http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17704409&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Attitudes toward research participation and investigator conflicts of interest among advanced cancer patients participating in early phase clinical trials.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17687154&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

These two articles touch on a critical subject - when an oncologist recommends a treatment the reason behind the recommendation may be complex. It can be a result of the doctor's training and experience in combination with the investments made by the hospital or the doctors own research interests or their financial relationships with various outside entities. In short, a patient and their family must be their own best advocate and get at the heart as to why a specific treatment regimen is being suggested. Don't be afraid to ask questions to make informed treatment decisions!

Source: Cancer Wire

Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need, medical oncologist Dr. Ian Haines reported in the Journal of Clinical Oncology. Emerging evidence shows that many of the highly expensive "targeted" cancer drugs (Herceptin, Avastin and Rituximab) may be just as effective and produce fewer side effects if taken over shorter periods and in lower doses.

He stated in the Journal that "it would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments." He suggested the we make the search for minimum effective doses of these treatments one of the key goals of cancer research.
He gave as an example, Avastin, used to fight colon and lung cancers, the dose being tested is 15 milligrams per kilogram of body weight, despite other research showing it may work with 3 milligrams per kilogram.

A study published in the journal of the American Cancer Society, led by Jeffrey Peppercorn of the University of North Carolina Lineberger Cancer Center, along with three researchers at the Dana-Farber Cancer Institute, found that 84% of trials with pharmaceutical-company involvement showed positive results, compared to 54% for trials without industry backing. Another previous study in oncology, looking at multiple myeloma, found that pharmaceutical studies reported positive results in 74% of trials compared to 47% of non-industry-sponsored trials.

An increasing number of drug studies are developed through collaborations between academic medical centers and drug companies. In fact, pharmaceutical-industry investment in research exceeds the entire operating budget of the NIH. It is important to understand the influence that industry involvement may have on the nature and direction of cancer research. Studies backed by pharmaceutical companies were significantly more likely to report positive results.

As the Haines study suggests more must be spent on analyzing drug data, we also need larger and more detailed studies to figure out why there is an association between pharmaceutical involvement and positive results. Some of the connection between industry and positive results may be because industry focuses on drug development and they do it well.

However, drugmakers are going directly to the consumer at a time when their products are indeed at the margins of evidence-based medicine. On one hand, pharmaceuticals advertise extensively and the advertising is manipulative in the extreme. On the other hand, even NCI-designated cancer centers do this sort of direct to consumer, hard sell advertising. And in cancer medicine, the media advertising is no more misleading than the one-on-one communication which often goes on between a chemotherapy candidate and an oncologist.

A Karolinska Institute in Sweden study showed that U.S. health care system is good at delivering expensive drugs, but that our health care system is not so good at simple medicine like preventive care. Our pharmaceutical-based health care system is very good at creating new health care products that will make a lot of money, but it it's something that has no chance of profit, forget it.

It doesn't take a rocket scientist to figure out that the United States does a good job of developing and delivering new and expensive drugs to cancer patients, because that is the only thing we're good at. But it'll take a rocket scientist to figure out how this makes for a better health care system.

http://jco.ascopubs.org/cgi/content/full/25/25/e31

The cancer industry derives most of its profits from chemotherapy. Both the drug companies and the treatment providers profit from the chemotherapy drugs and the medications used to combat the side effects. The obscene profits made off chemotherapy override any incentive to find a cure or better treatments.

Doctors administer chemotherapy in their offices, buy the drugs at a lower cost than what insurance companies and public health care programs pay and pocket the difference. This system provides an incentive to overuse chemotherapy and the most expensive medications.

http://www.lawyersandsettlements.com/articles/01828/anemia-overuse.html
*** Edited 1/24/2008 7:13:59 AM UTC by gdpawel***

Cancer's two most compelling words these days are "cure" and "costs," and each holds capacity to create patient heartache and promise, according to roundtable participants at the National Comprehensive Cancer Network's 13th Annual Conference, March 5-9.

When doctors recommend cancer treatments, best practices dictate that they follow guidelines created by NCCN and other professional medical organizations. Currently, such guidelines do not include treatment-cost data. Leonard Saltz, M.D., of Memorial Sloan-Kettering Cancer Center said doctors traditionally assumed "we must be very sanctimonious and above the idea of considering cost." But panelists unanimously agreed - and so did the majority of the audience by a show of hands - that cost data should be appended to guidelines.

Panelist Alice Gosfield, an attorney with more than a decade of experience in oncology issues, condemned as "basically wrong" widespread reimbursement practices that profit doctors more who prescribe the most expensive drugs. She said that while it might be unfair to shoulder clinicians with the burden of factoring costs into a patient's treatment plan, insurers and others will be forced to make such decisions, and in the process "there will be blood."

Guidelines help oncologists evaluate treatments and reflect evolving professional consensus. NCCN's guidelines are the "Mercedes" of treatment standards, said David S. Ettinger, M.D., of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. In the future, adding cost data might help doctors choose between two chemotherapy regimens for colorectal cancer that, according to Saltz, are equally effective. Yet one costs $60,000 extra over the course of 10 months' of treatment.

Aetna's James D. Cross, M.D., said that Aetna covers evidence-based treatments regardless of cost. "We exclude experimental treatments from most plans," he explained, but always reimburse experimental treatment costs for cancer patients enrolled in clinical trials. "Depending upon what the evidence states, what the state of the art is, what the NCCN guidelines recommend, that is what we cover."

Cost has suddenly become more crucial to cancer patients, said Nancy Davenport-Ennis of the National Patient Advocate Foundation. Logging 6.8 million inquiries from patients in 2007, the foundation's analysis shows 70 percent of patient dilemma involved cost. That compares with only 38 percent of callers complaining of a cost problem the previous year.

As for whether the C-word - "cure" - belongs in doctor-patient discussions, Saltz argued that doctors sometimes "sugarcoat the reality" in employing the phrase "progression-free survival" to describe new cancer drugs' effectiveness. Doctors understand something patients don't, he said: the phrase refers specifically to the time span between the start of treatment and the moment the tumor begins to grow again. Doctors should not impart false hope when they know "the person is not going to live longer." He urged replacing the phrase with terminology that avoids the word "survival."

Ettinger, by contrast, defended incremental improvements in treatment that may extend patients' lifespans by only weeks or months. "Are we making advances?" he asked. "Yes. Is it slow? Yes."

National Comprehensive Cancer Network (NCCN)
Thomas Mitchell, 215-690-0245
mitchell@nccn.org
www.nccn.org

http://www.pr-inside.com/is-cancer-community-in-alignment-about-r475340.htm

Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists

http://www.healthyskepticism.org/news/2007/Jun.php