Category Archives: Cancer

More states adopting law allowing terminal patients to try experimental treatments

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One dye showing 2By Michelle Andrews
KHN

Earlier this month, Arizona voters approved a referendum that allows terminally ill patients to receive experimental drugs and devices. It’s the fifth state to approve a “right-to-try” law this year.

Supporters say the laws give dying patients faster access to potentially life-saving therapies than the Food and Drug Administration’s existing “expanded-access” program, often referred to as “compassionate use.”

Supporters say the laws give dying patients faster access to potentially life-saving therapies. Critics charge such ‘right-to-try” acts are  feel-good laws that don’t address some of the real reasons patients may not receive experimental treatments.

But critics charge they’re feel-good laws that don’t address some of the real reasons patients may not receive experimental treatments.

The legislatures in Colorado, Louisiana, Michigan and Missouri also passed right-to-try laws this year as part of a nationwide effort spearheaded by the conservative Goldwater Institute, which hopes to get right-to-try laws on the books in all 50 states.

The measures generally permit a patient to get access to an experimental drug after it’s passed through phase 1 of a clinical trial, the initial testing in which a drug is given to a small group of people to evaluate its safety and side effects. Continue reading

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Washington state to offer breast cancer license plates

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BC-MountainRibbonOLYMPIA – There’s a new way to donate and show your support for breast cancer screening and testing. Starting Oct. 16, you have a chance to bid on the first batch of breast cancer license plates before they go on sale to everyone, starting in January.

Money raised from the sale of the plates will pay for breast cancer screenings and follow up tests for women with limited or no insurance through the state Department of Health’s Breast, Cervical, and Colon Health Program.

Money raised from the sale of the plates will pay for breast cancer screenings and follow up tests for women with limited or no insurance.

The auction runs through the end of the month. More information about the auction and how to bid can be found online. After this month’s auction, breast cancer license plates will be available for purchase in January 2015 for $60 through the state Department of Licensing. Continue reading

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States negotiate for better drug prices

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Because of skyrocketing prescription drug prices, some state Medicaid programs and prison systems are limiting certain drugs to only the sickest patients. Some states are negotiating better pricing.

By Michael Ollove
Stateline

Twenty-dollar bill in medicine bottleThe new hepatitis C drug Sovaldi promises a cure rate of well over 90 percent, compared to 45 percent (at best) for older drugs. But when Sovaldi went on the market earlier this year for as much as $84,000 for a single course of treatment, critics blasted the cost as “exorbitant” and “gouging.”

It is estimated that between 3.2 million and 5.2 million Americans have hepatitis C, an infectious illness that can eventually compromise the liver.

The disease falls disproportionately on the poor and the incarcerated, which makes it a particular challenge for Medicaid, the federal-state health plan for the poor, and for state prison systems.

One study by Express Scripts, a drug benefits management company, estimated it would cost states $55 billion to provide Sovaldi to all prisoners and Medicaid beneficiaries with hepatitis C.

Because of its high cost, some state Medicaid programs and prison systems are refusing to provide Sovaldi to any but the sickest patients. Most recently, Oregon last month threatened to limit access to the drug unless it can get Sovaldi at a deeply discounted price.

“Sovaldi is a seminal event,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s clear that states are not equipped to handle this. They simply do not have the tools to maintain control.”

But Sovaldi is only the beginning. Expensive new treatments for certain cancers, rheumatoid arthritis and other conditions also have rattled Medicaid officials, patients and health care providers.

What can states do to hold down drug costs? Drug pricing is a complicated and opaque process. Here are some of the basics.

Question: Is each state Medicaid program on its own when it comes to drug pricing?

Answer: Not completely. The federal Omnibus Budget Reconciliation Act of 1990 mandates that drug makers give all Medicaid programs a 23 percent rebate off the Average Manufacturers Price (AMP) for all prescription drugs purchased, or the difference between the AMP and the best price given to a private payer. (Prisons aren’t covered by this discount provision and have to negotiate drug prices as any retailer does.)

In return for the rebates, Medicaid programs must carry all drugs approved by the U.S. Food and Drug Administration on their “formularies,” which is the list of the medications each health plan will pay for.  That guarantee means that the drug makers get access to substantial markets in all 50 states and the District of Columbia. Continue reading

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One proton center closes, but that doesn’t slow new construction

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proton therapy baltimore 300

In this May 2013 photo, construction continues at the Maryland Proton Treatment Center. (Photo by Jenny Gold/KHN).

This KHN story also ran on NPR

Proton therapy has been touted as the next big thing in cancer care. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.

There are already 14 proton therapy centers in the U.S., and another dozen facilities are under construction even though each can cost $200 million to build.

But Indiana University shocked experts who watch the industry last month when it announced that it plans to close down its facility in Bloomington, as reported by Modern Healthcare.

“I never thought that in my lifetime I would see a proton center close,” says Amitabh Chandra, a professor at Harvard’s Kennedy School of Government who studies the cost of American medical care.

He’s surprised because until now, industry growth has been entirely in the other direction, even though there’s little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

“But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,” Chandra says.

In the Washington, D.C., area alone, three proton therapy centers are under construction — one at Johns Hopkins Medicine Sibley Memorial Hospital, another at MedStar Georgetown University Hospital, and a third, the Maryland Proton Treatment Center, is slated to open at the University of Maryland in Baltimore next year.

All three say they are continuing to build their centers, despite the news out of Bloomington. In email statements, two said that the larger population of the DC-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it’s building a smaller, one room center that will be more cost effective.

Proton Therapy Baltimore 2 300

Dr. Minesh Mehta, medical director of the Maryland Proton Therapy Center stands with Dr. William F. Regine, radiation oncologist at the University of Maryland and James DeFilippi, vice president of project development at the construction site of the Maryland Proton Treatment Center in this May 2013 photo (Photo by Jenny Gold/KHN).

But in Indiana, a review committee determined that it just wasn’t worth spending the money that would be necessary to update their proton facility.

One reason for the closure is that insurers have been refusing to cover the treatment for common diseases such as prostate and breast cancer.

Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the insurer’s national medical officer.

“When it’s used, however, for all other tumors, it’s not been shown to be any more effective than other forms of radiation therapy,” says Finley.

Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn’t any better than the cheaper options, it can increase the cost of everyone’s health care.

“We said if two services offer the same result and one is much more expensive than the other one, we’re only going to pay for the one that is less expensive,” Finley says.

Other major insurers have also limited what they’ll cover with proton therapy, including Aetna and Blue Shield of California.

One health care payer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.

“That’s the problem with Medicare payment policy,” says Harvard’s Chandra, “it not only covers treatments that are dubious treatments, it also covers dubious treatments extremely generously.”

But the doctors and researchers involved with building new proton beam facilities don’t think the treatment is dubious. They point to proton therapy’s potential to kill cancer without damaging surrounding tissue, and they say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

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Many women receiving unnecessary Pap tests

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Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCIBy Stephanie Stephens,
Health Behavior News Service

As many as half to two-thirds of women who’ve undergone hysterectomies or are older than 65 years in the United States report receiving  Pap tests for cervical cancer.

This prevalence is surprising in light of the 2003 U.S. Preventive Services Taskforce guidelines recommending that women discontinue Pap testing if they have received a total hysterectomy without a history of cervical cancer and if they are over age 65 years with ongoing and recent normal Pap test results.

Performing these unnecessary tests can result in stress for the patient, increased costs, and inefficient use of both provider and patient time, concludes a new study in the American Journal of Preventive Medicine.

“During this time of health care reform, we could probably use our resources more wisely,” said corresponding author Deanna Kepka, Ph.D., M.P.H., assistant professor at the University of Utah’s College of Nursing and Huntsman Cancer Institute. Continue reading

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Vicodin, some other pain meds will be harder to get – DEA

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Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month.

The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” (HCP) from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen.

The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances.

Many patients with painful chronic diseases, including cancer, take hydrocodone combination products

.The regulation is a response to the widespread misuse of prescription pain killers.

In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply.

These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. Continue reading

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Insurers hesitant to cover many proton beam treatments

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Comparison_of_dose_distributions_between_IMPT_(right)_and_IMRT_(left)By Michelle Andrews
KHN

Everyone seems to agree that proton beam therapy–a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue–is an exciting technology with a lot of potential.

But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine.

That approach doesn’t sit well with proponents, some of whom say that insurance coverage is critical for necessary research of the controversial therapy’s uses.

Critics assert that the rush to build the centers is putting a very large cart before the horse.

Meanwhile, the number of proton therapy centers — huge structures that can cost more than $200 million — continues to increase.

Fourteen are in operation in the United States and a dozen more under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

Critics assert that the rush to build the centers is putting a very large cart before the horse. Continue reading

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Quantifying the ‘Angelina Jolie effect’

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Actress’ impact on genetic testing for breast, ovarian cancer is ‘global and long lasting’

Angelina Jolie - Photo courtesy of the UK Foreign and Commonwealth Office

Angelina Jolie – Photo courtesy of the UK Foreign and Commonwealth Office

By Mary Engel / Fred Hutch News Service

Sept. 18, 2014

The so-called Angelina Jolie effect not only is real but has been “global and long lasting,” leading to a twofold increase in the number of women getting genetic testing to help determine their risk for hereditary breast cancer, according to new studies from the United Kingdom and Canada.

The number of women found to have a genetic mutation that increased their risk also has doubled.

And contrary to concerns that women at low risk for hereditary breast cancer would flood testing centers, researchers said that those being tested are women like Jolie who have a family history of breast cancer or who have personal risk factors such as ethnicity.

Certain ethnic groups, including Ashkenazi Jews, have a higher prevalence of BCRA mutations, which significantly increase breast cancer risk.

Women got the correct message

“What surprised us was that we didn’t get the worried well,” said Dr. Andrea Eisen, head of preventive oncology for breast cancer care at the Sunnybrook Odette Cancer Centre in Toronto and an author of the Canadian study, in a phone interview.  “We got women who got the correct message. That was gratifying.”

Jolie disclosed in a May 2013 op-ed in The New York Times that she had undergone a preventive double mastectomy after finding that she carries the rare BRCA1 gene mutation, which dramatically raises her risk of breast and ovarian cancers. Continue reading

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Too many of us die in hospital instead of home. Here’s why.

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Paula Ron Faber 300

Paula and Ron Faber walk their dog Millie in 2009, between cancer diagnoses. (Photo by Shelley Seccombe)

This story is part of a partnership that includes WNYCNPR and Kaiser Health News. 

It was September 2012 and it was life-long smoker Paula Faber’s third cancer in a decade, but she did not hesitate.

“She was going to fight it every inch of the way,” says her husband Ron Faber.

“I would have rather have had a really okay four-and-a half months than this endless set of treatments.”

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves.

Instead, the pain could have been managed so she could focus on the quality of life.

“I would have rather have had a really okay four-and-a half months than this endless set of treatments,” the stage actor said.

As they confronted Paula’s terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make.

But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans. Continue reading

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County receives $6m grant to improve hepatitis C care

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Hepatitis C by the numbersKing County has received a four-year, $6 million grant to improve testing, treatment and cure rates of people with chronic HCV infection.

Hepatitis C virus (HCV) affects large numbers of people in King County, but it often goes unnoticed until it’s too late.

“Thousands of people in King County have chronic HCV, but many don’t know they have it,” said Dr. Jeff Duchin, Chief of Communicable Disease & Epidemiology at Public Health – Seattle & King County. “This grant will allow us to make sure that patients with chronic HCV are not just identified, but also seen by a provider, receive follow-up testing, and get the care they need.”

The grant will fund the Hepatitis C Test & Cure Project, which will provide training for clinicians on the diagnosis, evaluation, and treatment of HCV and connect them to specialists. Continue reading

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Seattle Brain Cancer Walk — this Saturday, Sept. 20th

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Brain Cancer WalkThe 7th annual Seattle Brain Cancer Walk will take place on Saturday, Sept. 20, 2014 at Seattle Center’s Fisher Pavilion.

Founded in 2008 by a group of committed volunteers and families, the Seattle Brain Cancer Walk has raised over $2.5 million for research, clinical trials and comprehensive care for brain cancer patients in the Pacific Northwest.

100% of the walk proceeds go directly to patient care and research. Continue reading

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Are nurse practitioners, physician assistants encroaching on specialists’ turf?

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One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.

Mid-level providers – PAs and NPs – “are doing invasive procedures and surgery. I’m not sure they were trained to do that.”

Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for  dermatological surgeries. Continue reading

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Keep your cool in hot weather – CDC

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Sun Orange Orb by Cris DeRaudGetting too hot can make you sick. You can become ill from the heat if your body can’t compensate for it and properly cool you off.

Heat exposure can even kill you: it caused 7,233 heat-related deaths in the United States from 1999 to 2009.

Learn about heat-related illness and how to stay cool and safe in hot weather

.Main things affecting your body’s ability to cool itself during extremely hot weather:

  • High humidity. When the humidity is high, sweat won’t evaporate as quickly, which keeps your body from releasing heat as fast as it may need to.
  • Personal factors. Age, obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn, and prescription drug and alcohol use can play a role in whether a person can cool off enough in very hot weather.

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New hepatitis C treatments – FDA Consumer Update

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fda-logo-thumbnailFrom the US Food and Drug Administration

At the approval of several new drugs for hepatitis C is  welcome news for baby boomers—who make up three of four adults with the hepatitis C virus—and millions of other Americans, many of whom don’t yet know they are infected and carriers, says the US Food and Drug Administration in this Consumer Update.

Hepatitis C can be cured, and today’s drug therapies are very effective and easier for patients to take, says Jeffrey S. Murray, M.D., the deputy director of the Division of Antiviral Products in FDA’s Center for Drug Evaluation and Research. Murray is an internist who specializes in infectious diseases.

A Preventable and Curable Disease

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