Research roundup: Docs' views of industry gifts; Chemotherapy payments; Health law an

[Rich66]

How is it that Academic oncologists have different reimbursements than community clinics?

Unfortunately, cell based assays don't seem to test for sensitivity to most endocrine therapies which are at the lower end of the cost curve.
Cell based analysis could be a great way to check for off label benefits.
Of course, repeated biopsies for test tissue isn't always possible.
Another issue is the possible need to keep the infusion rooms full.
Let's hope the repeatedly delayed Medicare reimbursement cuts (21%) don't ever happen. That could increase the influence of drug choice incentives.

[gdpawel]

Office chemotherapy has served as an incentive to overtreat with infusion chemotherapy and to encourage the patient to receive 2nd, 3rd, and 4th line chemotherapy, regardless of the likelihood of meaningful benefit. This kind of system creates hopeless conflicts of interest, in that certain forms of therapy are much more remunerative than others. Of course, ASCO has never felt the need to perform clinical trials to determine whether or not treatment outcomes and patient satisfaction are altered by profit incentives.

On the other hand, large academic cancer institutions that are soulfully involved in clinical trials may feel a subtle pull towards getting patients involved in those trials. Some researchers may discourage patient empowerment so they can call the shots through these trials. They've even broaden their appeal by encompassing community hospital oncology practices. These researchers seem to have a readiness to believe that the clinical trial is more reasonable for the patient and that other options do not offer an advantage. Many of these academic researchers, supported by specialty medical societies and other fraternal organizations, are often paid phenomenal amounts of money for enrolling patients in clinical trials, making financial gain the key motivation.

Functional profiling assays can test for sensitivity to hormonal therapies like tamoxifen. It can include anti-vascular drugs, such as Avastin, Sutent, Nexavar, Tarceva, Iressa, Tykerb, both as single agents and in combination with each other and with traditional cytotoxic agents and hormonal therapies. It can simultaneously test for direct anti-tumor activity and for antivascular activity against the microvascular present within the three dimensional tumor cell clusters. High-dose tamoxifen can potentiate chemotherapy through inhibition of p-glycoprotein and/or inhibition of protein kinase c.