Most Popular Articles in Evidence-Based Oncologyâ„¢ in 2016

The year 2016 has been a very important year for the field of oncology—we have seen tremendous clinical progress; oncology care has been a part of the movement toward value-based care, with the largest payer in the country (CMS) launching the Oncology Care Model (OCM); and patients have been active participants in their care decisions. With each issue of Evidence-Based Oncology™ (EBO™) in 2016, we have contributed to these and other conversations in cancer care, to highlight stakeholder challenges and help identify potential solutions. Following are the top articles from EBO™ for the year. Clearly, immuno-oncology and value-based care derived most interest for our readers.

5. A new model for patient assistance programs. The influx of very effective immuno-oncology agents has created a significant imbalance in healthcare budgets, especially when the patient is uninsured or is provided the drug for off-label use. However, drug-replacement programs by manufacturers of these drugs can ease these financial strains. Healthcare networks such as the Smilow Cancer Hospital at Yale-New Haven have created a best practice model that provides pharmaceutical manufacturers an insight into real-life patient and provider experiences.

In the February issue of EBO™, Jacqueline Cabán and Charles Lynch—program coordinators at Smilow Cancer Hospital at Yale-New Haven—provided an overview of patient assistance programs, including their innovative hospital-based explanation of benefits form, which can eliminate patient responsibilities and help expedite the turnaround times for payment processing with copay assistance.

4. Policy changes to reduce patient cost sharing for cancer patients. Cost sharing, especially for expensive oncology medications, represents a significant barrier to patient access to treatment. With rising drug costs, the cost-sharing burden has witnessed a change—employers and health plans have increasingly been shifting the burden to patients. In their article describing this trend, representatives of The Leukemia & Lymphoma Society (LLS) describe the steep rise in premiums and out-of-pocket (OOP) costs faced by patients. They specifically describe tactics such as placing Medicare Part D drugs in “specialty tiers” as an access barrier. LLS urges healthcare policymakers to seriously consider solutions such as an upper limit on OOP costs for prescription medications. Additionally, the policy wing of LLS is independently working with patients to understand their cost concerns and to resolve the issue.

3. Immune-based treatments in value-based healthcare. Harnessing the immune system to boost the body’s response to cancer has revolutionized cancer care. Inhibitors of programmed death-1 (nivolumab) and programmed death ligand-1 (pembrolizumab), and treatments such as chimeric antigen receptor T-cells, are extremely promising. However, according to Bruce Feinberg, DO, “cost weighs heavily on the value assessment” of immunotherapies, since the single agents themselves regularly cost more than a $100,000. Further, in the absence of standardized diagnostic tests that can identify individuals who will definitely respond to these treatments, how does one select patients to receive immunotherapy? In his review of these agents at the beginning of 2016, Feinberg states that while stakeholders have rapidly adopted these treatments, some unanswered questions remain, including how long should patients be treated with these agents and the global impact of immunotherapy on the cost of cancer care.

2. A dive into quality reporting requirements for OCM. OCM, developed and launched by CMS, is a multi-payer model where physician practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. For practices that have been preparing for the transition from fee-for-service to value-based care, OCM participation would not be a big challenge. However, for others, significant process changes would be necessary.

Two experts in the field, Kim Charland, BA, RHIT, CCS, and Robin Zweifel, BS, MT (ASCP), wrote an informative article that takes an in-depth look into the provisions of OCM, and also guides oncology practices on changes that might be necessary in the clinic to meet the quality and performance measures for OCM participation.

1. A review of the opportunities and challenges with immuno-oncology. Immune-based treatments have been used for a variety of indications, including oncology. The most popular article in EBO™ in 2016 was one that provided greater insight into the science and history of immune-based treatments. In his review of this treatment modality, Michael V. Seiden, MD, PhD, states that even though these agents are effective in a fraction of patients, those who respond to treatment show a very durable response. Although challenges, including the management of toxicity and reimbursement concerns, remain, the interest in this field is real. “The further development and marketing of these agents could escalate the discussion on care equity in a time of constrained resources,” Seiden writes.