Parker County Today October 2016 - Page 39

Certain high-risk breast cancers are being undertreated. There is a potential problem. “There is nothing more important to me as a physician than your cancer treatment. I’ve been in practice for nearly two decades and have had the privilege of telling many patients that there is life beyond cancer. As president of The Center for Cancer and Blood Disorders, I want to lead by example, practicing a firm belief that all patients should receive the finest medical care available, with the same concern and compassion as a cherished member of the family.” Ray Page, D.O., Ph.D. President and Medical Oncologist The Center for Cancer and Blood Disorders PA R K E R C O U N T Y T O D AY Support services provided by: OCTOBER 2016 Schedule appointments by calling 817-596-0637 or online at It is breast cancer awareness month and I have some disturbing news. Many cancer doctors across the U.S. are NOT AWARE of the best chemotherapy treatments for high risk breast cancer! Earlier this year I published an editorial in the Journal of Oncology Practice titled “Refining the Standard of Care: How Oncology Treatment Pathways Can Make a Difference”. I wrote this editorial because I was tremendously concerned about a breast cancer study that was published. A retrospective review of a commercial insurance claims database in the United States demonstrate that 28% of patients with human epidermal growth factor receptor 2 (HER2)–overexp ressed breast cancer did not receive standard-of care trastuzumab-based therapy. Trastuzumab (Herceptin) is a targeted monoclonal antibody therapy where numerous clinical trials over the past decade have proven it to be of substantial survival benefit for women who overexpress the HER2 receptor. The National Comprehensive Cancer Network guidelines have now celebrated 20 years as a vetted, evidence-based resource for oncologist. However, they do not hold the physician accountable, and we should be alarmed that patients with high-risk breast cancer, physicians are not choosing the best care, thereby potentially resulting in adverse outcomes, namely metastatic recurrence and early death. There are prudent and acceptable reasons why Herceptin would not be offered to patients with early-stage HER2 breast cancer. Reasons can range from pathology and laboratory reporting discrepancies, underlying cardiac disease or other comorbidities, advanced age, social and economic disparities, or shared decision making with the patient’s choice to decline therapy. For a comparison, I looked at this study population in my own practice. Among the last 100 patients with HER2 + early-stage breast cancer, 13% did not receive HER2-targeted adjuvant or neoadjuvant therapy. So why the difference between the national average of 28% and my practice average of 13%? My practice has been using a commercial, value-based, oncology pathway program for the past 8 years. Such pathways allow us to manage patients wisely by giving physicians guidance about treatment choices, with preferences generally based on considerations of treatment effectiveness, toxicities, and costs. By using such pathways, it must be recognized that 100% concordance with oncology pathways is unreasonable, undesirable, and potentially unsafe.Well-designed pathways allow for a universally accepted rate of nonadherence to accommodate unique clinical circumstances that are best addressed off of the pathway. The comparison of their 28% nontreatment rate with my practice’s 13% rate raises the issue of whether the use of pathways influenced the difference. The bottom line is that all the stakeholders in cancer care—which include physicians, payers, employers, and patients—desire to provide the greatest value of cancer care available today. As I write this I am on a flight back from Boston where I debated the value of treatment pathways at the Clinical Pathways Congress. The goal of optimal,value-based cancer treatment is one of the most difficult challenges ahead of us. We still have a lot of work to do to develop solutions to improve patient care and outcomes. I have diligently worked with a handful of oncologists over the past 18 months to publish a timely pathways policy statement that addresses the most appropriate organization, development, and use of pathways systems going forward. Last June I presented on the AMA House of Delegates floor and got acceptance of our first in history treatment pathways resolution, which will further influence national policy making. To learn more about cancer care issues or to consult with a physician about a cancer diagnosis, contact us at 817.596.0637. 37