Balancing Between ‘Rational’ and ‘Rationed’ Care

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WifeOfMike
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Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby WifeOfMike » Sat May 31, 2014 12:08 am

In Community Practice: Balancing Between ‘Rational’ and ‘Rationed’ Care
Clinical Oncology News
Independent News for the Oncologist and Hematologist/Oncologist
Some excerpts here:

“Washington—Balancing personalized cancer care with the need to lower health care costs relies on a number of factors, including thinking rationally about cancer treatments, better educating patients about their options, and educating payers, said a panel of oncology experts at the Association of Community Cancer Centers’ (ACCC) national meeting.”

“There are a few theories about how to reduce spending on oncology, said Peter Bach, MD, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center in New York City. One is to shift the risk for discretionary spending to oncologists. A payer would provide an oncologist with a lump-sum payment to cover all costs for a typical patient with breast cancer, for example, and the oncologist would then be responsible for achieving high-quality care without overspending.”

Another theory calls for removing physicians’ financial incentive to spend health care dollars.”

“A third idea, being employed at his hospital, is to make treatment decisions piece by piece while considering cost, Dr. Bach said. For example, Memorial Sloan-Kettering decided not to stock the drug ziv-aflibercept (Zaltrap, Sanofi/ Regeneron) in its formulary for patients with advanced colorectal cancer because it was more than twice the price of a similar medicine, Bevacizumab (Avastin, Genentech/Roche).”

Patients tend to get “emotionally stuck in a place where they cannot make a rational decision,” Mr. Cohen said, and tends to choose the most expensive treatment, the one that will extend their lives for a short time or have the fewest side effects, without perspective.”

http://www.clinicaloncology.com/ViewArt ... a_id=24625

***”Payer” refers to insurance companies

After reading the ENTIRE article, I came away a little perturbed. Am I off base? Without PERSPECTIVE…..Did they just call us stupid???? Uninformed my butt! I’m reading some of the same publications you “GODS” are and I am a mere mortal! Emotional….YES it IS MY husband I’m considering, but again I am NOT STUPID! AND by the way DR…… how much DID you make on the drugs you prescribed for my hubby????

This is not the FIRST article I have read discussing the new protocols, and cost factors associated coming down the pike for Clinical Trials. Plus it will be a COLD day in you know where, before I let the insurance company tell us what my hubby can and cannot try if there is a decent shot it will work & he is ready, willing and able. I will meet them in the parking lot with a Louisville slugger and my hubby’s name in Glitter & sequins on its side! :twisted:

Wife of Mike,
Vicki
Bad Ass WIFE
Hubs: CRC IVA,T3, N0, M1A
Resect/LN Mets 10/12
Folfox4/Avastin 11/12-5/13
Folfiri/Erbitux 6/13-10/13
Stivarga 12/13-4/14
Trial 4/14-/14
Trial 8/14-11/14
HOME Hospice 11/17/14
Guardian Angel 1/1/15
Cost of HOPE? PRICELESS

dianne052506
Posts: 1651
Joined: Sun Nov 02, 2008 11:57 pm
Location: North Carolina

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby dianne052506 » Sat May 31, 2014 9:26 am

There are few things I've read that are as scary as this (about cost control, not about Vicki in the parking lot).

Vicki, when you meet the so-and-so in the parking lot, we'll be right there with you.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

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exaussie
Posts: 618
Joined: Sun Jan 19, 2014 1:19 am
Location: Silverton OR
Contact:

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby exaussie » Sat May 31, 2014 10:33 am

Um that's scary and a slippery slope to render patients mute in their own health decisions. If it's based on money alone gee only the rich can afford to get sick.
DS 26 yrs old diagnosed 6/13 T3N2aM1b
Resection 6/13
6 rounds chemo folfax
12/13 Fissure
hernia surgery 12/13
5 months break
Maintenance chemo 3/14
Crazy growth. Liver failing. Folfox and vectibex 7-29-14
Chemo failure Hospice 8/26
Left us 8/28

Laurettas
Posts: 1606
Joined: Tue Jun 21, 2011 9:49 pm

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby Laurettas » Sat May 31, 2014 11:44 am

Is my memory flaking out on me or has government run health care in some European countries already denied the use of some of these expensive drugs except in clinical trials? I thought I remembered reading that Avastin is not prescribed in some countries because of the cost versus benefit?
DH 58 4/11 st 4 SRC CC
Lymph, peri, lung
4/11 colon res
5-10/11 FLFX, Av, FLFRI, Erb
11/11 5FU Erb
1/12 PET 2.4 Max act.
1/12 Erb
5/12 CT ext. new mets
5/12 Xlri
7/12 bad CT
8/12 5FU solo
8/12 brain met
9/12 stop tx
11/4/12 finished race,at peace

rp1954
Posts: 1535
Joined: Mon Jun 13, 2011 1:13 am

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby rp1954 » Sat May 31, 2014 1:12 pm

With generic oral chemo including capecitabine, with celecoxib, cimetidine, metformin, PSK, aspirin, vit D repletion etc, cancer treatments don't have to be expensive. The cancer treatment structure in the US is an incredibly inflated artifice that excludes much technical and price competition. Various interests prefer it that way and lobby hard for their respective piece of the pie. If CRC patients could be real price shoppers, treated to the best, most probable odds from modern literature, they would live longer, and pay $100-500 per month for generic chemo with stage II, III, and IVa in most cases. Today, not some indefinite tomorrow.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

vickitwo
Posts: 696
Joined: Thu Apr 26, 2012 9:56 am
Location: USA

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby vickitwo » Sat May 31, 2014 2:44 pm

Vicki,
Those insurance companies should be shaking in their boots. :lol: But seriously this is serious stuff and we are talking about people's lives, people we love dearly. When I read story after story about all of this health insurance c?#p, well, I find it all to be so shameful. How can a society which is supposedly based on Christian values treat it's citizens who are sick so shabbily. Why can't we have universal healthcare for all like other countries. It is all such a complicated, expensive mess. During the last month of my husband's life when his health was rapidly deteriorating, I spent hours and hours and hours, lost plenty of sleep, drove an hour away to get help and was stressed out trying to get him signed up on the health exchange. His PCIP plan was going away and we were given a deadline. He could not be without health insurance. I felt that I was being held hostage by a system that was impossible to use. How could they give me a deadline when the system was destined to fail each time I tries to sign up. At one point the deadline was changed to Dec 24th. Well, that was exactly how I wanted to spend my last Christmas Eve with my DH, on the phone or computer. NOT! I was wasting precious time that should have been spent with my husband. All in all, I was unsuccessful. In the meantime, I got a notice from Dennis' PCIP plan that they would extend his enrollment thru the month of Jan. 2014, but we would have to pay another deductable just for that month. We had already met the deductable for 2013 when they changed the insurance in July 2013 and thus had to meet another deductable for the remainder of the year. On Dec 27th my DH was scheduled for a round of chemo which he received at our local hospital. I had decided that paying the deductable was worth it. I was so defeated and frustrated trying to sign up on the ACA Health Exchange. I had my daughter come to sit with my husband in hospital for a while, so I could go to the post office to mail the PCIP premium. As soon as I returned to the hospital and walked thru the door, my DH, Dennis sat up in bed, said he could not breath and coded. He spent the rest of the day and night on a ventilator in the ICU then the next week at hospice house before his ultimate death. In Feb 2014, I sought the help of an agency to sign myself and some of my family members up for health insurance via the excange. The agent was ultimately successful signing us up but told me that he had spent at least 15 hrs on the whole process. Last week, I went back to the agent's office to add my 23 year old daughter to our health plan. She had just graduated from college and was losing the plan that she had thru the college. The agent was on the phone for at least 1 1/2 hrs with the ACA Health Care exchange and was unable to complete the transaction. They said they would call me back sometimes between 10 am and 2 pm when the computer glitches are fixed. So here I wait for that phone call. It has been 3 days. What a never ending nightmare. There has got to be a better way. I can't imagine that our story is that unique.
Vicki

DH Dx 1/2012 @ age 52
stage IV CC
transverse colon,omentum, cecum,liver,lungs,L5
9 rounds of Folfox, Avastin,
5FU/Leucovorin/Avastin
radiation tx to L5 and hips
Folfiri/Zaltrap
12/13/13 Folfox/Avastin
1/4/2014 passed away @ Hospice House- age 54

WifeOfMike
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Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby WifeOfMike » Sat May 31, 2014 3:21 pm

Socialized medicine like in other countries MAY be the path our Country is being forced to go in the direction of. Don't even get me on the subject of politics :twisted:

I do have a dear friend of 35 years, who has a dual residency with Canada. She pays next to nothing for her Canadian Health Care. HOWEVER she has had TWO hip surgeries, and although they both started hurting about the same time, it took her a YEAR to wait for the FIRST surgery and TWO YEARS later to get the second done. Don't know about YOU...... but I would rather have paid my Ridiculously HIGH health insurance policy, my Ridiculously HIGH Co-Pay and had BOTH surgeries done ASAP and be on the path to feeling better and pain free for those 3 years!!!! :shock:

I have a question to Memorial Sloan decision makers who opted for NOT stocking Zaltrap because it was SIMILAR to Bevacizumab (AVASTIN) BECAUSE it was TWICE the price........ WHAT IF a patient could benefit from that drug? WHAT IF patients have an allergy to the OTHER drug? WHAT IF Your loved one or YOU, dear decision maker were ill with Stage IV FRICKING CANCER? Would you be sneaking off down the street somewhere that does supply this other drug????

Well one could argue lots of Drugs are similar..... Vectibix and Erbitux are BOTH EGFR targeted therapies. Avastin is a VEGF-A, Zaltrap is VEGF A+B, and The just hot off the presses April 2014 FDA released drug for Colorectal Cancer CYRAMZA is VEGF targeted therapy. Should we go back to the stone ages and all be prescribed 5FU/ Leucovorin? Can't go there buddies, as there is a SHORTAGE of Leucovorin!

BTW..... If you ever wondered Where the Dr's get their 1,2,3 Colorectal Cancer Playbook of what do I do with YOU??... :?
Got to this website, set up a login with your email address like I did.......

National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology with latest 2014 versions
NCCN Guidelines for Treatment of Cancer by Site
NCCN Guidelines for Detection, Prevention, & Risk Reduction
NCCN Guidelines for Supportive Care
NCCN Guidelines for Age Related Recommendations
NCCN Guidelines for Patients


http://www.nccn.org/professionals/physi ... s.asp#site

I'M MAD AS HELL AND I'M NOT GOING TO TAKE IT ANY MORE!!!!! :twisted:
And Thank you Dianne.......... I'll let you know when & where our Cancer Flash Mob will be!!!
Big Hugs...... Wife of Mike,
Vicki
Bad Ass WIFE
Hubs: CRC IVA,T3, N0, M1A
Resect/LN Mets 10/12
Folfox4/Avastin 11/12-5/13
Folfiri/Erbitux 6/13-10/13
Stivarga 12/13-4/14
Trial 4/14-/14
Trial 8/14-11/14
HOME Hospice 11/17/14
Guardian Angel 1/1/15
Cost of HOPE? PRICELESS

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Voxx66
Posts: 1844
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Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby Voxx66 » Sat May 31, 2014 5:26 pm

I expect government run health care here would closely resemble the mess that is the VA. Insurance companies aren't angels but there are many of us who greatly prefer less government interference with our healthcare. There is absolutely NO way socialized health care won't contain rationed and limited care. Yes private companies may limit care at times - but you at least have a choice. You can go to a different center. As to the Zaltrap deal - I actually don't fault Sloan for that. The drug is way overpriced and Sloan drew a line here. If someone really wants it they can get it elsewhere and if enough do then Sloan will likely rethink their decision.
DX and resect 10/2012 age 46
Stage IIa CRC
liver mets both lobes 8/2013
CEA 28
FOLFOX + Avastin 8/26/13 3 rounds
Folfox only 3 rds + rd 8
platelets low round 7,9,10 5FU only
1/14 CEA 1.0 y90
5fu
10/14 mets lung and peri
1/15 Folfiri

justin case
Posts: 4266
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby justin case » Sat May 31, 2014 6:16 pm

Voxx66 wrote:I expect government run health care here would closely resemble the mess that is the VA. Insurance companies aren't angels but there are many of us who greatly prefer less government interference with our healthcare. There is absolutely NO way socialized health care won't contain rationed and limited care. Yes private companies may limit care at times - but you at least have a choice. You can go to a different center. As to the Zaltrap deal - I actually don't fault Sloan for that. The drug is way overpriced and Sloan drew a line here. If someone really wants it they can get it elsewhere and if enough do then Sloan will likely rethink their decision.


You know Voxx, you may not have a positive attitude, but you are surely one of the most rational posters on this forum :roll:
Regards,
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

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Voxx66
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Facebook Username: Michael Void Ward

Re: Balancing Between ‘Rational’ and ‘Rationed’ Care

Postby Voxx66 » Sat May 31, 2014 6:50 pm

Yes in more ways than one ha ha.
DX and resect 10/2012 age 46
Stage IIa CRC
liver mets both lobes 8/2013
CEA 28
FOLFOX + Avastin 8/26/13 3 rounds
Folfox only 3 rds + rd 8
platelets low round 7,9,10 5FU only
1/14 CEA 1.0 y90
5fu
10/14 mets lung and peri
1/15 Folfiri


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