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Insured cancer patients forgo care, scrimp to get by
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients. 
*Data in the abstract differ from data presented.
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients.
*Data in the abstract differ from data presented.
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients.
*Data in the abstract differ from data presented.
NICE supports use of rivaroxaban in ACS
Credit: Andre E.X. Brown
The UK’s National Institute for Health and Care Excellence (NICE) has issued a draft guidance recommending rivaroxaban (Xarelto) as an option for preventing atherothrombotic events in patients with acute coronary syndrome (ACS).
The agency is recommending rivaroxaban in combination with aspirin plus clopidogrel or aspirin alone to prevent atherothrombotic events in ACS patients with elevated cardiac biomarkers.
This includes patients who have had ST-segment-elevation myocardial infarctions (STEMIs) or non-ST-segment myocardial infarctions (NSTEMIs) but not unstable angina. In unstable angina, damage to the heart is not severe enough to result in the release of biomarkers into the blood, so this condition is not included in the draft guidance.
Because rivaroxaban increases the risk of bleeding, NICE recommends that clinicians undertake a careful assessment of a patient’s bleeding risk prior to treatment and ensure patients understand the benefits and risks associated with rivaroxaban.
Furthermore, clinicians should reassess the relative benefits and risks of continuing rivaroxaban treatment no later than 12 months after starting treatment.
Clinical and cost-effectiveness
An independent appraisal committee advising NICE concluded that rivaroxaban given at 2.5 mg twice daily in combination with aspirin plus clopidogrel or with aspirin alone was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and myocardial infarction in patients with ACS and raised cardiac biomarkers.
“The committee therefore recommended rivaroxaban as a cost-effective use of [National Health Service] resources,” said Carole Longson, NICE Health Technology Evaluation Centre Director.
The committee noted that, according to Bayer Healthcare (makers of rivaroxaban), the base case incremental cost-effectiveness ratio (ICER) was £6203 per quality-adjusted life-year (QALY) gained. The evidence review group’s preferred base case estimate was £5622 per QALY gained.
The committee acknowledged that there is uncertainty about the validity of the results, which were based on the ATLAS-ACS 2-TIMI 51 trial, because of the risk of bias resulting from missing trial data and informative censoring.
However, the committee considered that the ICERs presented were all within the range that could be considered cost-effective, and adjusting for the various types of bias that might have occurred was unlikely to increase the ICER to the extent that it would become unacceptable.
The list price of rivaroxaban is £58.88 per 2.5 mg, 56-capsule pack (excluding value-added tax). The license dose is 2.5 mg twice daily, which equates to a price of £2.10 per day.
Assuming a treatment duration of 12 months, total acquisition costs are £766.50. Costs may vary in different settings because of negotiated procurement discounts.
The draft guidance for rivaroxaban in ACS can be found on the NICE website. The closing date for comments is November 13, 2014.
Credit: Andre E.X. Brown
The UK’s National Institute for Health and Care Excellence (NICE) has issued a draft guidance recommending rivaroxaban (Xarelto) as an option for preventing atherothrombotic events in patients with acute coronary syndrome (ACS).
The agency is recommending rivaroxaban in combination with aspirin plus clopidogrel or aspirin alone to prevent atherothrombotic events in ACS patients with elevated cardiac biomarkers.
This includes patients who have had ST-segment-elevation myocardial infarctions (STEMIs) or non-ST-segment myocardial infarctions (NSTEMIs) but not unstable angina. In unstable angina, damage to the heart is not severe enough to result in the release of biomarkers into the blood, so this condition is not included in the draft guidance.
Because rivaroxaban increases the risk of bleeding, NICE recommends that clinicians undertake a careful assessment of a patient’s bleeding risk prior to treatment and ensure patients understand the benefits and risks associated with rivaroxaban.
Furthermore, clinicians should reassess the relative benefits and risks of continuing rivaroxaban treatment no later than 12 months after starting treatment.
Clinical and cost-effectiveness
An independent appraisal committee advising NICE concluded that rivaroxaban given at 2.5 mg twice daily in combination with aspirin plus clopidogrel or with aspirin alone was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and myocardial infarction in patients with ACS and raised cardiac biomarkers.
“The committee therefore recommended rivaroxaban as a cost-effective use of [National Health Service] resources,” said Carole Longson, NICE Health Technology Evaluation Centre Director.
The committee noted that, according to Bayer Healthcare (makers of rivaroxaban), the base case incremental cost-effectiveness ratio (ICER) was £6203 per quality-adjusted life-year (QALY) gained. The evidence review group’s preferred base case estimate was £5622 per QALY gained.
The committee acknowledged that there is uncertainty about the validity of the results, which were based on the ATLAS-ACS 2-TIMI 51 trial, because of the risk of bias resulting from missing trial data and informative censoring.
However, the committee considered that the ICERs presented were all within the range that could be considered cost-effective, and adjusting for the various types of bias that might have occurred was unlikely to increase the ICER to the extent that it would become unacceptable.
The list price of rivaroxaban is £58.88 per 2.5 mg, 56-capsule pack (excluding value-added tax). The license dose is 2.5 mg twice daily, which equates to a price of £2.10 per day.
Assuming a treatment duration of 12 months, total acquisition costs are £766.50. Costs may vary in different settings because of negotiated procurement discounts.
The draft guidance for rivaroxaban in ACS can be found on the NICE website. The closing date for comments is November 13, 2014.
Credit: Andre E.X. Brown
The UK’s National Institute for Health and Care Excellence (NICE) has issued a draft guidance recommending rivaroxaban (Xarelto) as an option for preventing atherothrombotic events in patients with acute coronary syndrome (ACS).
The agency is recommending rivaroxaban in combination with aspirin plus clopidogrel or aspirin alone to prevent atherothrombotic events in ACS patients with elevated cardiac biomarkers.
This includes patients who have had ST-segment-elevation myocardial infarctions (STEMIs) or non-ST-segment myocardial infarctions (NSTEMIs) but not unstable angina. In unstable angina, damage to the heart is not severe enough to result in the release of biomarkers into the blood, so this condition is not included in the draft guidance.
Because rivaroxaban increases the risk of bleeding, NICE recommends that clinicians undertake a careful assessment of a patient’s bleeding risk prior to treatment and ensure patients understand the benefits and risks associated with rivaroxaban.
Furthermore, clinicians should reassess the relative benefits and risks of continuing rivaroxaban treatment no later than 12 months after starting treatment.
Clinical and cost-effectiveness
An independent appraisal committee advising NICE concluded that rivaroxaban given at 2.5 mg twice daily in combination with aspirin plus clopidogrel or with aspirin alone was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and myocardial infarction in patients with ACS and raised cardiac biomarkers.
“The committee therefore recommended rivaroxaban as a cost-effective use of [National Health Service] resources,” said Carole Longson, NICE Health Technology Evaluation Centre Director.
The committee noted that, according to Bayer Healthcare (makers of rivaroxaban), the base case incremental cost-effectiveness ratio (ICER) was £6203 per quality-adjusted life-year (QALY) gained. The evidence review group’s preferred base case estimate was £5622 per QALY gained.
The committee acknowledged that there is uncertainty about the validity of the results, which were based on the ATLAS-ACS 2-TIMI 51 trial, because of the risk of bias resulting from missing trial data and informative censoring.
However, the committee considered that the ICERs presented were all within the range that could be considered cost-effective, and adjusting for the various types of bias that might have occurred was unlikely to increase the ICER to the extent that it would become unacceptable.
The list price of rivaroxaban is £58.88 per 2.5 mg, 56-capsule pack (excluding value-added tax). The license dose is 2.5 mg twice daily, which equates to a price of £2.10 per day.
Assuming a treatment duration of 12 months, total acquisition costs are £766.50. Costs may vary in different settings because of negotiated procurement discounts.
The draft guidance for rivaroxaban in ACS can be found on the NICE website. The closing date for comments is November 13, 2014.
Managing CNS relapse in cardiac lymphoma
Two cases of central nervous system (CNS) relapse in patients with primary cardiac lymphoma underline the importance of CNS evaluation in these patients, according to researchers.
Cardiac lymphoma is a rare condition, and doctors often overlook the potential of metastasis to the CNS, said study author Niccolò Frungillo, MD, of the European Institute of Oncology in Milan, Italy.
“In my opinion, it is very important to identify prognostic factors that predict the brain relapse of lymphoma,” he said. “It’s a rare—but often fatal—complication.”
In ecancermedicalscience, Dr Frungillo and his colleagues described the diagnosis and treatment of two women with cardiac lymphoma who achieved remission and later presented with isolated CNS relapse.
Doctors diagnosed the patients via endomyocardial biopsy, and results were consistent with diffuse large B-cell lymphoma in both cases. Immunochemotherapy produced complete remissions (CRs) in both women.
The patients then experienced isolated CNS relapses, one 8 weeks after achieving a CR, and one 5 weeks after CR.
In the first patient, MRI and cerebrospinal fluid confirmed her relapse, after she presented with a 3-day history of headache and vomiting.
The patient then received high-dose methotrexate and high-dose cytarabine, which prompted a second CR. She went on to receive an autologous stem cell transplant but died before engraftment due to a pulmonary infection.
The second patient received systemic CNS prophylaxis with high-dose methotrexate prior to her relapse. Nevertheless, one week after she was declared lymphoma-free, she presented with headache and a deterioration of motor skills.
MRI and lumbar puncture confirmed her relapse, and she received induction chemotherapy with high-dose methotrexate. Her disease progressed after two courses of treatment, so she was placed on salvage therapy with cytarabine and high-dose methotrexate.
Whole-brain radiotherapy prompted a CR, and the patient went on to receive an autologous stem cell transplant.
The researchers noted that isolated CNS relapse is very uncommon in cardiac lymphoma, but CNS evaluation should be considered. Additional studies are needed to determine the appropriate management of CNS relapse in cardiac lymphoma.
Two cases of central nervous system (CNS) relapse in patients with primary cardiac lymphoma underline the importance of CNS evaluation in these patients, according to researchers.
Cardiac lymphoma is a rare condition, and doctors often overlook the potential of metastasis to the CNS, said study author Niccolò Frungillo, MD, of the European Institute of Oncology in Milan, Italy.
“In my opinion, it is very important to identify prognostic factors that predict the brain relapse of lymphoma,” he said. “It’s a rare—but often fatal—complication.”
In ecancermedicalscience, Dr Frungillo and his colleagues described the diagnosis and treatment of two women with cardiac lymphoma who achieved remission and later presented with isolated CNS relapse.
Doctors diagnosed the patients via endomyocardial biopsy, and results were consistent with diffuse large B-cell lymphoma in both cases. Immunochemotherapy produced complete remissions (CRs) in both women.
The patients then experienced isolated CNS relapses, one 8 weeks after achieving a CR, and one 5 weeks after CR.
In the first patient, MRI and cerebrospinal fluid confirmed her relapse, after she presented with a 3-day history of headache and vomiting.
The patient then received high-dose methotrexate and high-dose cytarabine, which prompted a second CR. She went on to receive an autologous stem cell transplant but died before engraftment due to a pulmonary infection.
The second patient received systemic CNS prophylaxis with high-dose methotrexate prior to her relapse. Nevertheless, one week after she was declared lymphoma-free, she presented with headache and a deterioration of motor skills.
MRI and lumbar puncture confirmed her relapse, and she received induction chemotherapy with high-dose methotrexate. Her disease progressed after two courses of treatment, so she was placed on salvage therapy with cytarabine and high-dose methotrexate.
Whole-brain radiotherapy prompted a CR, and the patient went on to receive an autologous stem cell transplant.
The researchers noted that isolated CNS relapse is very uncommon in cardiac lymphoma, but CNS evaluation should be considered. Additional studies are needed to determine the appropriate management of CNS relapse in cardiac lymphoma.
Two cases of central nervous system (CNS) relapse in patients with primary cardiac lymphoma underline the importance of CNS evaluation in these patients, according to researchers.
Cardiac lymphoma is a rare condition, and doctors often overlook the potential of metastasis to the CNS, said study author Niccolò Frungillo, MD, of the European Institute of Oncology in Milan, Italy.
“In my opinion, it is very important to identify prognostic factors that predict the brain relapse of lymphoma,” he said. “It’s a rare—but often fatal—complication.”
In ecancermedicalscience, Dr Frungillo and his colleagues described the diagnosis and treatment of two women with cardiac lymphoma who achieved remission and later presented with isolated CNS relapse.
Doctors diagnosed the patients via endomyocardial biopsy, and results were consistent with diffuse large B-cell lymphoma in both cases. Immunochemotherapy produced complete remissions (CRs) in both women.
The patients then experienced isolated CNS relapses, one 8 weeks after achieving a CR, and one 5 weeks after CR.
In the first patient, MRI and cerebrospinal fluid confirmed her relapse, after she presented with a 3-day history of headache and vomiting.
The patient then received high-dose methotrexate and high-dose cytarabine, which prompted a second CR. She went on to receive an autologous stem cell transplant but died before engraftment due to a pulmonary infection.
The second patient received systemic CNS prophylaxis with high-dose methotrexate prior to her relapse. Nevertheless, one week after she was declared lymphoma-free, she presented with headache and a deterioration of motor skills.
MRI and lumbar puncture confirmed her relapse, and she received induction chemotherapy with high-dose methotrexate. Her disease progressed after two courses of treatment, so she was placed on salvage therapy with cytarabine and high-dose methotrexate.
Whole-brain radiotherapy prompted a CR, and the patient went on to receive an autologous stem cell transplant.
The researchers noted that isolated CNS relapse is very uncommon in cardiac lymphoma, but CNS evaluation should be considered. Additional studies are needed to determine the appropriate management of CNS relapse in cardiac lymphoma.
Patients in GDR trials were not properly informed
Credit: Esther Dyson
New research has shown that clinical trials carried out in the German Democratic Republic (GDR) in the second half of the 20th century were not always conducted with the full knowledge or understanding of participants.
A review of documents from that time suggests that, although questionable practices took place, the GDR attempted to conduct trials according to international ethical standards.
And there was no evidence to suggest that trial investigators intentionally hurt patients.
Nevertheless, these trials were hidden from the public, there was no record of patient consent, and some documents suggest patients did not receive adequate information.
Dr Rainer Erices, of Friedrich-Alexander-Universität Erlangen-Nuernberg in Germany, and his colleagues detailed these findings in the Journal of Medical Ethics.
The GDR, also known as East Germany, was a state within the Eastern Bloc during the Cold War period and between 1949 and 1990. Since the 1990s, the media has reported that unofficial clinical trials were conducted by Western pharmaceutical companies in East Germany from the 1960s onward.
Reports have suggested the GDR “sold” its patients as “guinea pigs” for experiments in exchange for hard currency; for example, for tests on doping effects in premature babies and on treating seriously ill patients with placebo instead of actual medicine.
However, there is still a lack of reliable data about the extent of studies taking place then, the contracts, the amount of money paid, and more moral issues, such as patient education and informed consent.
Dr Erices and his colleagues set out to uncover more information by evaluating the clinical trials based on archival material from the health system and the secret service.
The team found documents related to 220 trials carried out between 1983 and 1990, which involved more than 14,000 patients and 68 Western pharmaceutical companies.
However, there was no record of patient information forms or systematic documentation regarding the provision of patient consent.
A range of drugs were tested in these studies, including chemotherapeutic agents, heparin, insulin, anti-depressants, anti-allergy drugs, contrast agents, and toothpastes.
Between 1983 and 1990, the GDR’s health system received approximately DM 16.5 million for the trials, which were cost-effective for the drug firms, according to the researchers. The team also noted that the GDR agreed to these trials due to its desperate need for hard currency (impending bankruptcy).
Overall, the files the researchers studied suggested that the GDR attempted to conduct trials according to international ethical standards.
However, the trials were concealed from the public. And state legislation stipulated that patients had to consent to the trials, but no evidence was found to suggest that patients were systematically informed.
Some documents suggested that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. And it was unclear whether the patients themselves knew that they were participating in trials and were aware of all the risks.
The researchers concluded that further investigation of these trials is needed, and specific trials should be studied separately.
Credit: Esther Dyson
New research has shown that clinical trials carried out in the German Democratic Republic (GDR) in the second half of the 20th century were not always conducted with the full knowledge or understanding of participants.
A review of documents from that time suggests that, although questionable practices took place, the GDR attempted to conduct trials according to international ethical standards.
And there was no evidence to suggest that trial investigators intentionally hurt patients.
Nevertheless, these trials were hidden from the public, there was no record of patient consent, and some documents suggest patients did not receive adequate information.
Dr Rainer Erices, of Friedrich-Alexander-Universität Erlangen-Nuernberg in Germany, and his colleagues detailed these findings in the Journal of Medical Ethics.
The GDR, also known as East Germany, was a state within the Eastern Bloc during the Cold War period and between 1949 and 1990. Since the 1990s, the media has reported that unofficial clinical trials were conducted by Western pharmaceutical companies in East Germany from the 1960s onward.
Reports have suggested the GDR “sold” its patients as “guinea pigs” for experiments in exchange for hard currency; for example, for tests on doping effects in premature babies and on treating seriously ill patients with placebo instead of actual medicine.
However, there is still a lack of reliable data about the extent of studies taking place then, the contracts, the amount of money paid, and more moral issues, such as patient education and informed consent.
Dr Erices and his colleagues set out to uncover more information by evaluating the clinical trials based on archival material from the health system and the secret service.
The team found documents related to 220 trials carried out between 1983 and 1990, which involved more than 14,000 patients and 68 Western pharmaceutical companies.
However, there was no record of patient information forms or systematic documentation regarding the provision of patient consent.
A range of drugs were tested in these studies, including chemotherapeutic agents, heparin, insulin, anti-depressants, anti-allergy drugs, contrast agents, and toothpastes.
Between 1983 and 1990, the GDR’s health system received approximately DM 16.5 million for the trials, which were cost-effective for the drug firms, according to the researchers. The team also noted that the GDR agreed to these trials due to its desperate need for hard currency (impending bankruptcy).
Overall, the files the researchers studied suggested that the GDR attempted to conduct trials according to international ethical standards.
However, the trials were concealed from the public. And state legislation stipulated that patients had to consent to the trials, but no evidence was found to suggest that patients were systematically informed.
Some documents suggested that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. And it was unclear whether the patients themselves knew that they were participating in trials and were aware of all the risks.
The researchers concluded that further investigation of these trials is needed, and specific trials should be studied separately.
Credit: Esther Dyson
New research has shown that clinical trials carried out in the German Democratic Republic (GDR) in the second half of the 20th century were not always conducted with the full knowledge or understanding of participants.
A review of documents from that time suggests that, although questionable practices took place, the GDR attempted to conduct trials according to international ethical standards.
And there was no evidence to suggest that trial investigators intentionally hurt patients.
Nevertheless, these trials were hidden from the public, there was no record of patient consent, and some documents suggest patients did not receive adequate information.
Dr Rainer Erices, of Friedrich-Alexander-Universität Erlangen-Nuernberg in Germany, and his colleagues detailed these findings in the Journal of Medical Ethics.
The GDR, also known as East Germany, was a state within the Eastern Bloc during the Cold War period and between 1949 and 1990. Since the 1990s, the media has reported that unofficial clinical trials were conducted by Western pharmaceutical companies in East Germany from the 1960s onward.
Reports have suggested the GDR “sold” its patients as “guinea pigs” for experiments in exchange for hard currency; for example, for tests on doping effects in premature babies and on treating seriously ill patients with placebo instead of actual medicine.
However, there is still a lack of reliable data about the extent of studies taking place then, the contracts, the amount of money paid, and more moral issues, such as patient education and informed consent.
Dr Erices and his colleagues set out to uncover more information by evaluating the clinical trials based on archival material from the health system and the secret service.
The team found documents related to 220 trials carried out between 1983 and 1990, which involved more than 14,000 patients and 68 Western pharmaceutical companies.
However, there was no record of patient information forms or systematic documentation regarding the provision of patient consent.
A range of drugs were tested in these studies, including chemotherapeutic agents, heparin, insulin, anti-depressants, anti-allergy drugs, contrast agents, and toothpastes.
Between 1983 and 1990, the GDR’s health system received approximately DM 16.5 million for the trials, which were cost-effective for the drug firms, according to the researchers. The team also noted that the GDR agreed to these trials due to its desperate need for hard currency (impending bankruptcy).
Overall, the files the researchers studied suggested that the GDR attempted to conduct trials according to international ethical standards.
However, the trials were concealed from the public. And state legislation stipulated that patients had to consent to the trials, but no evidence was found to suggest that patients were systematically informed.
Some documents suggested that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. And it was unclear whether the patients themselves knew that they were participating in trials and were aware of all the risks.
The researchers concluded that further investigation of these trials is needed, and specific trials should be studied separately.
Cancer survivors face financial, work-related issues
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
Healthcare pricing transparency may have pros and cons
Credit: Rhoda Baer
Searching a health service pricing website prior to receiving medical care can reduce patients’ payments, but it may have negative effects as well, researchers have reported in JAMA.
Their study showed that searching the website allowed patients to pay lower prices for clinical services such as advanced imaging and lab tests.
However, the researchers suggested that knowing the price of services ahead of time may prompt some patients to forgo care.
And although cost savings from price shopping might lead to improved treatment adherence, it might also lead to overuse of services.
Neeraj Sood, PhD, of the University of Southern California in Los Angeles, and his colleagues examined the association between price availability and the total claims payments (the total amount paid by patient and insurer) for lab tests, advanced imaging services, and clinician office visits.
The researchers compared payments made by patients who searched a pricing website before using a service to patients who had not researched pricing. The team analyzed medical claims data from 2010 to 2013. This included 502,949 patients who were insured in the US by 18 employers who provided a price transparency platform to their employees.
Patients with access to the pricing website 14 days before receiving care had lower claim payments than those who did not. Adjusted payments were approximately 14% lower for lab tests, 13% lower for advanced imaging, and 1% lower for clinician office visits.
The relative differences translated into lower absolute dollar payments of $3.45 for lab tests, $124.74 for advanced imaging, and $1.18 for clinician office visits.
In the period before either group had access to the pricing website, payments for searchers were about 4% higher for lab tests and 6% higher for advanced imaging but 0.26% lower for office visits than for nonsearchers.
The researchers said future studies should evaluate services beyond those examined in this study. They should also examine how the use of care is affected to better understand the broader effect of price transparency on healthcare spending and population health.
This study was published alongside a related editorial.
Credit: Rhoda Baer
Searching a health service pricing website prior to receiving medical care can reduce patients’ payments, but it may have negative effects as well, researchers have reported in JAMA.
Their study showed that searching the website allowed patients to pay lower prices for clinical services such as advanced imaging and lab tests.
However, the researchers suggested that knowing the price of services ahead of time may prompt some patients to forgo care.
And although cost savings from price shopping might lead to improved treatment adherence, it might also lead to overuse of services.
Neeraj Sood, PhD, of the University of Southern California in Los Angeles, and his colleagues examined the association between price availability and the total claims payments (the total amount paid by patient and insurer) for lab tests, advanced imaging services, and clinician office visits.
The researchers compared payments made by patients who searched a pricing website before using a service to patients who had not researched pricing. The team analyzed medical claims data from 2010 to 2013. This included 502,949 patients who were insured in the US by 18 employers who provided a price transparency platform to their employees.
Patients with access to the pricing website 14 days before receiving care had lower claim payments than those who did not. Adjusted payments were approximately 14% lower for lab tests, 13% lower for advanced imaging, and 1% lower for clinician office visits.
The relative differences translated into lower absolute dollar payments of $3.45 for lab tests, $124.74 for advanced imaging, and $1.18 for clinician office visits.
In the period before either group had access to the pricing website, payments for searchers were about 4% higher for lab tests and 6% higher for advanced imaging but 0.26% lower for office visits than for nonsearchers.
The researchers said future studies should evaluate services beyond those examined in this study. They should also examine how the use of care is affected to better understand the broader effect of price transparency on healthcare spending and population health.
This study was published alongside a related editorial.
Credit: Rhoda Baer
Searching a health service pricing website prior to receiving medical care can reduce patients’ payments, but it may have negative effects as well, researchers have reported in JAMA.
Their study showed that searching the website allowed patients to pay lower prices for clinical services such as advanced imaging and lab tests.
However, the researchers suggested that knowing the price of services ahead of time may prompt some patients to forgo care.
And although cost savings from price shopping might lead to improved treatment adherence, it might also lead to overuse of services.
Neeraj Sood, PhD, of the University of Southern California in Los Angeles, and his colleagues examined the association between price availability and the total claims payments (the total amount paid by patient and insurer) for lab tests, advanced imaging services, and clinician office visits.
The researchers compared payments made by patients who searched a pricing website before using a service to patients who had not researched pricing. The team analyzed medical claims data from 2010 to 2013. This included 502,949 patients who were insured in the US by 18 employers who provided a price transparency platform to their employees.
Patients with access to the pricing website 14 days before receiving care had lower claim payments than those who did not. Adjusted payments were approximately 14% lower for lab tests, 13% lower for advanced imaging, and 1% lower for clinician office visits.
The relative differences translated into lower absolute dollar payments of $3.45 for lab tests, $124.74 for advanced imaging, and $1.18 for clinician office visits.
In the period before either group had access to the pricing website, payments for searchers were about 4% higher for lab tests and 6% higher for advanced imaging but 0.26% lower for office visits than for nonsearchers.
The researchers said future studies should evaluate services beyond those examined in this study. They should also examine how the use of care is affected to better understand the broader effect of price transparency on healthcare spending and population health.
This study was published alongside a related editorial.
Supercomputers can predict drugs’ side effects
Credit: FDA
Scientists have found they can use supercomputers to identify proteins that cause adverse drug reactions.
The team noted that, during the drug development process, researchers often miss side effects that kill at least 100,000 patients a year.
In PLOS ONE, Montiago LaBute, PhD, of Lawrence Livermore National Laboratory in California, and his colleagues explained how we might use high-performance computers to solve this problem.
Side effects go undetected during drug development
A typical drug discovery process begins with identifying which proteins are associated with a specific disease. Candidate drug compounds are combined with target proteins to determine the drug’s efficacy and toxicity.
While this method allows researchers to identify side effects with many target proteins, there are myriad unknown, off-target proteins that may bind to the candidate drug and could cause unanticipated side effects.
Because it is cost-prohibitive to experimentally test a drug candidate against a potentially large set of proteins—and the list of possible off-targets is not known ahead of time—pharmaceutical companies usually only test a minimal set of off-target proteins during the early stages of drug discovery.
So certain adverse drug reactions remain undetected through the later stages of drug development, and the drugs may make it to the marketplace before these reactions are detected.
There have been several highly publicized medications with off-target protein side effects that have reached the marketplace. For example, Avandia, an anti-diabetic drug, caused heart attacks in some patients.
And Vioxx, an anti-inflammatory medication, caused heart attacks and strokes in certain patient populations. Both drugs were recalled because of their side effects.
“There were no indications of side effects of these medications in early testing or clinical trials,” Dr LaBute said. “We need a way to determine the safety of such therapeutics before they reach patients. Our work can help direct such drugs to patients who will benefit the most from them with the least amount of side effects.”
Supercomputers predict adverse drug reactions
Dr LaBute and colleagues tackled the problem by using supercomputers and information from public databases of drug compounds and proteins.
The databases included DrugBank, UniProt, and Protein Data Bank (PDB), as well as drug databases from the US Food and Drug Administration (FDA) and SIDER, which contain FDA-approved drugs with adverse drug reactions.
The team examined 4020 off-target proteins from DrugBank and UniProt. Those proteins were indexed against the PDB, which whittled the number down to 409 off-proteins that have high-quality 3D crystallographic X-ray diffraction structures essential for analysis in a computational setting.
The researchers fed the 409 off-target proteins into high-performance computer software known as VinaLC, along with 906 FDA-approved drug compounds. VinaLC used a molecular docking matrix that bound the drugs to the proteins. A score was given to each combination to assess whether effective binding occurred.
The team fed binding scores into another computer program and combined them with 560 FDA-approved drugs with known side effects. They used an algorithm to determine which proteins were associated with certain side effects.
In two categories of disorders—vascular disorders and neoplasms—the researchers’ computational model of predicting side effects was more predictive than current statistical methods that do not include binding scores.
In addition, the team’s calculations predicted new potential side effects. For example, they predicted a connection between a protein normally associated with cancer metastasis to vascular disorders like aneurysms.
“We have discovered a very viable way to find off-target proteins that are important for side effects,” Dr LaBute said. “This approach using [high-powered computers] and molecular docking to find [adverse drug reactions] never really existed before.”
The team’s findings provide drug companies with a cost-effective and reliable method to screen for side effects, according to Dr LaBute. Now, his group’s goal is to expand their computational pharmaceutical research to include more off-target proteins for testing and eventually screen every protein in the body.
“If we can do that, the drugs of tomorrow will have less side effects that can potentially lead to fatalities,” Dr Labute said. “Optimistically, we could be a decade away from our ultimate goal. However, we need help from pharmaceutical companies, healthcare providers, and the FDA to provide us with patient and therapeutic data.”
Credit: FDA
Scientists have found they can use supercomputers to identify proteins that cause adverse drug reactions.
The team noted that, during the drug development process, researchers often miss side effects that kill at least 100,000 patients a year.
In PLOS ONE, Montiago LaBute, PhD, of Lawrence Livermore National Laboratory in California, and his colleagues explained how we might use high-performance computers to solve this problem.
Side effects go undetected during drug development
A typical drug discovery process begins with identifying which proteins are associated with a specific disease. Candidate drug compounds are combined with target proteins to determine the drug’s efficacy and toxicity.
While this method allows researchers to identify side effects with many target proteins, there are myriad unknown, off-target proteins that may bind to the candidate drug and could cause unanticipated side effects.
Because it is cost-prohibitive to experimentally test a drug candidate against a potentially large set of proteins—and the list of possible off-targets is not known ahead of time—pharmaceutical companies usually only test a minimal set of off-target proteins during the early stages of drug discovery.
So certain adverse drug reactions remain undetected through the later stages of drug development, and the drugs may make it to the marketplace before these reactions are detected.
There have been several highly publicized medications with off-target protein side effects that have reached the marketplace. For example, Avandia, an anti-diabetic drug, caused heart attacks in some patients.
And Vioxx, an anti-inflammatory medication, caused heart attacks and strokes in certain patient populations. Both drugs were recalled because of their side effects.
“There were no indications of side effects of these medications in early testing or clinical trials,” Dr LaBute said. “We need a way to determine the safety of such therapeutics before they reach patients. Our work can help direct such drugs to patients who will benefit the most from them with the least amount of side effects.”
Supercomputers predict adverse drug reactions
Dr LaBute and colleagues tackled the problem by using supercomputers and information from public databases of drug compounds and proteins.
The databases included DrugBank, UniProt, and Protein Data Bank (PDB), as well as drug databases from the US Food and Drug Administration (FDA) and SIDER, which contain FDA-approved drugs with adverse drug reactions.
The team examined 4020 off-target proteins from DrugBank and UniProt. Those proteins were indexed against the PDB, which whittled the number down to 409 off-proteins that have high-quality 3D crystallographic X-ray diffraction structures essential for analysis in a computational setting.
The researchers fed the 409 off-target proteins into high-performance computer software known as VinaLC, along with 906 FDA-approved drug compounds. VinaLC used a molecular docking matrix that bound the drugs to the proteins. A score was given to each combination to assess whether effective binding occurred.
The team fed binding scores into another computer program and combined them with 560 FDA-approved drugs with known side effects. They used an algorithm to determine which proteins were associated with certain side effects.
In two categories of disorders—vascular disorders and neoplasms—the researchers’ computational model of predicting side effects was more predictive than current statistical methods that do not include binding scores.
In addition, the team’s calculations predicted new potential side effects. For example, they predicted a connection between a protein normally associated with cancer metastasis to vascular disorders like aneurysms.
“We have discovered a very viable way to find off-target proteins that are important for side effects,” Dr LaBute said. “This approach using [high-powered computers] and molecular docking to find [adverse drug reactions] never really existed before.”
The team’s findings provide drug companies with a cost-effective and reliable method to screen for side effects, according to Dr LaBute. Now, his group’s goal is to expand their computational pharmaceutical research to include more off-target proteins for testing and eventually screen every protein in the body.
“If we can do that, the drugs of tomorrow will have less side effects that can potentially lead to fatalities,” Dr Labute said. “Optimistically, we could be a decade away from our ultimate goal. However, we need help from pharmaceutical companies, healthcare providers, and the FDA to provide us with patient and therapeutic data.”
Credit: FDA
Scientists have found they can use supercomputers to identify proteins that cause adverse drug reactions.
The team noted that, during the drug development process, researchers often miss side effects that kill at least 100,000 patients a year.
In PLOS ONE, Montiago LaBute, PhD, of Lawrence Livermore National Laboratory in California, and his colleagues explained how we might use high-performance computers to solve this problem.
Side effects go undetected during drug development
A typical drug discovery process begins with identifying which proteins are associated with a specific disease. Candidate drug compounds are combined with target proteins to determine the drug’s efficacy and toxicity.
While this method allows researchers to identify side effects with many target proteins, there are myriad unknown, off-target proteins that may bind to the candidate drug and could cause unanticipated side effects.
Because it is cost-prohibitive to experimentally test a drug candidate against a potentially large set of proteins—and the list of possible off-targets is not known ahead of time—pharmaceutical companies usually only test a minimal set of off-target proteins during the early stages of drug discovery.
So certain adverse drug reactions remain undetected through the later stages of drug development, and the drugs may make it to the marketplace before these reactions are detected.
There have been several highly publicized medications with off-target protein side effects that have reached the marketplace. For example, Avandia, an anti-diabetic drug, caused heart attacks in some patients.
And Vioxx, an anti-inflammatory medication, caused heart attacks and strokes in certain patient populations. Both drugs were recalled because of their side effects.
“There were no indications of side effects of these medications in early testing or clinical trials,” Dr LaBute said. “We need a way to determine the safety of such therapeutics before they reach patients. Our work can help direct such drugs to patients who will benefit the most from them with the least amount of side effects.”
Supercomputers predict adverse drug reactions
Dr LaBute and colleagues tackled the problem by using supercomputers and information from public databases of drug compounds and proteins.
The databases included DrugBank, UniProt, and Protein Data Bank (PDB), as well as drug databases from the US Food and Drug Administration (FDA) and SIDER, which contain FDA-approved drugs with adverse drug reactions.
The team examined 4020 off-target proteins from DrugBank and UniProt. Those proteins were indexed against the PDB, which whittled the number down to 409 off-proteins that have high-quality 3D crystallographic X-ray diffraction structures essential for analysis in a computational setting.
The researchers fed the 409 off-target proteins into high-performance computer software known as VinaLC, along with 906 FDA-approved drug compounds. VinaLC used a molecular docking matrix that bound the drugs to the proteins. A score was given to each combination to assess whether effective binding occurred.
The team fed binding scores into another computer program and combined them with 560 FDA-approved drugs with known side effects. They used an algorithm to determine which proteins were associated with certain side effects.
In two categories of disorders—vascular disorders and neoplasms—the researchers’ computational model of predicting side effects was more predictive than current statistical methods that do not include binding scores.
In addition, the team’s calculations predicted new potential side effects. For example, they predicted a connection between a protein normally associated with cancer metastasis to vascular disorders like aneurysms.
“We have discovered a very viable way to find off-target proteins that are important for side effects,” Dr LaBute said. “This approach using [high-powered computers] and molecular docking to find [adverse drug reactions] never really existed before.”
The team’s findings provide drug companies with a cost-effective and reliable method to screen for side effects, according to Dr LaBute. Now, his group’s goal is to expand their computational pharmaceutical research to include more off-target proteins for testing and eventually screen every protein in the body.
“If we can do that, the drugs of tomorrow will have less side effects that can potentially lead to fatalities,” Dr Labute said. “Optimistically, we could be a decade away from our ultimate goal. However, we need help from pharmaceutical companies, healthcare providers, and the FDA to provide us with patient and therapeutic data.”
Collaborative cancer care cuts readmission rates
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.
LOY linked to higher risk of cancer, mortality in men
Credit: William Weinert
SAN DIEGO—Age-related loss of the Y chromosome (LOY) from blood cells is associated with an elevated risk of cancer and mortality, a new study indicates.
This finding could help explain why men tend to have a shorter life span and higher rates of non-sex-specific cancers than women, said Lars Forsberg, PhD, of Uppsala University in Sweden.
He and his colleagues presented this research at the American Society of Human Genetics 2014 Annual Meeting and described it
in a letter to Nature Genetics.
LOY, which occurs occasionally as a man’s blood cells replicate, was first reported nearly 50 years ago and remains largely unexplained in both its causes and effects. Recent advances have allowed researchers to use a blood test to detect when only a small fraction of a man’s blood cells have undergone LOY.
Dr Forsberg and his colleagues studied the relationship between LOY, cancer, and mortality using blood samples from 1153 men aged 70 to 84 years who were followed for up to 40 years.
In survival analyses, the investigators studied 982 participants who did not have cancer prior to sampling. The team adjusted their analyses for age, hypertension, exercise, smoking, diabetes, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ancestry.
The researchers calculated the degree of LOY for each subject from the median log R ratio values for approximately 2560 probes in the male-specific region of chromosome Y (mLRR-Y).
In a primary analysis, the investigators found that men with a higher degree of LOY had an increased risk of all-cause mortality (hazard ratio [HR]=2.13, P=0.029).
And LOY was a key risk factor for cancer-related mortality (HR=3.76, P=0.022), but it was not significantly associated with non-cancer-related mortality (P=0.245).
The researchers then scored participants on the basis of a defined threshold of mLRR-Y. Men with an mLRR-Y of –0.4 or less were scored as 1, and other subjects were scored as 0.
This analysis confirmed the effect of LOY on the risk of all-cause mortality (HR=1.91, P=0.010). It also showed that median survival times in men with LOY were 5.5 years shorter than for the other subjects, representing half the survival time.
In addition, the analysis confirmed the effect of LOY on the risk of cancer-related mortality (HR=3.29, P=0.003) and death from non-hematologic cancers (HR=3.62, P=0.003).
The investigators could not test the effect of LOY on mortality related to hematologic malignancies, as only one man with an mLRR-Y of –0.4 or less died from a hematologic malignancy.
However, the team did find that the risk of any cancer diagnosis was higher in men with an mLRR-Y of −0.4 or less (HR=2.47, P=0.014). And the same was true for the risk of developing a non-hematologic cancer (HR=2.68, P=0.008).
“Many people think the Y chromosome only contains genes involved in sex determination and sperm production,” said Jan Dumanski, MD, PhD, also of Uppsala University. “In fact, these genes have other important functions, such as possibly playing a role in preventing tumors.”
The researchers noted that LOY in blood cells is associated with many different cancers, and this may be because Y chromosome genes enable blood cells to assist with immunosurveillance.
“Our hypothesis is that LOY disrupts the immunosurveillance normally conducted by blood cells, allowing tumors to grow unchecked and develop into cancer,” Dr Forsberg said.
These findings suggest a new approach to early detection of cancer risk in men: a blood test to assess LOY.
“LOY is not very dangerous in a small fraction of blood cells but becomes increasingly predictive of cancer as more cells lose their Y chromosome,” Dr Forsberg explained. “This takes years, so you’d have a window of time to do something to reduce your risk.”
The investigators are currently exploring LOY in more detail, including the effects of various lifestyle factors and other health conditions on LOY. They are also examining the frequency and consequences of LOY in different types of cells and throughout life.
Credit: William Weinert
SAN DIEGO—Age-related loss of the Y chromosome (LOY) from blood cells is associated with an elevated risk of cancer and mortality, a new study indicates.
This finding could help explain why men tend to have a shorter life span and higher rates of non-sex-specific cancers than women, said Lars Forsberg, PhD, of Uppsala University in Sweden.
He and his colleagues presented this research at the American Society of Human Genetics 2014 Annual Meeting and described it
in a letter to Nature Genetics.
LOY, which occurs occasionally as a man’s blood cells replicate, was first reported nearly 50 years ago and remains largely unexplained in both its causes and effects. Recent advances have allowed researchers to use a blood test to detect when only a small fraction of a man’s blood cells have undergone LOY.
Dr Forsberg and his colleagues studied the relationship between LOY, cancer, and mortality using blood samples from 1153 men aged 70 to 84 years who were followed for up to 40 years.
In survival analyses, the investigators studied 982 participants who did not have cancer prior to sampling. The team adjusted their analyses for age, hypertension, exercise, smoking, diabetes, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ancestry.
The researchers calculated the degree of LOY for each subject from the median log R ratio values for approximately 2560 probes in the male-specific region of chromosome Y (mLRR-Y).
In a primary analysis, the investigators found that men with a higher degree of LOY had an increased risk of all-cause mortality (hazard ratio [HR]=2.13, P=0.029).
And LOY was a key risk factor for cancer-related mortality (HR=3.76, P=0.022), but it was not significantly associated with non-cancer-related mortality (P=0.245).
The researchers then scored participants on the basis of a defined threshold of mLRR-Y. Men with an mLRR-Y of –0.4 or less were scored as 1, and other subjects were scored as 0.
This analysis confirmed the effect of LOY on the risk of all-cause mortality (HR=1.91, P=0.010). It also showed that median survival times in men with LOY were 5.5 years shorter than for the other subjects, representing half the survival time.
In addition, the analysis confirmed the effect of LOY on the risk of cancer-related mortality (HR=3.29, P=0.003) and death from non-hematologic cancers (HR=3.62, P=0.003).
The investigators could not test the effect of LOY on mortality related to hematologic malignancies, as only one man with an mLRR-Y of –0.4 or less died from a hematologic malignancy.
However, the team did find that the risk of any cancer diagnosis was higher in men with an mLRR-Y of −0.4 or less (HR=2.47, P=0.014). And the same was true for the risk of developing a non-hematologic cancer (HR=2.68, P=0.008).
“Many people think the Y chromosome only contains genes involved in sex determination and sperm production,” said Jan Dumanski, MD, PhD, also of Uppsala University. “In fact, these genes have other important functions, such as possibly playing a role in preventing tumors.”
The researchers noted that LOY in blood cells is associated with many different cancers, and this may be because Y chromosome genes enable blood cells to assist with immunosurveillance.
“Our hypothesis is that LOY disrupts the immunosurveillance normally conducted by blood cells, allowing tumors to grow unchecked and develop into cancer,” Dr Forsberg said.
These findings suggest a new approach to early detection of cancer risk in men: a blood test to assess LOY.
“LOY is not very dangerous in a small fraction of blood cells but becomes increasingly predictive of cancer as more cells lose their Y chromosome,” Dr Forsberg explained. “This takes years, so you’d have a window of time to do something to reduce your risk.”
The investigators are currently exploring LOY in more detail, including the effects of various lifestyle factors and other health conditions on LOY. They are also examining the frequency and consequences of LOY in different types of cells and throughout life.
Credit: William Weinert
SAN DIEGO—Age-related loss of the Y chromosome (LOY) from blood cells is associated with an elevated risk of cancer and mortality, a new study indicates.
This finding could help explain why men tend to have a shorter life span and higher rates of non-sex-specific cancers than women, said Lars Forsberg, PhD, of Uppsala University in Sweden.
He and his colleagues presented this research at the American Society of Human Genetics 2014 Annual Meeting and described it
in a letter to Nature Genetics.
LOY, which occurs occasionally as a man’s blood cells replicate, was first reported nearly 50 years ago and remains largely unexplained in both its causes and effects. Recent advances have allowed researchers to use a blood test to detect when only a small fraction of a man’s blood cells have undergone LOY.
Dr Forsberg and his colleagues studied the relationship between LOY, cancer, and mortality using blood samples from 1153 men aged 70 to 84 years who were followed for up to 40 years.
In survival analyses, the investigators studied 982 participants who did not have cancer prior to sampling. The team adjusted their analyses for age, hypertension, exercise, smoking, diabetes, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ancestry.
The researchers calculated the degree of LOY for each subject from the median log R ratio values for approximately 2560 probes in the male-specific region of chromosome Y (mLRR-Y).
In a primary analysis, the investigators found that men with a higher degree of LOY had an increased risk of all-cause mortality (hazard ratio [HR]=2.13, P=0.029).
And LOY was a key risk factor for cancer-related mortality (HR=3.76, P=0.022), but it was not significantly associated with non-cancer-related mortality (P=0.245).
The researchers then scored participants on the basis of a defined threshold of mLRR-Y. Men with an mLRR-Y of –0.4 or less were scored as 1, and other subjects were scored as 0.
This analysis confirmed the effect of LOY on the risk of all-cause mortality (HR=1.91, P=0.010). It also showed that median survival times in men with LOY were 5.5 years shorter than for the other subjects, representing half the survival time.
In addition, the analysis confirmed the effect of LOY on the risk of cancer-related mortality (HR=3.29, P=0.003) and death from non-hematologic cancers (HR=3.62, P=0.003).
The investigators could not test the effect of LOY on mortality related to hematologic malignancies, as only one man with an mLRR-Y of –0.4 or less died from a hematologic malignancy.
However, the team did find that the risk of any cancer diagnosis was higher in men with an mLRR-Y of −0.4 or less (HR=2.47, P=0.014). And the same was true for the risk of developing a non-hematologic cancer (HR=2.68, P=0.008).
“Many people think the Y chromosome only contains genes involved in sex determination and sperm production,” said Jan Dumanski, MD, PhD, also of Uppsala University. “In fact, these genes have other important functions, such as possibly playing a role in preventing tumors.”
The researchers noted that LOY in blood cells is associated with many different cancers, and this may be because Y chromosome genes enable blood cells to assist with immunosurveillance.
“Our hypothesis is that LOY disrupts the immunosurveillance normally conducted by blood cells, allowing tumors to grow unchecked and develop into cancer,” Dr Forsberg said.
These findings suggest a new approach to early detection of cancer risk in men: a blood test to assess LOY.
“LOY is not very dangerous in a small fraction of blood cells but becomes increasingly predictive of cancer as more cells lose their Y chromosome,” Dr Forsberg explained. “This takes years, so you’d have a window of time to do something to reduce your risk.”
The investigators are currently exploring LOY in more detail, including the effects of various lifestyle factors and other health conditions on LOY. They are also examining the frequency and consequences of LOY in different types of cells and throughout life.
Hospital acquisitions lead to increased patient costs
Credit: NCI
The trend of hospitals consolidating medical groups and physician practices is increasing the cost of patient care, new research suggests.
The study was conducted using 4 years of data from nearly 160 medical groups in California.
Results showed that hospital-owned physician organizations incurred higher expenditures than physician-owned organizations for services to patients covered by commercial health maintenance organization (HMO) insurance.
The findings, published in JAMA, come as a growing number of local hospitals and large, multihospital systems in the US are acquiring physician groups and medical practices.
“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said James Robinson, PhD, of the University of California, Berkeley School of Public Health.
“The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in ‘accountable care organizations’ can provide care better than the traditional fee-for-service and solo-practice models. The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”
Dr Robinson teamed up with Kelly Miller, of Integrated Healthcare Association in Oakland, California, to analyze data on 158 major medical groups. The data spanned the period from 2009 to 2012.
Of the 158 organizations, 118 (75%) were physician-owned and provided care for 3,065,551 patients, 19 (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 (13%) were owned by multihospital systems and provided care for 693,254 patients.
The patients were covered by commercial HMO insurance. The data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid.
The researchers assessed costs related to physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except mental health services.
Results revealed that the average expenditure per patient across all physician organizations increased by 16.5% between 2009 and 2012, from $2954 to $3443.
By 2012, expenditures per patient had increased to an average of $3066 in physician-owned organizations, $4312 in local hospital-owned organizations, and $4776 in multihospital system-owned organizations.
This represents a 40.6% relative difference in expenditures per patient associated with hospital ownership and a 55.8% relative difference associated with ownership by a multihospital system compared with ownership by member physicians.
After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3% higher than physician-owned organizations. And organizations owned by multihospital systems incurred expenditures 19.8% higher than physician-owned organizations.
Dr Robinson said these findings might be explained by the fact that, once a medical group has been acquired by a multihospital system, physicians in those groups are expected to admit their patients to the high-priced hospital.
“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.
Dr Robinson added that public policy should not encourage mergers and acquisitions as a means of promoting collaboration. Instead, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve the coordination of care.
“Hospitals are an essential part of the healthcare system, but they should not be the center of the delivery system,” he said. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”
The researchers noted that their findings are limited to California, and further studies should be conducted using data from other states.
“Nevertheless, these findings are important,” Dr Robinson said, “since California is the nation’s leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to ‘accountable care organizations’ by the Obama administration.”
Credit: NCI
The trend of hospitals consolidating medical groups and physician practices is increasing the cost of patient care, new research suggests.
The study was conducted using 4 years of data from nearly 160 medical groups in California.
Results showed that hospital-owned physician organizations incurred higher expenditures than physician-owned organizations for services to patients covered by commercial health maintenance organization (HMO) insurance.
The findings, published in JAMA, come as a growing number of local hospitals and large, multihospital systems in the US are acquiring physician groups and medical practices.
“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said James Robinson, PhD, of the University of California, Berkeley School of Public Health.
“The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in ‘accountable care organizations’ can provide care better than the traditional fee-for-service and solo-practice models. The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”
Dr Robinson teamed up with Kelly Miller, of Integrated Healthcare Association in Oakland, California, to analyze data on 158 major medical groups. The data spanned the period from 2009 to 2012.
Of the 158 organizations, 118 (75%) were physician-owned and provided care for 3,065,551 patients, 19 (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 (13%) were owned by multihospital systems and provided care for 693,254 patients.
The patients were covered by commercial HMO insurance. The data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid.
The researchers assessed costs related to physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except mental health services.
Results revealed that the average expenditure per patient across all physician organizations increased by 16.5% between 2009 and 2012, from $2954 to $3443.
By 2012, expenditures per patient had increased to an average of $3066 in physician-owned organizations, $4312 in local hospital-owned organizations, and $4776 in multihospital system-owned organizations.
This represents a 40.6% relative difference in expenditures per patient associated with hospital ownership and a 55.8% relative difference associated with ownership by a multihospital system compared with ownership by member physicians.
After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3% higher than physician-owned organizations. And organizations owned by multihospital systems incurred expenditures 19.8% higher than physician-owned organizations.
Dr Robinson said these findings might be explained by the fact that, once a medical group has been acquired by a multihospital system, physicians in those groups are expected to admit their patients to the high-priced hospital.
“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.
Dr Robinson added that public policy should not encourage mergers and acquisitions as a means of promoting collaboration. Instead, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve the coordination of care.
“Hospitals are an essential part of the healthcare system, but they should not be the center of the delivery system,” he said. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”
The researchers noted that their findings are limited to California, and further studies should be conducted using data from other states.
“Nevertheless, these findings are important,” Dr Robinson said, “since California is the nation’s leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to ‘accountable care organizations’ by the Obama administration.”
Credit: NCI
The trend of hospitals consolidating medical groups and physician practices is increasing the cost of patient care, new research suggests.
The study was conducted using 4 years of data from nearly 160 medical groups in California.
Results showed that hospital-owned physician organizations incurred higher expenditures than physician-owned organizations for services to patients covered by commercial health maintenance organization (HMO) insurance.
The findings, published in JAMA, come as a growing number of local hospitals and large, multihospital systems in the US are acquiring physician groups and medical practices.
“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said James Robinson, PhD, of the University of California, Berkeley School of Public Health.
“The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in ‘accountable care organizations’ can provide care better than the traditional fee-for-service and solo-practice models. The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”
Dr Robinson teamed up with Kelly Miller, of Integrated Healthcare Association in Oakland, California, to analyze data on 158 major medical groups. The data spanned the period from 2009 to 2012.
Of the 158 organizations, 118 (75%) were physician-owned and provided care for 3,065,551 patients, 19 (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 (13%) were owned by multihospital systems and provided care for 693,254 patients.
The patients were covered by commercial HMO insurance. The data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid.
The researchers assessed costs related to physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except mental health services.
Results revealed that the average expenditure per patient across all physician organizations increased by 16.5% between 2009 and 2012, from $2954 to $3443.
By 2012, expenditures per patient had increased to an average of $3066 in physician-owned organizations, $4312 in local hospital-owned organizations, and $4776 in multihospital system-owned organizations.
This represents a 40.6% relative difference in expenditures per patient associated with hospital ownership and a 55.8% relative difference associated with ownership by a multihospital system compared with ownership by member physicians.
After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3% higher than physician-owned organizations. And organizations owned by multihospital systems incurred expenditures 19.8% higher than physician-owned organizations.
Dr Robinson said these findings might be explained by the fact that, once a medical group has been acquired by a multihospital system, physicians in those groups are expected to admit their patients to the high-priced hospital.
“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.
Dr Robinson added that public policy should not encourage mergers and acquisitions as a means of promoting collaboration. Instead, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve the coordination of care.
“Hospitals are an essential part of the healthcare system, but they should not be the center of the delivery system,” he said. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”
The researchers noted that their findings are limited to California, and further studies should be conducted using data from other states.
“Nevertheless, these findings are important,” Dr Robinson said, “since California is the nation’s leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to ‘accountable care organizations’ by the Obama administration.”