November 12, 2014
(This blog was originally posted on Medpage Today and is reprinted here with permission)
A simple word with lots of meanings, all of which depend on the context of the moment. Value in healthcare -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern.
At the crux of the debate is the question of whether we will continue to see improvements in cancer care that are meaningful, and whether we will be able to support the very innovation that, in no small part, holds such great promise for the future of making cancer a chronic disease for many and even finding a cure for some.
A recent Washington conference sponsored by the Turning The Tide Against Cancercoalition is an excellent case in point.
Conference organizers brought together experts from around the country who are vitally concerned about the progress we are making, and must continue to make, in elevating personalized (or precision) medicine as a key part of advancing cancer research and cancer care. The agenda included a number of presentations about not only how to make personalized medicine more relevant to all of us, but also how to address the question of "value." More...
October 02, 2014
It's October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.
But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! More...
September 30, 2014
I had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.
In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren't necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.
Not long after, I was informed of an online discussion on Twitter (called a "tweet chat" at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a "scrum" of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the limitations of our knowledge or potential problems with the treatment. It was all about "we can do it, call us and we will tell you how good we are, and insurers won't pay us." Simply stated, the "conversation" seemed to be glancing by some of the inconvenient facts surrounding what has become another poster story for how we develop and promote new treatments in medicine, let alone cancer care. More...
June 17, 2014
This past week I had the privilege of participating in a meeting hosted by the President's Cancer Panel on the role of social media in improving cancer control and treatment. The goal was to give advice to the Panel on a planned series of meetings they will be convening to discuss the topic. It was the range and quality of the discussion that day that left me thinking about the broader topic of social media and how it could help improve cancer control going forward. More...
June 04, 2014
As in years past, the trip home from the Annual Meeting of the American Society of Clinical Oncology in Chicago gives me a moment to reflect on what I have heard and hopefully learned over the past five days.
This meeting is a whirlwind of activity and information, far too much for any one person to absorb and process. You can be focused on one topic, you can be general, and you can hear new cutting edge research or be educated on topics of general interest in cancer. You can go to the exhibit hall and be overwhelmed by the booths and displays (I tend not to go there, but obviously many others do). I suspect you get the idea.
Ultimately for me it is the take away messages about trends in cancer research and cancer care that matter the most personally. And this year the trends appear to be somewhat similar to past years, with perhaps some new wrinkles. What is undeniable is that if immunotherapy is the queen at the ball, then "panomics" (I really like that word) holds the keys to the kingdom. More...
June 04, 2014
It was the picture (see below) that, to me, said it all: a 96 year old woman -- one of the first patients in the world to receive a brand new cancer drug--, and a large tumor on her neck had melted completely away. But it was the smile on her lips that you couldn't avoid noticing. More...
May 31, 2014
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. More...
March 19, 2014
An article published this week in the American Cancer Society journal CA: A Journal for Clinicians received a lot of media attention. The report showed dramatic declines in the rate of people being diagnosed with colorectal cancer, as well as decreases in the rates of colorectal cancer deaths over the past number of years.
But the press didn't say much about the fact that not everyone has benefitted from the progress we have made in the prevention, early detection, and improved treatment for colorectal cancer. It is a sad but very real commentary on how we approach health care in this country that African Americans have not benefitted equally from this progress in treating a cancer that for many people can be prevented or effectively treated when found before it spreads to other parts of the body.
As a nation, I believe it is incumbent that we address this glaring health disparity. To do less is unacceptable. More...
August 09, 2013
A newspaper story last week caught my eye when it headlined: "Senators Revive Push for End-of-Life-Care Planning." It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.
You remember "end of life care planning," don't you? It was part of the Affordable Care Act debate several years ago, and quickly became translated into "death panels" where opponents made the argument that the government wanted to help people decide not to receive needed treatment. That was a moment that will live in my memory forever, and it's not a pleasant memory.
So here we are with this new bill, and a headline that suggests we may be headed down the same path once again. This time, however, I hope we can have a more rational and appropriate discussion about an issue that is rapidly evolving in cancer care, supported by medical evidence and medical professionals, not to mention organizations like the American Cancer Society who believe the time has come to engage our patients, their families and caregivers, and the nation at large in understanding the need for compassion as we care for patients with serious illness, including cancer. More...
August 06, 2013
There was a memorable scene in the movie "The Graduate" from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: "plastics."
Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central ones that our becoming our new "plastics" in medicine: genomics and big data. Words that didn't mean much to most people a year or so ago now occupy front and center discussions at every level, not to mention are the topics of a number of meetings I have attended recently.
This past week I went to one of those meetings (sponsored by e Health Initiative) where over 450 people spent two days hearing from experts about the meaning, uses, and precautions that come along with "big data" in medical care. (Interestingly, there were also several presentations on the intersection of genomics and big data. So the two are definitely not mutually exclusive.)
Not that medicine is unique: big data is transforming much of the way we live and the way we experience life. What is different about medical care is that we are so far behind everyone else when it comes to adopting and effectively using information technology and data analysis to improve healthcare. But that is quickly changing. The power of technology is just beginning to impact health care as hospitals and doctors' offices increasingly adopt (and adapt to) health information technology, but it takes lots of resources and commitment--both human and financial--to make that happen. More...