OBR Daily Commentary

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Cancer Drugs Are Getting Better and Dearer

(The Economist) May 4, 2017 - AstraZeneca’s Imfinzi costs $180,000 for a year’s treatment.

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Thomas Marsland, MD (Posted: May 10, 2017)

quotesI have been and on again and off again reader of the Economist for a long time. This article reminded me of the quaint old English expression used by my immigrated English relatives who referred to something too expensive as "dear." The point however is on target. The ever rising cost of cancer drugs is unsustainable. The idea of "value based purchasing" is intriguing. But who and how does one decide "how well they work?" Are we looking at clinical outcomes such as response rate, over all survival, or progression free survival ? Where does the patients point of view come into the equasion ? Should we be looking at the cost for total care not just the cost of the drug? (YES) Do they mean basing cost on the efficacy in a specific clnical senario ? Clearly these are complex and valid issues. To make these choice we obviously need lots of data, including clinical outcomes, patient satisfaction, and claims information. Who and how will these data be collected ?? Hopefully some of the next generation of research tools such as Cancer Linq, Flatiron and other will help us decide the right drug, for the right patient, at the right time.quotes

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This Is What’s Missing in the Data-Centric Approach to Cancer

(Fortune) May 3, 2017 - In order to treat cancer successfully, doctors need data—but they need data about several things.

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Thomas Marsland, MD (Posted: May 04, 2017)

quotesHi, all well, settling in in Petaluma. Thought I might comment on this. Data indeed is king. However, there are lots of sites out there that do provide the data. NCCN, Up to Date, to name a couple. CancerLinq, Flatiron, IBM/Watson, and others are also trying to do what is being proposed with Tempus. No question we need real-time data. Things are changing so quickly that even an extremely tech adverse guy like me is running to the cloud (I believe that is where I am going ???) to help me with treatment decisions. quotes

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Oncology Medical Homes, Patient Navigators Improved Quality and Saved Costs at End of Life

(AJMC.com) March 13, 2017 - A recent study in Health Affairs assessed cost and utilization outcomes for 3 innovative care models for Medicare beneficiaries with cancer: oncology medical homes, patient navigator programs, and palliative care initiatives.

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Thomas Marsland, MD (Posted: March 20, 2017)

quotesThis report again confirms what we all suspected. That there are indeed significant savings to the "system" when practitioners take the responsibility to direct appropriate care themselves. This as discussed involved standardization of how the practice deals with patients that have "pathways" in place for triage and treatments. Also having expanded access by the patients to the physicians and other caregivers in the practice. No longer is it acceptable to have a recording say "hang up and dial 911" or have the practice on-call person say "go to the ER." WE have to be there for our patients. If we really do this and take responsibility, indeed this can result in reduced costs of care. HOWEVER, there have been numerous examples (Drexel, Wilshire and others) that also clearly show that the costs to the practice are significantly increased. Obviously in any new payment model these increased costs have to be recognized. In addition, these three newer models should be included as potential options for new APM's. quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...