Enrolling Patients with Renal-Cell Carcinoma

Clinical Trials Tracker

The following studies represent a selection of key clinical trials that are currently recruiting patients with renal-cell carcinoma (RCC) for inclusion in investigations of new therapies or new combinations of available ther­apies for patients with kidney cancer. Each trial description includes the NLM Identifier to be used as a reference with ClinicalTrials.gov. The information below can help oncology practice managers and providers direct their eligible patients to one of these clinical trials. [ Read More ]

Strategies to Reduce the Use of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia

Phoebe Starr

ASH 2016 Highlights

Although tyrosine kinase inhibitors (TKIs), including imatinib (Gleevec), nilotinib (Tasigna), and dasatinib (Sprycel), have dramatically improved outcomes in patients with chronic myeloid leukemia (CML), the costs of these drugs have spiraled out of control, causing some patients to stop treatment or cut their dosage because of financial toxicity. Data presented at the 2016 American Society of Hematology meeting show that it is possible for some patients with CML to reduce their TKI dose by 50% and maintain remission, perhaps even stop treatment altogether once deep and durable remission has been achieved after approximately 5 years of treatment. [ Read More ]

Triplet Therapy That Includes Elotuzumab Stops Progression of High-Risk Smoldering Multiple Myeloma

Wayne Kuznar

ASH 2016 Highlights

High response rates with the combination of elotuzumab (Empliciti), lenalidomide (Revlimid), and dexamethasone in the treatment of patients with high-risk smoldering multiple myeloma suggest that early intervention may be worthwhile in this patient population, based on results from a phase 2 study, said Irene M. Ghobrial, MD, Attending Physician, Medical Oncology, Dana-Farber Cancer Institute, Boston, at the 2016 American Society of Hematology meeting. [ Read More ]

Venetoclax plus Bortezomib and Dexamethasone Produces High Responses in Relapsed or Refractory Multiple Myeloma

Wayne Kuznar

ASH 2016 Highlights

The addition of venetoclax (Venclexta) to bortezomib (Velcade) and dexamethasone yields high response rates in patients with relapsed or refractory multiple myeloma, especially in patients with disease that is not refractory to bortezomib and who received 1 to 3 previous lines of therapy, according to findings presented by Philippe Moreau, MD, Department of Hematology, Nantes University Hospital, France, at the 2016 American Society of Hematology meeting.

[ Read More ]

CAR T-Cell Therapy Succeeds in Aggressive Lymphoma

Phoebe Starr

ASH 2016 Highlights

The investigational chimeric antigen receptor (CAR) T-cell therapy KTE-C19 achieved complete responses that were durable for >1 year in more than 75% of patients with aggressive lymphomas who had no other effective treatment options, according to results from the phase 2 pivotal clinical trial ZUMA-1 that were presented by Sattva S. Neelapu, MD, Department of Lymphoma/Myeloma, M.D. Anderson Cancer Center, at the 2016 American Society of Hematology meeting. [ Read More ]

Glasdegib, a Hedgehog Inhibitor, Nearly Doubles Survival in Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome

Wayne Kuznar

ASH 2016 Highlights

Adding the investigational smoothened (SMO) receptor inhibitor glasdegib to low-dose cytarabine (Depo­Cyt) significantly increased overall survival (OS) compared with low-dose cytarabine monotherapy in patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS) who were ineligible for intensive chemotherapy, according to a phase 2 study presented by Jorge E. Cortes, MD, Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX, at the 2016 American Society of Hematology meeting. [ Read More ]

Obinutuzumab Prolongs Survival in Follicular Lymphoma

Phoebe Starr

ASH 2016 Highlights

Obinutuzumab (Gazyva)-based induction and maintenance chemotherapy extended progression-free survival (PFS) compared with standard-of-care rituximab (Ritux­an)-based chemotherapy in patients with untreated follicular lymphoma, said Robert E. Marcus, MBBS, FRCP, FRCPath, King’s College Hospital, London, who presented the results from the phase 3 GALLIUM clinical trial at the 2016 American Society of Hematology meeting. [ Read More ]

Is Value-Based Pricing the Solution to Controlling the Cost of Oncology Drugs?

Meg Barbor, MPH

Care Delivery

Anticancer drugs should be priced based on the value they deliver to patients, according to Peter B. Bach, MD, Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York. “The prices have gotten to a scale that they’re actually harming the people the products are intended to help,” Dr Bach said at the 2016 Annual meeting of the Hematology/Oncology Pharmacy Association Oncology Pharmacy Practice Management Program. [ Read More ]

The Limitations of Big Data in Cancer Care

Jessica Miller

Practice Management

There is little chance of escaping the spell that big data has cast over the healthcare industry. “Anytime you listen to any conference, just about every panel, just about every speaker at some point brings up the idea of the use of data for value based care, for value contracts, for quality measures, for new indications for drugs,” said Brad Hirsch, MD, Senior Medical Director, Flatiron Health, New York, NY, at the Sixth Annual Conference of the Association for Value-Based Cancer Care. [ Read More ]

Lenvima (Lenvatinib) Approved in Combination with Everolimus for Patients with Advanced Renal-Cell Carcinoma

Loretta Fala

Drug Update

Approximately 394,336 Amer­icans were living with kidney cancer in 2013. In 2016 alone, an estimated 62,700 people were diagnosed with kidney cancer, and 14,240 people died from the disease. Renal-cell carcinoma (RCC), the most common type of kidney cancer, accounts for 85% to 90% of new cases of the disease. More than 70% of kidney cancers are clear-cell tumors—named for the clearness (or paleness) of the cells when viewed under a microscope. [ Read More ]