1. Just a note that there's a site with a variety of Q&A's on cancer that might be useful here:

http://xooxleanswers.com/cancer.aspx

It covers incidence and prevelance, Gleason scores and prostate cancer, alternative treatments, etc. Other topics will be added.

David

Posted at 7:03PM on Mar 11th 2007 by davidsarokin

2. I wonder if reporters arn't put onto the story by insurance companies? Superficially, it sounds like a great expose, greedy clinics/doctors trying to make money by pushing drugs. The New York Times article states that the drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug. That's not really a new revelation. We've been down that road before without much done to change it.

According to Dr. John Glaspy, director of UCLA's Outpatient Oncology Clinic, one complicating factor, experts say, is that oncologists make significant revenue buying cancer drugs from manufacturers and charging patients a higher price for receiving the drugs in their offices. That profit motive could influence some doctors' decisions. However, patients with anemia, which can cause sluggishness in its early stages and can be fatal in advanced phases, can get blood transfusions, typically every few weeks, instead of using EPO.

Could it be that increased numbers of red cells deliver more oxygen to the tumor cells and thereby increase their activity across the board, including with respect to invasion, proliferation, and metastasis? On one hand they're developing drugs to halt and reverse angiogenesis while on the other hand they're helping the tumor to obtain more oxygen with existing vasculature. And nobody in charge foresaw that? Amazing how they can apply differing standards for proof or benefit when profit is involved.

Medicare and insurance companies have pretty strict guidelines about how low the hematocrit must be in order for them to be eligible for reimbursement. But some patients feel draggy/listless/weak when their hematocrits are above the cut-off levels for reimbursement (meaning they have to wait until their levels drop low enough).

Maybe this could be one of those situations where what makes the doctor money also could help the patient considerably? The real loser in this are the patients who have to pay for the drugs, who would be happier were they just be moping around at home, as opposed to out living full lives. These drugs have shown signs that they could improve the quality of life for both dialysis and cancer patients, even though their safety labelling has already been revised three times since 1997. Let the patient be the judge?

Posted at 10:14AM on Mar 13th 2007 by Gregory D. Pawelski

3. In panel discussion that highlighted the 12th annual conference of the National Comprehensive Cancer Network, Lee Newcomer, former chief medical officer and currently an executive with Minneapolis-based United Health Group, pointed out that in reviewing records of patients who were prescribed the drug erythropoietin -- an expensive agent that boosts blood supply in patients with anemia -- said that 44 percent of those patients had blood work-ups that would indicate they were not anemic.

Erythropoietin is a hormone that stimulates red blood cell precursors in the bone marrow. As a therapeutic agent, it is produced by recombinant DNA technology. It is used in treating anemia rsulting from chronic renal failure or from cancer chemotherapy. A six-month course of treatment can cost more than $10,000 per patient.

Len Lichtenfeld, deputy chief medical officer for the Atlanta-based American Cancer Society, told United Press International, "Probably more than a billion dollars is spent on erythropoietin each year, which makes it one of the most expensive cancer drugs."

Newcomer said he objected to prescriptions for erythropoietin written for patients with hematocrit higher than 36. Low hematocrit, the ratio of the volume of red cells to the volume of whole blood, is an indication of anemia, Lichtenfeld said.

Normal range for hematocrit is different between the sexes and is approximately 45 percent to 52 percent for men and 37 percent to 48 percent for women. Lichtenfeld said clinicians generally would not treat a hematocrit that was about 36 percent.

Newcomer also stated at the meeting that when he scrutinized prescribing habits for treatment of patients with pancreatic cancer, their were doctors writing prescriptions for 188 different combinations of treatments, yet there are only two drugs that have any activity against that disease.

Newcomer also cited in the meeting last year that the use of the new breast cancer drug tratuzumab, sold as Herceptin, which has been found to be helpful in a group of women with breast cancer that overexpresses a certain gene known as HER2. The drug is ineffective in women with normal levels of HER2, yet about 12 percent of drugs orders -- which costs thousands of dollars per treatment -- were for women who tested negative for HER2 overexpression.

One of the newest biological targeted agents, bevacizumab, sold under the trade name Avastin, which is rapidly being included in numerous drug cocktails because it has been shown to extend survival in diseases such as colon cancer, can cost as much as $47,000 a year for one person.

Newcomer stated, "We know that Avastin improves outcomes in about 20 percent of patients, but we have no idea which cancer patients will benefit from a course of treatment." According to his calculations, it costs $354,000 per year of life extended with Avastin.

http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20070316-20215500-bc-us-cancercosts-analysis.xml

Posted at 11:28AM on Mar 20th 2007 by Gregory D. Pawelski