The Community Oncology Alliance (COA) announced results of a national survey that reveals the inability to pay for cancer care is among Americans’ top fears about the disease. Seven out of ten report being very concerned about paying for cancer treatment if they developed the disease (69%), the same proportion who are very concerned about dying of it (68%). Only the cancer consequences of having a poor quality of life (75%) and being in pain (72%) evoke slightly more concern.

COA commissioned Opinion Research Corporation to survey a statistically representative sample of 1,022 adult Americans 18 years of age or older. The survey was conducted June 26-30, 2009.

These Americans speak from experience: 79% of the survey respondents reported having a family member or friend diagnosed with cancer. Other top concerns regarding a cancer diagnosis include being unable to work (61%) and leaving their families in debt (59%).

“The need for healthcare reform is especially critical for cancer care,” explained Patrick Cobb, M.D., president of COA and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. “The increasing cost of drugs, declining Medicare reimbursement, and current financial crisis have created a ‘perfect storm’ that jeopardizes community cancer clinics, where most Americans with cancer are treated.”

The survey reveals a lack of confidence in the cancer healthcare payment system, including both private insurance plans and the Medicare system. Less than half (45%) believe their private insurance plans would cover the full cost of cancer treatment, while only 25% believe Medicare would cover treatment costs. Only 41% believe they would be covered for care in a community cancer clinic, where 84% of cancer treatment actually occurs.

Dr. Cobb continued, “Though the U.S. has the best cancer care delivery system in the world, the system is now in first-stage crisis because Medicare has substantially cut payments for cancer drugs and essential services. Oncologists are spending an inordinate amount of time dealing with patient financial issues, including trying to find ways of navigating the insurance maze and identifying drug and co-payment assistance for patients in need. Community cancer clinics have had to close satellite facilities and cut staff. Smaller clinics are struggling to operate and more will close.”

The survey found that most Americans say they could not afford the typical monthly cost of cancer treatment not covered by insurance plans. Only a third (37%) say they could pay up to $1,000 per month towards their cancer care not covered by insurance plans. And only 16% say they could pay up to $2,500 per month towards cancer care.

“Monthly out-of-pocket costs for cancer care and treatment, not covered by private insurance plans or Medicare, can easily run to $1,000 or more,” explained Dr. Cobb. “For many cancer patients, the costs of diagnostic imaging, surgery and expensive cancer medications, especially in the first few months of treatment, can add up to well beyond $2,500 per month.”

To pay for cancer care, Americans report they would take a variety of dire steps. Nearly seven out of ten (66%) report they would go on government assistance to pay the cost of cancer treatment. Four out of ten or more would sell their cars (48%) or their homes (38%), would borrow the money (44%) or declare bankruptcy (40%). Fully one third (33%) say they would simply stop the cancer treatment.

Most (85%) of Americans believe a government-run health plan would have significant disadvantages for cancer care, compared to their own current insurance plans. They see higher taxes as the mostly likely disadvantage of a government-run health plan (74%), while more than half cite negative impacts on treatment and quality of care: longer wait for medical appointments (62%), less coverage of expensive cancer medications or treatments (60%), less coverage of cancer detection and diagnostic tests (54%) and lower quality of care in general (56%).

“The need for healthcare reform is especially critical to cancer care,” said Ted Okon, executive director of COA. “However, the proposals currently under consideration by Congress and the Administration to reform the healthcare payment system do not take into account the special circumstances and requirements of cancer care. What is needed is a substantive program developed with the involvement of oncologists to enhance the delivery of quality cancer care.”

COA Offers Aggressive Solutions

Recently, H.R. 2872, the “Medicare Quality Cancer Care Demonstration Act of 2009,” was introduced into the House of Representatives by U.S. Representatives Artur Davis (D-AL), Steve Israel (D-NY) and Mary Jo Kilroy (D-OH). H.R. 2872 is a bill that will authorize Congress to direct the Centers for Medicare & Medicaid Services (CMS) to implement the Quality Cancer Care Demonstration (QCCD) project. The QCCD, a landmark initiative to transform the payment system for cancer care, will focus on patients covered by Medicare (approximately 45% of cancer patients), involving the collection of data and implementation of a patient-centric program that enhances quality cancer care while controlling costs.

“The Quality Cancer Care Demonstration project offers a means of moving forward immediately, and an architecture for a solution to the current crisis in cancer care,” said Dr. Cobb.

Earlier this year, Sen. Arlen Specter (D-PA) introduced into the U.S. Senate S. 1221, “The Medicare Prompt Pay Correction Act,” as the companion to the H.R. 1392. Both seek to address problems with Medicare reimbursement for cancer drugs and help alleviate a national problem affecting the delivery of cancer care treatment to patients, almost all of whom are treated in community oncology clinics close to their homes.

About Community Oncology Alliance (COA)

COA is a non-profit organization dedicated solely to community oncology. COA was founded by community oncology to advocate for patients and providers in the community oncology setting, where 84 percent of Americans with cancer are treated. In only six years of existence, COA has mobilized community oncology to become more politically active, and increased awareness on Capitol Hill about the community cancer care delivery system. Additionally, COA has brought together community oncology practices from across the country to share information in order to enhance the effectiveness and efficiency of the cancer care they provide to their patients.

Currently, COA is working with the Congress in providing proactive solutions designed to protect the viability of the nation’s cancer care delivery system and patients’ access to quality, affordable cancer care.

The cancer death rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care. However, according to the American Cancer Society, men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women.

Source: Community Oncology Alliance

Virginia Tech chemistry Professor Harry C. Dorn, Emory and Henry College chemistry Professor James Duchamp, and Panos Fatouros, professor and chair of the Division of Radiation Physics and Biology at the Virginia Commonwealth University School of Medicine have co-invented a hands-off process for filling fullerenes with radio-active material.

Fullerenes are hollow carbon molecules. Dorn has created new materials by filling them with atoms of various metals. An important example is a fullerene that encases a sensitive contrast agent (gadolinium) for MRI applications, including as a diagnostic and therapeutic agent for brain tumors. Dorn and Fatouros at VCU have funding from the National Institutes of Health’s National Cancer Institute (NCI) to further develop, produce, and test fullerene nanoparticles that can identify brain tumor cells and selectively target them for radiation therapy.

What if the radioactive material could also be encased in a carbon cage? Dorn asked himself several years ago. With more funding from NCI and Virginia’s Commonwealth Technology Research Fund (CTRF), he set out to do it.

Now Dorn and Duchamp have invented a generator that makes the new material by remote control. “The new materials come out the bottom like a beer product,” Dorn said. The golden liquid is not dispensed into an open cup, of course.

Basically, rods about three times the size of a pencil lead that are made up of graphite and lutetium (Lu) are inserted into big jar through a tube on one side and moved slowly toward a source of electricity on the other side. The jolted rod burns dramatically and the inside of the jar is coated with ash. A nozzle kind of like a miniature carwash wand is lowered from the top to rinse the soot to the bottom and out through a filter. The soot is trapped and the resulting beer-colored solution contains Lu atoms bound to nitrogen inside of fullerenes. This radiolabeled nanomaterial is then further purified by passage through a column that traps the empty-cage fullerenes. The resulting liquid is evaporated and hydroxyl atoms are attached to the molecules so they will be soluble in biofluids.

All of the steps of the process are managed remotely and the purified product is decanted into a shielded container.

Dorn and Duchamp have used non-radioactive Lu to produce the trimetallic nitride endohedral metallofullerenes (Lu3N@C80) - in other words, three atoms of Lu attached to a nitrogen atom inside an 80-atom carbon molecule cage. Once the apparatus is at VCU, Fatouros will use isotope 177Lu, which is used to treat cancer. Although other details need to be worked out, Dorn is confident the generator will work just as well with the radiolabeled product and will produce (177Lu3N@C80).

It all takes less than a day, which is important because 177Lu has a half life of six and one-half days. “So we can’t take 30 days to make the product,” said Duchamp.

It will be the first time that 177Lu has been encapsulated in a fullerene and the first time any radioactive metal has been encapsulated under remote control with direct purification to a pure product.

“The advantage of the metal cage is we can control where it goes biologically,” Dorn said.

“We believe it will mean fewer side effects with better targeted localization, but that remains to be tested,” said Fatouros.

“Another advantage is we can deliver other materials inside the fullerene with the 177Lu - such as a targeting agent (interleukin-13) and an MRI contrast agent,” said Dorn.

Creation of such a multi-modality material for use on brain tumors is a specific goal of Fatouros and Dorn’s NCI-funded research project, “Metallofullerene imaging and targeting of glioma.” “The MRI agent lets you see where you are going and the 177Lu lets you treat an exact region,” said Dorn. “The imaging ability also lets you see if the tumor is shrinking or getting larger.”

An earlier stage of the research was presented at the NCI Alliance for Nanotechnology in Cancer Investigators Meeting in September 2008 and a patent application has been filed.

Dorn points out that the new device will also allow the production of other kinds of radio-labeled fullerenes that can be used for environmental studies, such as to track fullerene nanomaterials.

Source:
Susan Trulove

Virginia Tech

HOUSTON, July 10 — Women with hormone receptor-negative breast cancer had more than a trebling of risk of contralateral breast cancer compared with women who had receptor-positive primary tumors, a study of almost 5,000 women showed.

• Explain to patients that the risk of contralateral breast cancer was strongly influenced by the hormone receptor status of the initial breast cancer.

Moreover, survivors of receptor-negative breast cancer had a 10-fold greater risk of developing a receptor-negative second primary tumor compared with the general population, Christina A. Clarke, PhD, of the Northern California Cancer Center in Fremont, and colleagues reported in the July 9 issue of the Journal of the National Cancer Institute.

The findings have potentially major implications for follow-up of breast cancer survivors.

“Currently, guidelines of the American Cancer Society recommend intensive breast screening with yearly MRI for women at increased risk of developing breast cancer,” the authors said.

“In this context and in light of reports that standard mammography has low sensitivity for detecting HR-negative tumors, our findings, if confirmed, suggest that women diagnosed with an HR-negative breast cancer would benefit from MRI-based breast screening.”

Almost one in 25 breast cancer survivors will develop a second primary breast cancer within six months of the initial diagnosis. Aside from a link to a strong family history of breast cancer, little is known about patterns of second primary breast cancer, particularly within the context of breast cancer heterogeneity.

In an effort to increase the knowledge base about second primary breast cancer, Dr. Clarke and colleagues turned to the NCI’s Surveillance, Epidemiology, and End Results (SEER) database.

They identified a population-based cohort of 4,927 women with an initial diagnosis of breast cancer and then followed the patients’ clinical course to ascertain occurrence of second primary breast tumors.

The study population comprised 3,701 who had a first hormone receptor-positive tumor and 1,226 who had a receptor-negative first primary.

Women with a receptor-positive initial cancer had a twofold greater risk of contralateral primary breast cancer compared with the general population, reflected in a standardized incidence ratio (SIR) of 2.22.

Women whose first primary was hormone receptor-negative had more than threefold greater risk of a second primary compared with patients whose initial cancer was receptor-positive (SIR 3.57, 95% CI 3.38 to 3.78).

A receptor-negative first primary tumor substantially increased the risk of a second receptor-negative breast cancer (SIR 9.81, 95% CI 9.00 to 10.7) compared with general population. The risk of a receptor-positive contralateral breast cancer was approximately twofold greater (SIR 1.94, 95% CI 1.77 to 2.13).

By contrast, for those with receptor-positive first tumors, the risks for a hormone receptor-positive or -negative second tumor were similar.

Diagnosis of hormone receptor-negative breast cancer before age 30 had a dramatic effect on a woman’s risk of receptor-negative contralateral primary breast cancer (SIR 169, 95% CI 106 to 256).

The risk of any contralateral breast cancer, irrespective of the primary tumor’s receptor status, was greater in non-Hispanic blacks, Hispanics, and Asians or Pacific Islanders compared with non-Hispanic whites.

The study had limitations including lack of data on HER2/neu status, risk factors for breast cancer, family history, genetic mutations, and treatments for the first tumor, especially tamoxifen.

The study was supported by National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 with the Northern California Cancer Center. The authors reported no financial disclosures.

Primary source: Journal of the National Cancer Institute

Source reference:

Kurian AW, et al “Second primary breast cancer occurrence according to hormone receptor status” J Natl Cancer Inst 2009; DOI: 10.1093/jnci/djp181.