Results from the 2012 Eisai Oncology Digest

Las Vegas—Regardless of the rising costs of oncology drugs, health insurers, the federal government, and other payers are increasingly likely to cover oncology medications, according to a recent survey.

The 2012 Eisai Oncology Digest asked cancer patients if their health plan or prescription drug plan had rejected coverage of a prescribed medication during the previous 12 months. In 2012, only 17% responded “yes” compared with 25% two years earlier, a statistically significant difference.

In 2012, 15% of patients surveyed said their Medicare Part D drug plan stopped reimbursing their prescription medications because they reached the “donut hole” coverage limit compared with 30% of patients in 2010. The difference was also statistically significant.

Fewer people in 2012 said costs or insurance obstacles kept them from getting the treatment they needed or requested, taking the medication they were prescribed, seeing their preferred physician or oncologist, or receiving treatment at their preferred hospital or treatment center.

Survey results were presented at the NAMCP meeting by Terry Sullivan, MD, vice president of enterprise sales and managed care for Golden Living, a healthcare firm based in Plano, Texas, that offers long-term care, subacute care, rehabilitation therapy, and nursing services. Dr. Sullivan cited data from the National Cancer Institute (NCI) that found direct medical costs associated with cancer in 2007 were $103.8 billion and indirect medical costs were $123.0 billion.

The digest, funded by Eisai Co., Ltd., included data collected from 418 cancer patients who responded to an online survey in December 2011. Dr. Sullivan said there was an equal distribution of patients by age groups, and it was a nationally representative sample. Survey respondents had similar percentages for most cancers compared with prevalence estimates from the NCI, although more patients in the survey had female breast cancer and melanoma compared with NCI estimates (33% vs 22%, 17% vs 7%, respectively).

According to estimates from the NCI, the highest cancer incidences for females in 2012 were breast (29%), lung and bronchus (14%), colon and rectum (9%), uterine corpus (6%), thyroid (5%), skin melanoma (4%), and non-Hodgkin lymphoma (4%). For males, the highest cancer incidences were prostate (29%), lung and bronchus (14%), colon and rectum (9%), urinary bladder (7%), skin melanoma (5%), kidney and renal pelvis (5%), and non-Hodgkin lymphoma (4%).

Patients were eligible if they had been diagnosed with cancer or had been cancer free for ≤5 years, were aware of their health insurance and prescription drug coverage status, were currently receiving prescription drugs for any condition, and were between 21 and 84 years of age.

Of the patients surveyed, 41% had their health insurance and prescription drug coverage provided by their current employers, 24% had them provided by Medicare with prescription coverage, 16% had them provided by their former employers, 11% paid for their insurance and prescriptions themselves, 3% had them provided by Medicare without prescription coverage, 2% had them provided by the Veterans Administration, and 2% had them provided by Medicaid.

The most common procedures or tests performed prior to cancer diagnosis were mammography (89% of patients), papanicolaou testing (89%), prostate-specific antigen test (85%), colonoscopy (58%), skin checks (57%), fecal occult blood test (48%), cervical human papillomavirus (28%), and sigmoidoscopy (21%). Following a cancer diagnosis, patients were significantly less likely to have mammography, papanicolaou testing, colonoscopy, fecal occult blood test, sigmoidoscopy, and cervical human papillomavirus.

In addition, 79% of patients had undergone surgery, 51% had radiation, and 40% had chemotherapy. Further, 30% had surgery only, 21% had surgery plus radiation, 20% had surgery, radiation, and chemotherapy, 12% had surgery and chemotherapy, 9% had radiation only, and 5% had chemotherapy plus radiation.

For patients who received intravenous chemotherapy in 2010, most received treatment in a hospital (41%), physicians’ office (31%), or infusion center (28%). In 2010, a similar percentage had treatment in a hospital or physicians’ office, but significantly fewer patients (14%) went to an infusion center outside of a hospital or physicians’ office.

With regard to care coordination, 33% of survey respondents said surgeons helped them, followed by oncologists/hematologists (31%), family/spouse (26%), the patient him or herself (23%), the oncology nursing staff (22%), family physician (20%), or patient navigator (10%).

The survey also asked about the information that patients received during visits: 95% received information on follow-up care, 65% received a pain treatment plan, 62% received nutrition and exercise advice, 51% received palliative care, 51% received chemotherapy plans, 48% received predictions on life expectancy, 41% received support for family and caregivers, 38% received information on clinical trials, 34% received information on will planning, 15% received financial counseling, and 8% received hospice care.

Dr. Sullivan also discussed palliative care, which he defined as patient- and family-centered care that attempts to optimize a patient’s quality of life by anticipating, preventing, and treating suffering. According to the American College of Surgeons Commission on Cancer^® (CoC), palliative care should begin when a patient is diagnosed with cancer and continue throughout treatment, surveillance, and bereavement.

In the United States, palliative care is available in 63% of hospitals with ≥50 beds and 85% of hospitals with >300 beds, according to Dr. Sullivan. He added, however, that only a small percentage of physicians use palliative care services for their patients, and there are only a few outpatient and home-delivered palliative care programs available.

Of the patients in this survey, 47% said they received a summary of the cancer treatment they received and follow-up care required. Surgeons and oncologists/hematologists were the people most likely to provide the report, but some patients said radiation oncologists, oncology nurses, and patient navigators spoke to them about their treatment regimens. When given the summary of their treatment, patients were most likely to share the information with their family physician, spouse and other family members, and other specialists.

Dr. Sullivan also mentioned the CoC’s survivorship career plan, which officials hope will become part of the standard care for patients. The patient’s primary provider develops the plan and provides the information to the patient after completing treatment. The plan includes a record of the care the patient has received, disease characteristics, and a follow-up care plan.

The survey also found that 83% of patients sought information on their disease or condition, 64% asked about their prescription medications, 42% asked about national organizations for the disease or condition, 32% sought ways to better understand their health plan benefits, 32% asked about alternate treatments such as massage, meditation, yoga, and acupuncture, 30% asked about advocacy or support groups, and 28% sought information on ways to order or manage their prescription medications.

In 2012, 83% of patients received healthcare information from their physicians, while 62% gathered information via websites, up from 47% in 2010. Dr. Sullivan expects the trend will continue, as more people access the Internet for information on their diseases and conditions.

In fact, in 2012, 38% of patients said they preferred receiving information delivered via e-mail compared with 32% who wanted to receive information during in-person visits, and 10% through the mail. In 2010, only 15% of patients said they preferred e-mail, while 32% preferred in-person visits and 32% through the mail.

“[E-mail] is really the future,” Dr. Sullivan said.