Interviews

Identifying patients with smoldering multiple myeloma is difficult as they often do not have any symptoms, but we could still do a much better job than what we are currently implementing, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Networking with other practices, sharing ideas, and getting physicians involved in the process can aid community practices moving to alternative payment models (APMs), said Michael Diaz, MD, president of Community Oncology Alliance.

Prakash Bhuyan, MD, PhD, vice president of clinical development at Inovio, discusses the company's vaccine trial for coronavirus disease 2019 (COVID-19) as well as its DNA medicine platform for rare genital cancers.

Developing an expansive program to meet the needs of all of our patients, at all education levels, is 1 of the biggest challenges we face at Pontchartrain Cancer Center, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center. Kathy Oubre is additionally scheduled to speak at the Community Oncology Alliance Virtual Meeting, which runs from April 23-24, 2020.

Age and severe comorbidities were among the differences found when real-world data on Medicare patients receiving CAR T-cell therapy was compared to clinical trial outcomes, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

MRD assessments are probably 1 of the most powerful predictors that we have to see how well a treatment has worked, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Following the International Myeloma Working Group criteria, we usually check for minimal residual disease when the patient has reached a complete remission or is very close to complete remission, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Part of the reason COA recommended a 'ramp up' period is we need time for the vendors to understand what they need to be incorporating in their software, said Michael Diaz, MD, president of Community Oncology Alliance.

"I am not convinced yet that the Oncology Care First Model truly takes into account necessary elements, including high-cost drugs," said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.

Although it is true that there are people who still don't use minimal residual disease (MRD) testing, I think that its use is going to pick up based on results of emerging clinical studies, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

"There is this mentality that hospice means the patient is going to die very soon, and that's really not true," said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

Right now, it's not really used for decision treatment in most centers, but there are a lot of studies that have started this year or starting next year that have MRD as an endpoint so we will see, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Sharing records and encouraging conversation will promote better collaboration between primary care and cancer care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

Several challenges arise when using real-world data derived from claims to study the impacts of CAR T-cell therapy on Medicare patients, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

Patient safety is paramount when deciding how to roll out a new program or even if a program should be developed or not, said Jeremy Whalen, PharmD, BCOP, specialty clinical program director for oncology at Prime Therapeutics.

There are studies exhibiting progression within treatment for smoldering multiple myeloma, but nothing has been FDA approved yet, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Educating primary care providers and patients on accessible lung cancer screenings can help reduce lung cancer mortality, said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

When patients present to the emergency department (ED) with sickle cell disease (SCD)–related pain, they often have been experiencing that pain for days, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

There has been significant improvement in payers' understanding of site of care issues, but steps still need to be taken to address these issues, said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.

Co-pay accumulator adjustment programs can have different effects for individuals with varying health plan types or income levels, explained Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Some of the best ways to assess minimal residual disease (MRD) are using flow cytometry or using sequencing, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Ongoing studies are aiming to determine how co-pay accumulator adjustment programs affect individuals’ medication adherence and persistence, with the hope that the results will inform employers on more equitable benefits strategies, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

More data is needed to get wider acceptance of the use of palliative care services for patients with blood cancers, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Education efforts among providers, payer, and patients can help answer the fundamental and important questions raised by the use of real-world data, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

Medicare patients' health care utilization, including hospitalizations and emergency department visits, decreased after CAR T-cell therapy, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

When we looked at the pre-treatment creatinine data, we found that African Americans were more likely to have abnormal results and white patients were more likely to have normal results–these differences were statistically significant, said Abby Statler, PhD, MPH, MA, research associate at Cleveland Clinic.

Co-pay accumulator adjustment programs will probably not be used for high-cost therapies because deductible amounts are trivial compared with their price tags and because these novel treatments are used for small populations, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Fragmentation in the US healthcare system hinders implementation of efficient workflows when it comes to real-world data, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

Our outcomes suggest that eligibility criteria for patients with MDS relevant to liver function, renal function, and comorbidities may be relaxed, especially for those who have minor renal function abnormalities who have shown to have similar clinical outcomes to those without such abnormalities, said Abby Statler, PhD, MPH, MA, research associate at Cleveland Clinic.