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Medicare cuts damage cancer care, group finds

February 5, 2010

Last Updated: 2010-02-04 9:50:39 -0400 (Reuters Health)

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - Changes to Medicare, the federal health plan for the elderly, may be damaging important aspects of cancer care in the United States, according to a study released on Thursday.

They found that many centers offering cancer care are losing money on patients and predicted that some may be forced out of business.

The Community Oncology Alliance, which commissioned the report, said the findings have implications for healthcare reform in Congress but also require immediate attention from Medicare.

"For some patients, particularly in rural areas, it means the infusion clinic that is close to them will close," the group's Dr. David Eagle said in a telephone interview.

Cancer is diagnosed in 1.3 million Americans every year, according to the American Cancer Society.

The alliance, which advocates for oncologists outside of big hospital centers, has been waging a public relations war to complain that changes to Medicare's reimbursement plans have inadvertently cut payments to cancer specialists.

The group commissioned Washington-based consulting group Avalere Health to survey community oncology practices, which the group says treat 85 percent of cancer patients in the United States.

They analyzed answers from 76 oncology practices representing 680 providers, which Avalere admitted may not be representative of all community oncology practices. The survey only looked at infusion services -- the delivery of chemotherapy -- not surgery or radiation treatment.

Eagle, of Lake Norman Oncology in Mooresville, North Carolina, is presenting the Avalere study at his group's annual meeting this weekend in Scottsdale, Arizona.

It found Medicare pays for 56 percent of the expenses of delivering chemotherapy.

"Under the rules, this 56 percent will go down by 20 percent to 45 percent in 2013," said Ted Okon, executive director of the Alliance.

He said the average practice was losing $500,000 a year. In many cases, patients with private insurance are charged more to make up the difference.

BUSINESSES THREATENED

Dr. Shannon Penland of Jefferson Medical Associates in Laurel, Mississippi is one of those affected.

"The busier I got, the more money we lost," Penland said in a telephone interview. "After my first eight months here, the practice had accrued almost $300,000 in debt."

Penland, the only oncologist in her group, said the other specialists were having to pay her debts. Treating cancer threatens the entire operation.

Much of the expense comes because cancer treatment requires many more staff than simple primary care, Penland said.

"Each internist has a nurse. They have one other person to help them," she said. But she has five staff to help her in handling the average 55 patients a day her clinic treats: two nurses, someone to mix the chemotherapy drugs, a nursing assistant and a nurse-practitioner.

"It is a small community but we have a lot of patients with cancer," said Penland, whose practice is about 45 minutes from Hattiesburg, Mississippi, the nearest town of any size.

Penland said she is considering leaving oncology and going into internal medicine.

Lindsey Spindle, a spokeswoman for Avalere Health, said the changes threaten more than cancer care.

"Medicare payment reductions are poised to affect a broad range of medical specialties, including medical oncology, in an environment where fiscal resources are being carefully scrutinized by Congress and the Administration," she said.

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Study opens new path to fighting leukemia relapse

Last Updated: 2010-02-04 9:53:09 -0400 (Reuters Health)

HONG KONG (Reuters) - Researchers in Japan have identified 25 different spots on leukemia cells, each of which could be used to design a new drug to fight the disease.

In a study published in Science Translational Medicine, the scientists said they found 25 different stretches of DNA that were especially active in the leukemia cells. Each one has the potential to become a target for a new drug.

"If we develop drugs against these molecules, we have a pretty good possibility of eliminating leukemia stem cells that cannot be killed by conventional anti-cancer drugs," lead researcher Fumihiko Ishikawa at the RIKEN Research Center for Allergy & Immunology in Yokohama, Japan, said by telephone.

Ishikawa and colleagues compared leukemia stem cells of 61 patients with blood stem cells of normal healthy adults. Leukemia stem cells are the cancer cells that give birth to new tumor cells and help the cancer spread through the body.

"Various anti-cancer drugs help many leukemia patients enter remission. But the most serious problem in AML (acute myeloid leukemia) is that many undergo relapse and eventually die," Ishikawa said.

"Now we have identified leukemia stem cells that are responsible for relapse ... The very important thing for us is how to overcome relapse in AML patients."

AML is a disease where there is rapid growth of abnormal white blood cells, which cannot fight infections. Patients are not only susceptible to infections, they also lose red blood cells, which carry oxygen though the body, so they become tired, short of breath and eventually die.

So-called targeted anti-cancer drugs, such as Novartis' Gleevec and AstraZeneca's Iressa, are already blockbusters that have saved the lives of many cancer patients.

But there are dozens of types of leukemia and doctors are finding there may also be many more different sub-types, each of which may need its own tailored treatment. Even targeted drugs eventually stop working because the tumor mutates even more.

Although most young and about half of elderly AML patients are cured, overall survival remains low because of relapse. Only about 20 percent of AML patients survive 5 years after being first diagnosed, according to the paper.

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