Assessing and Improving Value in Cancer Care Workshop Summary (2009) / Chapter Skim
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7 Ethical Issues and Value in Oncology
7 Ethical Issues and Value in Oncology
Pages 69-82
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From page 69... ...
The value answer to that question is based on cost-effectiveness, meaning that health care resources should be allocated to maximize health benefits from available resources to the population served, Dr. Brock explained.
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From page 70... ...
First, the intellectual property protections and monopoly pricing afforded by 20 years of patent protection enables pharmaceutical manufacturers to set any price they want or believe they can get for a new drug. Second, though Medicare is the biggest purchaser of cancer drugs in this country, it is explicitly prohibited under part B from negotiating prices with drug companies.
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From page 71... ...
Therefore, the most urgent are not the worst off, said Dr. Brock, and therefore urgent, dying cancer patients do not deserve special priority for medical interventions.
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From page 72... ...
When saving statistical lives, by improving cancer screening for instance, one does not know and will likely never know whose lives will be saved. There are many cases in which improving rates of cancer screening would save more QALYs than many expensive chemotherapeutic treatments, but the benefits due to cancer drugs receive more attention.
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From page 73... ...
While the RCT of erlotinib clearly showed a 2-month survival benefit and a 9 percent response rate for stage IIIB/IV non-small cell lung cancer (NSCLC) patients compared to less than 1 percent in the control arm (Shepherd et
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From page 74... ...
The patient's husband requested continued ICU care so that his wife might receive -- and perhaps benefit from -- erlotinib treatment. On hospital day 53, imaging showed further intracerebral tumor progression.
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From page 75... ...
Ramsey, Dr. Wenger said, is how willing are we to restrict access to marginally The erlotinib clinical trial inclusion criteria required patients 18 years or older; pathologic evidence of NSCLC; prior combination chemotherapy; the absence of other malignancies, cardiac disease, and gastrointestinal or ophthalmologic abnormalities; the absence of symptomatic brain metastases; and an Eastern Cooperative Oncology Group (ECOG)
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From page 76... ...
Wenger said, which requires that physicians promote the fair distribution of finite clinical resources and provide health care based on wise, cost-effective management while meeting the needs of individual patients. The Charter continues, "The provision of unnecessary services not only exposes one's patients to avoidable harm and expense, but also diminishes the resources available for others" (ABIM Foundation et al., 2002)
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From page 77... ...
. They posit that the physician's responsibilities go beyond shepherding individual patient care, extending to obligations to ensure access TABLE 7-1 Helpful Questions for Patients with Advanced Cancer to Consider Asking Their Oncologists Questions About Treatment Questions About Prognosis What is my chance of cure?
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From page 78... ...
. According to this model, the oncologist's stewardship role at the grabbed from journal source original community level should be to participate in decisions regarding the appropriate use of cancer resources, to work with health care teams in deciding reasonable options while maintaining a continuity role, to participate in setting limits, to participate in quality improvement efforts, and to aid in policy decisions regarding appropriate care within one's catchment area, Dr.
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From page 79... ...
It is to discuss prognosis, if the patient is willing, and to provide continuity of guidance. It is to work with care teams in deciding reasonable treatment options, and to participate in deciding appropriate use of cancer care resources on the policy level.
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From page 80... ...
Dr. Max Coppes of the Children's National Medical Center asked whether legal constraints and the pressure to practice defensive medicine force oncologists to make decisions that lead to low value.
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From page 81... ...
Santabarbara, L Seymour, and National Cancer Institute of Canada Clinical Trials Group.
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