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Is Cancer Community in Alignment About 'Cure' and 'Costs'? NCCN Conference Panel Asks

HOLLYWOOD, Fla., March 7, /PRNewswire-USNewswire/ -- Cancer's two most compelling words these days are "cure" and "costs," and each holds capacity to create patient heartache and promise, according to roundtable participants at the National Comprehensive Cancer Network's 13th Annual Conference, March 5-9.

When doctors recommend cancer treatments, best practices dictate that they follow guidelines created by NCCN and other professional medical organizations. Currently, such guidelines do not include treatment-cost data. Leonard Saltz, M.D., of Memorial Sloan-Kettering Cancer Center said doctors traditionally assumed "we must be very sanctimonious and above the idea of considering cost." But panelists unanimously agreed -- and so did the majority of the audience by a show of hands -- that cost data should be appended to guidelines.

Panelist Alice Gosfield, an attorney with more than a decade of experience in oncology issues, condemned as "basically wrong" widespread reimbursement practices that profit doctors more who prescribe the most expensive drugs. She said that while it might be unfair to shoulder clinicians with the burden of factoring costs into a patient's treatment plan, insurers and others will be forced to make such decisions, and in the process "there will be blood."

Guidelines help oncologists evaluate treatments and reflect evolving professional consensus. NCCN's guidelines are the "Mercedes" of treatment standards, said David S. Ettinger, M.D., of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. In the future, adding cost data might help doctors choose between two chemotherapy regimens for colorectal cancer that, according to Saltz, are equally effective. Yet one costs $60,000 extra over the course of 10 months of treatment.

Aetna's James D. Cross, M.D., said that Aetna covers evidence-based treatments regardless of cost. "We exclude experimental treatments from most plans," he explained, but always reimburse experimental treatment costs for cancer patients enrolled in clinical trials. "Depending upon what the evidence states, what the state of the art is, what the NCCN guidelines recommend, that is what we cover."

Cost has suddenly become more crucial to cancer patients, said Nancy Davenport-Ennis of the National Patient Advocate Foundation. Logging 6.8 million inquiries from patients in 2007, the foundation's analysis shows 70 percent of patient dilemmas involved cost. That compares with only 38 percent of callers complaining of a cost problem the previous year.

As for whether the C-word -- "cure" -- belongs in doctor-patient discussions, Saltz argued that doctors sometimes "sugarcoat the reality" in employing the phrase "progression-free survival" to describe new cancer drugs' effectiveness. Doctors understand something patients don't, he said: the phrase refers specifically to the time span between the start of treatment and the moment the tumor begins to grow again. Doctors should not impart false hope when they know "the person is not going to live longer." He urged replacing the phrase with terminology that avoids the word "survival."

Ettinger, by contrast, defended incremental improvements in treatment that may extend patients' lifespans by only weeks or months. "Are we making advances?" he asked. "Yes. Is it slow? Yes."

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

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The NCCN Member Institutions are: City of Hope, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University, Columbus, OH; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.

SOURCE National Comprehensive Cancer Network
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