Monthly Archives: March 2011

Medicare Decides To Pay For Provenge, Leaving The Battle Over Cost And Value To Be Fought Another Day

I bet there was a huge collective sigh of relief about the land among men with prostate cancer, their families, their physicians and especially the company involved when the Centers for Medicare and Medicaid Services (CMS)-which runs the Medicare program-announced their decision this afternoon to cover the new cancer immunotherapy treatment for advanced prostate cancer, called Provenge®, under Medicare.


The stakes are huge: I suspect the market (and cost to Medicare) will run into potentially billions of dollars, yet the benefits for all of that money at first glance seem to be modest.


Ordinarily, the outcome in favor of approval would have been as close to certain as possible. 


After all, this new treatment for prostate cancer did increase the survival of men with asymptomatic advanced prostate cancer that no longer responds to hormone treatment.  But the treatment doesn’t prevent progression of the disease, there isn’t much data to show that men live a better quality of life after receiving Provenge®, and then there is the key statistic: it will cost $93,000 for each treatment-without including the associated costs for doctor visits and everything else that comes along with cancer treatments.


So the … Continue reading →

DetermiNation: It’s All About The Meaning When Winning Isn’t Everything

Sometimes you read something that just touches you in a special way.  That’s what I thought after reading the note below, sent to me by Kimberly McAdams, a colleague at the American Cancer Society.


Kimberly’s email found its way to me as a thank you and follow-up for her participation in the Society’s recent DetermiNation event in New Orleans.  What made the note stand out was not that she was someone I (along with many others) supported financially and emotionally as she prepared for her marathon, but the points she touched on as she related how her participation impacted her life.  It wasn’t just about raising money.  No, it was much more: about how she did this together with friends, how she won the race before she ever finished it (a theme I have echoed in another blog this past summer), and how it was personal for her as she carried the thoughts and prayers of so many of her family and friends with her as she prepared for and participated in the race.


Most important was the fact that her mother is a cancer survivor, and at the same time Kimberly was preparing to run the race, her … Continue reading →

Where Have You Gone Vitamin D?

Oh, vitamin D, where have ye gone?  We miss ya!!


That might be the refrain of many who have labored so long to promote awareness of vitamin D as a possible cancer prevention agent for the past number of years. 


Not that the advocates have lost their faith-a recent article from Dr. Cedric Garland, who is an expert on vitamin D as a case in point-but a report from the Institute of Medicine (IOM) has thrown a bit of a damper on the unbridled enthusiasm that vitamin D was the answer to cancer prevention that many have been seeking for some time.


No, the IOM did not endorse vitamin D as a cancer prevention agent.  And based on what they could say from the literature, the panel did endorse the concept that vitamin D is important for bone health, while blood tests that reportedly showed substantial deficiencies throughout the United States were in fact not being appropriately interpreted.


Now, in a “Perspective” piece in this week’s New England Journal of Medicine, three of the IOM panel members share their thoughts with the public as to why the panel did not reach the conclusion that … Continue reading →

Tobacco Tourism Comes Of Age In Northeast US

Know what a “dilly” is?  The dictionary describes a “dilly” as something that is remarkable or extraordinary, as in size or quality. 


The headline I came across the other day from the Associated Press story is in fact a dilly of a story.  It has some of my colleagues here at the American Cancer Society and our affiliated advocacy organization American Cancer Society Cancer Action Network more than a bit concerned: “NH, RI, NJ Buck Trend, Propose Cigarette Tax Cut.”


Hard to believe, but after years of making progress in the fight against big tobacco and helping people to kick the habit or prevent young people from taking up smoking in the first place, now come proposals that would take us backwards, putting more people at risk for their lives all in the name of economic recovery.


Folks, in my humble opinion, this is one screwed-up way for states to make money. [more]


The story is reasonably straight forward: states are strapped for revenues, so they think they can poach people from other states looking for a cheap smoke, and get more money from tobacco taxes because people from adjoining states will come to their state to … Continue reading →

The Costs of Prostate Cancer Treatment: Up, Up and Away

“Up, Up and Away” were the words of a song popular many of years ago, but today may best reflect the incessant rise in the costs of medical care.  And the reality is that the balloon may have been a nice ride, but we can’t say today that we know whether or not we are getting our money’s worth when it comes to certain treatments, such as those now being popularized for the treatment of prostate cancer.


That’s the message from a paper published on line this week in the Journal of Clinical Oncology which looks closely at the substantial increase in the costs of treating men for prostate cancer, which is by far the most common cancer diagnosed in men in this country today.[more]


The researchers examined the costs of treating about 71,000 men for prostate cancer in the fee-for-service Medicare program from 2002 through 2005, with follow-up through the end of 2007.  The costs of treating men with surgery or radiation was the focus of the research and included a comparison of men who received external beam radiation, seed-implants (also known as brachytherapy), a combination of these two treatments, “open” nerve sparing surgery for prostate cancer, … Continue reading →

The Coach And The Critic: Stories Of Caregivers Where “Kill Me” Is Not An Option

Cancer is emotional.  It is emotional for patients, families, friends and colleagues.  And there are few moments that are more touching to the human soul than hearing their stories recounting their journey, whether it is a success or unfortunately not.  These stories are frequently incredible accounts of human spirit.


Yesterday–in a room of 1200 cancer professionals at the annual meeting of the National Comprehensive Cancer Network in Hollywood, Florida–there were stories told that left no one untouched.  A moment when you could hear a pin drop, and see tears in the eyes of professionals who have seen so much heartache you would think they were used to it by now.


There was the football coach almost everyone knows who said that although he had been a leader all of his life and was expected to have the answers, when his wife was dying from cancer and he was all alone what he valued most was having someone to talk to who could be honest with him while he was being optimistic and hopeful for his family and friends.


And then there was the moment when the wife of a cancer survivor who is known to many of … Continue reading →

Cancer Survivors Are (Fortunately) Very Much A Part Of Our Lives

An article just released by the Centers for Disease Control and Prevention in their weekly publication “Morbidity and Mortality Weekly Report” provides an assessment of the progress we have made in the diagnosis and treatment of cancer.


Clearly, since 1971, we have made substantial advances in the cancer treatment.  We have become a larger and older nation.  We have pushed the threshold for the diagnosis of cancer, with breast and prostate cancers as leading examples.


The result is that we have many millions more people alive with cancer today than was ever the case in our history.


But with the progress also comes cautions about what the data means, and where our journey must go if we are to address some of the key issues reflected in these statistics. [more]


Essentially, the authors of the report provide a picture of the number of cancer survivors who had previously been diagnosed with an invasive cancer and were alive at a moment in time on January 1, 2007.


So what did they find from their research?


Researchers had previously reported that in 1971 (which was coincidentally when I started my training in medical oncology) there were … Continue reading →

Why Is New York Using Public Money To Support Unproven And Possibly Unethical Screening For Brain Tumors?

Sometimes you see a story that is just too important to pass up–even if the comments I make here are going to get some New York politicians upset with me and possibly with the American Cancer Society.


But when you see something that defies logic and evidence, and involves millions of dollars that could be put to much better and more effective use, then I believe we have the responsibility to say something, even if it is at our peril.


The story is about New York City subsidizing “screening MRI brain scans” to detect brain cancer early as reported in yesterday’s New York Times.  And my opinion and that of others is that at the least New York is wasting the taxpayers’ money and at worst is promoting an unethical and experimental procedure to its citizens. [more]


Here are the basics:


The City Council of New York has been subsidizing a truck loaded with an MRI machine that goes around the city from borough to borough offering MRI scans to detect brain cancer “early” and nominally save lives.


And here is the evidence:


There are no published studies that would support the value of … Continue reading →