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| April 4, 2011 |

The Associated Press offers a look at how American medicine includes ongoing treatment — without real discussions of options — even as patients face imminent death.  Rosaria Vandenberg went home to share a final, touching moment with her 2-year-old daughter one day before dying of an incurable brain tumor.  Her sister-in-law says they didn’t know to talk about alternatives to aggressive treatment.  “We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital.  June 28, 2010

The fight for coverage of successful treatment

Paula Oertel’s brain tumor disappeared for nearly a decade with interferon injections.  But a move from one county to another triggered a Medicare review and subsequent denial of the drug.   Her tumor soon returned and more expensive, approved treatments aren’t working.  Now Oertel, in her early 40s, has fewer than five months to live.  The Milwaukee Journal Sentinel tracks her story, her doctor’s efforts to regain approval for interferon, and the “system in which an approved drug that was largely ineffective in Oertel and costs $20,000 a month is covered, but an unapproved drug that worked and cost a fraction of that, is not covered.”  Wrote Dr. Mark Malkin in a letter to Congressman Thomas Petri, “I have been practicing neuro-oncology for more than 20 years, yet decisions I wish to make on behalf of my patients are second-guessed or outright denied …  My staff and I spend hundreds of wasted hours trying to obtain authorizations and appealing wrong decisions when we could be treating patients.”   March 21, 2010

Revolution in health care delivery

An article in the New England Journal of Medicine explores the lack of standardization and evidence-based medicine, payment for volume rather than value, and the lack of coordination between doctors and medical facilities on behalf of their patients.  “It is well documented that U.S. patients receive only about half of scientifically advisable care; many unnecessary procedures are performed, leading to avoidable complications and costs; safety problems abound; and there are tremendous regional variations in the quality and quantity of care delivered. … Too often, U.S. health care overvalues local autonomy and undervalues disciplined science — not because of inattention or incompetence among doctors and nurses but because it is difficult for the human mind to keep up with the explosion of medical knowledge.”  February 4, 2010

Doctors delay end-of-life discussions

While medical guidelines suggest doctors begin discussing end-of-life decisions when the patient has a year or less to live, The New York Times highlights a new study that shows such conversations aren’t happening.  Of 4,074 doctors caring for cancer patients, 65 would talk about prognosis with a patient who has 4-6 months to live.  Just 26 percent would discuss hospice and 21 percent would explore the patient’s chosen site of death. “These conversations are time-consuming and difficult. Some doctors may feel patients will lose hope. It’s easier to say, ‘Let’s try another round of chemotherapy,’ instead of having a heart-to-heart discussion,” said Dr. Nancy L. Keating, the first author of the study and an associate professor of medicine and health care policy at Harvard.  January 11, 2010

The long war on cancer

Public Radio International speaks with Dr. Jerome Groopman of Harvard Medical School and the Beth Israel Deaconess Medical Center.  They discuss advances, breakthroughs and challenges — including variation in treatment for patients across the U.S. — in the fight against cancer.   January 11, 2010

Few breast cancer surgeons follow care standards
ScienceDaily reports most breast cancer surgeons’ practices do not follow standards associated with the best quality of care, according to a study by researchers at the University of Michigan Comprehensive Cancer Center.  The National Cancer Institute-funded study showed, for example, that 75% to 66% of surgeons did not routinely discuss their treatment plans and collaborate with medical or radiation oncologists.  January 5, 2010

The costly, time-consuming pursuit of claims
The Philadelphia Inquirer explores the bureaucracy of claims processing, which can be a months-long quest with countless communications among multiple employees in doctors’ and insurance offices.  In all, claims processing/health administration eats 7 percent of U.S. health spending.  November 22, 2009

10 ways to cut health costs right now
BusinessWeek highlights a new report from Thomson Reuters that documents how the U.S. medical system wastes $700 billion a year on unnecessary treatments, redundant tests, fraud, errors, etc.  The article addresses reduction of inappropriate billings, coordination of care across doctors, the need to ensure patients follow prescribed care, discussion of end-of-life options, and helping patients manage chronic illness.  November 17, 2009

Patient voices: coping with and without insurance
The New York Times continues its coverage of the health care debate through a look at six individuals struggling with medical bills even though they have insurance.  Tasha Huebner, 41, “found dealing with the insurance company worse than dealing with breast cancer.”  November 2, 2009

35, with stage IV breast cancer
Susan Sussman, 35, writes in Newsweek about being diagnosed with stage IV breast cancer at a major academic medical center in New York.  Previously she had seen numerous physicians in her home state for a variety of symptoms, including chest pains.  None of those original doctors found the cancer, even though family history made her a high-risk patient.  One doctor even told her, erroneously, that “girls her age do not get breast cancer.”  October 17, 2009

Many going unchecked for common, deadly cancers
An ABC News poll shows 75% of men aged 40 or older are not having the recommended annual prostate cancer screening. Further, 60% of men and women aged 50 and older have not had a recommended colonoscopy to test for polyps or tumors in the colon. August 5, 2009

Aggressive treatment for bladder treatment doesn’t show benefit
Brent K. Hollenbeck, MD, MS, assistant professor of urology at the University of Michigan Health System, has released a study showing aggressive treatment for early-stage bladder cancer does not appear to benefit patients and may increase the likelihood for later intervention. As reported in Modern Medicine, he described the evidence base underlying treatment approaches to bladder cancer patients as “suboptimal,” focused on preventing or reducing recurrences and not necessarily considering how best to manage patients. August 1, 2009

Considering longer chemotherapy
This New York Times article explores the growing trend of giving cancer patients extended periods of chemotherapy, as part of planned maintenance therapy. It’s possible because newer cancer drugs are less toxic. Oncologists are debating approval of a new standard of maintenance therapy for lung cancer, and it’s also being used in ovarian cancer, multiple myeloma and non-Hodgkin’s lymphoma. Doctors say such usage could prolong the time tumors are under control, although it also may exacerbate side effects and add tens of thousands of dollars in costs. July 20, 2009

Immigrant fighting cancer and the fear of losing care
The Boston Globe profiles Eugenio Hernandez, an immigrant from El Salvador who was diagnosed with prostate cancer two years ago. He was treated with surgery and radiation, and receives periodic checkups for the cancer that still remains. He’s among 30,000 legal immigrants in Massachusetts who are about to lose their state-subsidized health insurance. He recalls learning of the cancer, being afraid and depressed, and not asking any questions. His first medical bill was $24,000, and the required time off cost him one of his two jobs. July 15, 2009

Gene network may lead to brain cancer breakthrough
ABC reports on research showing a network of genetic changes related to the progression of fatal brain tumors. The findings may have relevance in the treatment of gliobastoma, since treatment with therapies targeting single genes has not been successful. July 14, 2009

Families battle cancer, complicated and costly healthcare system
Boston’s NECN/TV in Maine takes a look at the state’s #1 killer – cancer. The cover story looks at patients who must pay thousands of dollars for their treatment, even when they have insurance. A local American Cancer Society representative says the country has a flawed system – one that isn’t affordable, easily accessible, or portable. July 10, 2009

In Health Reform, a Cancer Offers an Acid Test
New York Times reporter David Leonhardt uses prostate cancer as a litmus test for health care reform, arguing that true reform needs to change a fee-for-service approach in favor of quality care that works. Men with slow-growing, early-state prostate cancer – the most common form – have at least five treatment options, he writes. No studies have proven that one is more effective than the other. Yet one option costs just a few thousand dollars, while another often exceeds $100,000. July 7, 2009

Cancer patients’ agony of options

Multiple treatment options and constantly emerging research in a complex field of medicine combine to leave cancer patients overwhelmed with the decisions they face.  This Philadelphia Inquirer story looks at what cancer patients go through after receiving their diagnosis. June 7, 2009

Making personalized cancer care routine

The National Cancer Institute’s Cancer Bulletin explores the use of genetic and molecular information from tumors to determine best treatment.  Much more is known than in this emerging science, yet genetic testing is hardly common.  “Doing this within the current health care system is unbelievably complicated,” said Dr. Mark Kris, chief of the Thoracic Oncology Service at Memorial Sloan-Kettering Cancer Center. “This is not how hospitals work right now, and it is not how oncology is practiced.”  June 2, 2009

‘Huge’ cancer case rise forecast
Bloomberg News’ Marilyn Chase reports that cancer cases could climb 45% by 2030, to 2.3 million a year.  Citing research published in the Journal of Clinical Oncology, Chase shows an aging population is the primary cause.  “These trends are strong and inescapable,” said Derek Raghavan of the Cleveland Clinic’s Taussig Cancer Center.  “We have a huge problem.  Like global warming, it’s here, it’s happening now.”  April 29, 2009

Why don’t more patients do clinical trials?
When children are diagnosed with cancer, 95% are enrolled in clinical trials.  In contrast, 95% of adults do NOT enroll in clinical trials, many without being told of them and never having asked, writes Marie McCullough, of the Philadelphia Inquirer.  She shows how doctors have little incentive to explore clinical trials with adult patients, unless the doctors are personally involved in the research.  She describes patients’ fear of receiving a placebo in place of real treatment – which doesn’t happen.  April 23, 2009

Costs of cancer pills hard to swallow
This Pharmacy Times article shows how insurers have been slow to address the transition to oral chemotherapy drugs vs. intravenous chemotherapy, leaving patients with exorbitant co-pays and annual coverage limits that are exceeded swiftly.  April 23, 2009

Push is on to tailor cancer care to tumor’s genes
Associated Press medical writer Lauren Neergaard portrays “the rush of new research pointing the way to tailor chemotherapy and other care to what’s written in your tumor’s genes.”  She notes a new standard adopted in January calling for advanced colon cancer patients to have a genetic test before receiving either of two leading treatments.  It’s been proven the pricey drugs don’t work in 40% of patients, and the test shows whether a patient’s tumor will respond.  Feb. 16, 2009

How to take American health care from worst to first
Billy Bean, Newt Gingrich and John Kerry team for a New York Times op ed that looks at how baseball fans have more data at their fingertips than doctors.  “Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.  It is no surprise then that the United States spends more than twice as much per capita on health care compared to almost every other country in the world — and with worse health quality than most industrialized nations.” October 24, 2008
(Note: To access this article, viewers may have to complete a free, online registration with the New York Times.)

Paying doctors to ignore patients
Peter Bach, a doctor at Memorial Sloan-Ketting Cancer Center, writes an op ed in the New York Times showing how the current reimbursement structure rewards doctors for quantity, not quality — for “using equipment as much as possible,” but “not to spend time with patients.” July 24, 2008

Pricey drugs put squeeze on doctors

Wall Street Journal reporter Marilyn Chase reveals that rising drug costs — sometimes exceeding $100,000 a year — are affecting oncologists’ treatment decisions.  She notes oncologists buy many drugs themselves, because they’re given intravenously in the office.  The doctors are left with the bill when insurers and patients don’t or can’t pay.  Chase sites a survey in the Journal of Clinical Oncology that showed 23% of oncologists said costs influence their treatment decisions, and 16% omit discussion of very expensive treatments when they know it would greatly strain patients’ resources.  July 8, 2008
(Note:  This is an archived story; you will need to subscribe online to access the full text.)

Surviving on the other side of care

Eye doctor Joseph Michelson describes life as a patient with metastatic lymphoma.  He describes the anxiety, waiting, questions, and annoyance over treatment he doubted.  “As frustrating as my experience has been, my story raises more questions about other people’s care than it does about mine. I have the education and training to question my experience. What of the typical patient?”  May 19, 2008

Cancer Patients, Lost in a Maze of Uneven Care

New York Times health reporter Denise Grady portrays a young mother’s battle against colon cancer, documenting alarming gaps in care and how patients often are on their own in finding appropriate treatment. “It’s patchwork, and frustrating that there’s not one person taking care of me who I can look to as my champion,” said Karen Pasqualetto, the story’s heroine. “I don’t feel I have a doctor who is looking out for my care. My oncologist is terrific, but he’s an oncologist. The surgeon seems terrific, but I found him through my own diligence. I have no confidence in the system.”  July 29, 2007

(Note: To access this article, viewers may have to complete a free, online registration with the New York Times.)

How I live with cancer
Newsweek reporter Jonathan Alter details his personal journey into the world of cancer treatment: the emotional trauma, different treatments recommended by different doctors, the expense, insurance nightmares… April 9, 2007

Cancer and me — how I refused to give in

Bernadine Healy is health editor for U.S. News & World Report.  The former head of the National Institutes of Health and the American Red Cross describes her own treatment for brain cancer.  She talks about the unique perspectives from each doctor in her “brain trust,” about evolving treatment standards, and about selecting and changing treatments based on the patient’s choice, unexpected conditions, and tumor response. April 1, 2007
Healthcare Reform: Better Care at Lower Cost

ITA Partners CEO & President Eduardo Beruff speaks about healthcare reform and the need to address a “systemic foundational crisis within the very delivery of care.”  His remarks address variable quality in treatment, ineffective management of chronic illness, and the lack of 21st century information technology.  February 26, 2010

Speech available here as a download

Putting evidence into practice — pain management in adult cancer patients
Lisa Aiello-Laws, RN, MSN, AOCNS®, APNG, APN-C, is a knowledge base manager at ITA Partners, responsible for maintaining ITA’s electronic library of 700+ evidence-based cancer treatment protocols.  The library systematically evaluates prescribed therapies against evidence-based medicine to ensure patients receive quality care from the start.  Ms. Aiello-Laws was the lead author and team leader for “Putting Evidence Into Practice — What are the Pharmacologic Interventions for Nociceptive and Neuropathic Cancer Pain in Adults?”  The Clinical Journal of Oncology Nursing article followed a project coordinated by the Oncology Nursing Society.  It addresses the fact that cancer pain continues to be under-treated in adults, despite substantial research on pain management.  It describes various pain management treatments and the positive impact of nursing interventions. November, 2009

Abstract available here as a download

Cancer doctors urged to discuss treatment costs with patients
A new guidance statement from the American Society of Clinical Oncologists (ASCO) urges oncologists to discuss potential financial costs of care with their patients.  The ASCO task force was headed by Dr. Lowell Schnipper, Chief of Hematology/Oncology at the Beth Israel Deaconess Medical Center in Boston and a member of ITA Partner’s Medical Advisory Board.  This article, in the National Cancer Institute’s Cancer Bulletin, discusses the implications of cancer costs, which are increasing about 15 percent annually.  July 14, 2009

Full article available here as a download

What health plans don’t know hurts them, their membersITA Chief Medical Officer William A. Flood, MD, describes how a significant portion of health care dollars covertreatment that is outdated, less than effective, or inadequately delivered. He shows how physicians and insurers struggle to stay abreast of the thousands of clinical trials annually that can determine new standards in care. Second Quarter, 2008

Full article available here as a download

Developments in cancer treatment standards ITA Chief Medical Officer William A. Flood, MD, summarizes key research discussed at the June 2007 meeting of the American Society of Clinical Oncology. Highlights include new agents in post-operative breast and colon cancer therapies and treatment of advanced lung cancers. Third Quarter, 2007


Full article available here as a download

Managing complex and increasingly expensive cancer claims
ITA’s founding CEO, Eduardo Beruff, writes about how advances in treatment and technology mean more success in the fight against cancer … and an even greater need for a coordinated effort among patients, physicians and insurers. Summer 2007

Full article available here as a download