Monthly Archives: December 2005

Why Can’t We Get It Right?

I recently wrote about the new Medicare program which asks oncologists to provide information about their cancer patients, and whether or not they were following accepted national guidelines in their treatment plans and programs.


Shortly afterward, an article and editorial appeared in the Journal of the American Medical Association which highlighted the problems we have as a nation in getting the right treatment to the right patient, and the length of time it takes to get “new” treatments accepted by the medical (and possibly the patient) community.


The article discusses a recommendation that was made by a National Cancer Institute consensus conference in 1990 about the treatment of patients with advanced, surgically resectable colon cancer.


Basically, based on research that had been completed prior to that conference, experts concluded that the use of a combination chemotherapy program after the surgical removal of advanced, resectable Stage III colon cancer significantly improved survival.  These studies had demonstrated a 40% decrease in the risk the colon cancer would recur in these patients at high risk, and a 33% decrease in the chance these same patients would die from their cancer.


In the cancer world, that was very … Continue reading →

Can Medicare Measure Quality Cancer Care?

One of the major questions facing medical practice today is how we measure the quality of care we deliver to our patients.


It is not an easy task. 


Most doctors’ offices don’t have electronic medical records, so gathering data by hand is a major barrier.  Even those offices with computers don’t have systems in place that can easily gather information (other than for billing purposes), much less analyze it.  And, looking at information as part of an overall quality improvement effort is not part of the doctor’s training or routine practice.


Some organizations have made substantial efforts to examine these issues, along with their group practice and individual physician performance.  Large medical groups such as Kaiser Permanente have been looking at their practice information and practice quality for some time.  There are certainly many others throughout the country who do the same thing.  But most doctors don’t practice in such groups, and collecting and analyzing data in a meaningful way is a difficult task for the reasons noted above.


For those reasons, a program that Medicare is undertaking on January 1st is worthy of note. It will be interesting … Continue reading →

The (High) Costs of Cancer Chemotherapy

There is an article in today’s Wall Street Journal that addresses a problem many cancer patients are going to face: How will we pay for these new, innovative, effective and very expensive medications that treat cancer and other chronic diseases?


This is not a new topic. The affordability of drugs have long been a problem for many patients.  Years ago, if you had hypertension, diabetes and heart failure and you had to take medications on a daily basis your drug bill could run to several hundred dollars a month. 


If you were insured, that wasn’t much of a problem.  The doctor prescribed the drug, the insurance company created a list of preferred drugs and adjusted the co-pay depending on whether you used a generic, a branded approved drug, or a drug that was not on the formulary, you went to the pharmacy and you got your medications..


There were howls from employers, insurers and others about the high and rapidly climbing costs of medications, and there were meetings held to discuss the topic and try to find a solution.  Discussions centered around the value of the drugs, and the impact they had on keeping people … Continue reading →