Navigation Links
Did Medicare Reimbursement Changes Affect Prostate Cancer Treatment?

Study suggests a link between less drug therapy and more surgical castration

MONDAY, April 7 (HealthDay News) -- In 2004, Medicare reduced its reimbursement rates to doctors for drugs that treat prostate cancer by blocking the activity of male hormones.

Coincidentally or not, the use of surgery -- castration -- to accomplish that same goal started to increase at just the same time, a new study found.

It's not possible to say that financial incentives had a direct influence on medical practice in the treatment of prostate cancer, said Dr. J. Stephen Jones, chairman of regional urology at the Cleveland Clinic, who led the study. "Certainly, I would not take that interpretation," he said, citing other possible explanations, such as increased concern about the side effects of the hormone-blocking drugs.

Still, Jones added, after the reimbursement rates were cut, "our study shows, essentially aligned with that change, progressive change in the two forms of treatment for prostate cancer. There was a major reduction in the use of lutenizing hormone-releasing (LHRH) agonists, which block the male hormone testosterone, and a less noticeable increase in surgery, which accomplishes the same thing," he said.

The use of only one of the LHRH agonists -- triptorelin -- increased after the Medicare reimbursement policy changed, the study said. It was the only drug in the class whose reimbursement rate was not changed.

The findings were expected to be published in the May 15 issue of the journal Cancer.

Medically, the drug therapy -- sometimes called hormonal castration -- and surgery are virtually equivalent in their effect on prostate cancer, Jones said. The goal is to combat the disease by shutting off the supply of male hormones -- called androgens, including testosterone -- that encourage prostate cancer growth.

But "socially or economically, there are other factors involved," Jones said, when considering the two treatment options.

Whether the men in the study had all the factors involving the two treatment options described for them wasn't addressed by the research, Jones said. "It has always been clear that the effectiveness and side effects of the two treatments appeared to be equal," he said. "So, the choice remains one of preference. When two treatments are equal, the choice is the patient's."

LHRH agonists render the testicles as inactive as surgical removal does, Jones said, so, "the choice is to some degree in the eyes of the beholders. Is it better to have a one-time operation or to come in for an injection every few months?"

Almost all the men in the study were 65 or older, and it's not possible to say whether different choices might have been made by younger men, Jones said.

In a way, the change in medical practice detailed in the study represents a reversion to the earlier treatment of prostate cancer, to the era before the drugs were developed, Jones said. "Before these medications came into existence, almost everyone was treated by surgical removal of the testicles," he said.

In an accompanying editorial in the journal, Dr. Gerald W. Chodak, director of the Midwest Prostate and Urology Health Center in Chicago, wrote that "changing a recommendation to a patient from an LHRH agonist to surgical castration solely for economic reasons is ethically inappropriate."

"However," he added, "asking urologists to take a financial loss while treating patients also is inappropriate."

Chodak said doctors should be totally honest with patients, making them aware of their choices in prostate cancer treatment.

Dr. Ethan Basch, an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City, called the new study an interesting but incomplete picture.

"The trend is probably real, but I feel the study doesn't get in as deep as one would want and show what's really going on," he said. "What we don't have is information on the number of people affected."

What's also not known are the characteristics of the specific patients in the study, Basch said. "Either the treatment is more consistent with medical guidelines, or people who were being appropriately treated before are no longer getting it. We can't tell from this paper. It's very important that we have more detailed information about the patients themselves," he said.

Another report in the same issue of the journal had encouraging news. It showed increased life expectancy for people with late-stage testicular, colorectal and ovarian cancer. Treatment improvements have increased life expectancy by two years for ovarian cancer, 2.8 years for colorectal cancer, and 24 years for testicular cancer, with the testicular cancer gains largely due to an increase in the cure rate from 23 percent to 81 percent, according to the study by researchers at the U.S. National Cancer Institute.

More information

An overview of prostate cancer and its treatment is given by the American Cancer Society.

SOURCES: J. Stephen Jones, M.D., chairman of regional urology, Cleveland Clinic; Ethan Basch, M.D., assistant attending physician, Memorial Sloan-Kettering Cancer Center, New York City; May 15, 2008, Cancer

Copyright©2008 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Medicare Bidding Program in Kansas City is Plagued by Problems, Says American Association for Homecare
2. Errors Plague Medicare Competitive Bidding Program in Ohio, Says American Association for Homecare
3. The Quantum Group Announces Increased Patient Enrollment Following Medicare Advantage Open Enrollment Period
4. Owner of Medicare Billing Service Sentenced to 10 Years In Prison For Role in $170 Million Medicare Fraud Scheme
5. Rochester Medical Applauds Improved U.S. Medicare Coverage Policy for Intermittent Catheters
6. CMS Releases Final E-Prescribing Standards in Medicare
7. Seven Miami-Area Residents Charged in $11 Million Medicare Fraud Scheme
8. Front Line Caregivers from 16 States to Visit Capitol Hill to Urge State Congressional Delegation to Reject Medicare Cuts that Could Threaten Quality Care in Nations Nursing Homes
9. Medicare Advantage Plans Have New, Better Way to Access CMS Data
10. Two Florida Men Sentenced To Prison For Medicare Fraud
11. National, State Front Line Caregivers Warn About $64 Million Cut to Medicare Funding for Care of Michigan Seniors
Post Your Comments:
(Date:10/13/2015)... ... October 13, 2015 , ... ... Anik Singal's newly launched "Publish Academy" training course . Singal's new program, ... for enrollment today, and marketers around the Internet are weighing in with reviews. ...
(Date:10/13/2015)... ... 2015 , ... T-System and Centegra Health System, a prominent ... visits per year, today announced the successful and rapid deployment of EV™, an ... financial outcomes. , In less than four days, Centegra Hospitals McHenry ...
(Date:10/13/2015)... ... October 13, 2015 , ... Local Gold’s Gym franchise owner, Bryce Berry, received ... 26. Berry, who owns and operates Gold's Gym Cheyenne in Cheyenne, Wyoming, ... in the United States. A brand leader in global fitness, Gold’s Gyms are located ...
(Date:10/13/2015)... ... October 13, 2015 , ... ... developed valuable new strategies for enrolling and serving insurance consumers who do not ... health insurance and pay monthly premiums. In “Health Plan Engagement Strategies: The ABCs ...
(Date:10/13/2015)... ... October 13, 2015 , ... ... Debbie Vereb has been named the organization’s Executive Vice President of Operations, and ... hired to key leadership roles in the company. , Debbie Vereb’s appointment to ...
Breaking Medicine News(10 mins):
(Date:10/13/2015)...  Yesterday Congresswoman Renee Ellmers (R-NC-02) visited ... located in Holly Springs, NC . ... ® (Influenza Vaccine) using cell-culture technology, a state-of-the-art production ... is not reliant on chicken eggs. 1,2 On ... business of Novartis AG in the US, which for ...
(Date:10/13/2015)... -- XiMo AG ( Lucerne , ... Milpitas, California ) announced today the launch of ... of metathesis chemistry was highlighted by the Nobel Prize ... This industrially-relevant application has been utilized in the production ... and polymers. Georg Fráter , COO of ...
(Date:10/12/2015)... , October 13, 2015 the ... be operating in a non-clinical capacity. --> the ... be operating in a non-clinical capacity. --> The University ... completed installation of the first high field (1.5 Tesla) MRI-guided linear ... next year, the system will be operating in a non-clinical capacity. ...
Breaking Medicine Technology: