2014 COA Community Oncology Conference Coverage

Brought to you by OBR

Videos

Community Oncology 2.0 Medical Home Report - Dr. Daniel McKeller, MD

Don Sharpe of OBR talks to Dr. Daniel McKeller, MD of the Commission on Cancer about the report on The Medical Home. The interview was at COA annual meeting.

How to innovate within oncology payment reforms - Stuart Genschaw, Exec. Dir.

Don Sharpe talks to Stuart Genschaw, Exec. Dir. of Cancer & Hematology Centers of Western Michigan about innovation within oncology payment reforms from the COA annual meeting.

Embracing Payment Reform in Oncology - Barry Russo, CEO

Don Sharpe asks the question, why are you embracing payment reform at The Center for Cancer and Blood Disorders to Barry Russon, CEO. Community Oncology Alliance annual meeting.

Accountable Care Organization (ACO) with Dr. Leonard Kalman, MD

Don Sharpe discusses the success at Advanced Medical Specialties using Accountable Care Organization (ACO) with Dr. Leonard Kalman, MD from the annual COA meeting.

CMMI Award and The Medical Home - Dr. Barbara McAneny, MD

Don Sharpe talks to Dr. Barbara McAneny, MD from New Mexico Cancer Center about the CMMI Award and setting up The Medical Home at the COA meeting in Orlando.

Patient Care Advocacy from a medical oncologists point of view - Dr. Erin Dunbar, MD

Don Sharpe talks about the importance of cancer patient advocacy from the point of view of a medical oncologists Dr. Erin Dunbar, MD of Piedmont Healthcare.

Good News from the Oncologist - Dr. Erin Dunbar, MD

Don Sharpe discusses Dr Erin Dunbar, MD or Piedmont Healthcare her presentation entitled “Good News from the Oncologist” at the COA annual meeting.

What's next for EMR and Big Data in Oncology? - Dr. Lucio Gordon, MD

Don Sharpe of OBR talks to Dr. Lucio Gordon, MD of Florida Cancer Specialists about the role of IT, Electronic Medical Records, and Big Data in the future for oncology.

Angel Aslo, PharmD discusses the role of in house pharmacies

Don Sharpe talks to Angel Aslo, PharmD about the role of in house pharmacies within the community oncology setting.

Ray Bailey, PharmD talks about The Role of In House Pharmacies for oncology practices

Don Sharpe discusses with Ray Bailey, PharmD the role in which in house pharmacies play within oncology practices.

Oncology Practice Value to the Hospital - Terri Guidi, MBA

Don Sharpe talks to Terri Guidi, MBA of Oncology Management and Consulting about a real life case study of an analysis of oncology practice value to the hospital.

What's Impacting Cancer Care? - Ted Okon Executive Director - COA

Don Sharpe sits down with Ted Okon the Executive Director of The Community Oncology Alliance and they talk about what's impacting cancer care at the COA annual meeting.

Understanding the business issue of quality cancer care. - Ricky Newton, CPA

Don Sharpe talks to Ricky Newton, CPA of Cancer Specialists of Tidewater about how to understand the business issue of quality cancer care. The interview was presented at COA annual meeting.

Effects of Sequestration to Community Oncologists - Dr. Jeff Vacirca, MD

Don Sharpe talks to Dr. Jeff Vacirca, MD of North Shore Hematology and Oncology concerning the Effects of Sequestration to Community Oncologists.

What is Gene Forward and Gene Backward? - Dr. Ira Klein, MD

Don Sharpe of OBR interviews Dr. Ira Klein, MD where he asks What is Gene Forward and Gene Backward?

Management and Treatment of Sarcoma - Dr. Dr. Brian Van Tine, MD PhD

Don Sharpe sits down with Dr. Brian Van Tine, MD PhD or Washington University to talk about Management and Treatment of Sarcoma.

Payer Perspective on Molecular Testing - Dr. Micheal Kolodziej, MD

Don Sharpe discusses the Payer Perspective on Molecular Testing with Dr. Micheal Kolodziej, MD from Aetna at the COA annual meeting.

Are All Genetic Tests Equal? - Dr. Lee Newcomer, MD

Don Sharpe of OBR talks about the variances in genetic testing and how that may affect health care decisions with Dr. Lee Newcomer, MD of UnitedHealthCare.

Molecular Testing for Cancer: Payer Perspective - Dr. Sundeep Reddy, MD

Don Sharpe talks about Molecular Testing for Cancer from a Payer Perspective with Dr. Sundeep Reddy, MD (Caris Life Sciences) at the COA annual meeting.

What's Making Your Oncologist Sick? - Dr. Joseph Lynch, MD

Don Sharpe of OBR discusses the topic What's Making Your Oncologist Sick? with Dr. Joseph Lynch, MD at the COA annual meeting.

Integrating Palliative Care and Oncology

Don Sharpe talks to Rebecca Bechhold, MD about Integrating Palliative Care and Oncology from the COA annual meeting in Orlando.

The Genetic Science Behind Heredity Colon Cancer Syndromes

Don Sharpe of OBR discusses The Genetic Science Behind Heredity Colon Cancer Syndromes with Dr. Larry Geier, MD at the COA annual meeting.

The Medical Home past and future - Bo Gamble, COA

Don Sharpe of OBR discusses The Medical Home past and future with Bo Gamble, Director of Strategic Practice Initiatives, Community Oncology Alliance.

How to implement The Medical Home model - Carol Murtaugh, RN, OCN

Don Sharpe of OBR discusses how an oncology practice gets started with The Medical Home model and the implemenation process with Carol Murtaugh, RN, OCN of Hematology & Oncology Consultants. Interview conducted at the annual COA meeting in Orlando, FL.

Medical Home progress for Payers - Gordon Kuntz - ION Solutions

Don Sharpe of OBR discusses the progress for payers who are using The Medical Home model with Gordon Kuntz of ION Solutions at the annual COA meeting in Orlando, FL.

Dr. Siddhartha Mukherjee - The Emperor of All Maladies

Don Sharpe of OBR discusses a surprise announcement from Dr. Siddhartha Mukherjee author and Pulitzer prize winner for The Emperor of All Maladies: A Biography of Cancer.

Dr. John Powderly discusses Molecular Profiling at COA

Don Sharpe of OBR discusses molecular profiling with Dr. John Powderly of Carolina BioOncology Institute at COA.

Blogs

COA Meeting Day #2 – Best Of The Day

As day two of the annual COA conference started, there were still a lot of topics to be covered by the faculty. I began in the clinical track with an interesting lecture on Lynch Syndrome.

Lynch Syndrome

Do You Know It When You See It?

Larry Geier, MD

Director, Clinical Cancer Genetics

Kansas City Cancer Center/University of Kansas Cancer Center

Dr. Geier set the stage by first discussing relatively common hereditary cancer syndromes:

  • Hereditary breast/ovary syndrome (BRCA genes)
    • Breast, ovary, others
      • Lynch syndrome (mismatch repair genes)
        • Colon, uterus, ovary, stomach, others
      • Colon polyposis syndromes (APC, MUTYH genes)
        • Colon, upper GI, others

          What are the hallmarks of hereditary cancers? Some of the more common signals include: family clustering, younger age at diagnosis, multiple cancers in the same person, typical phenotypes, and tumor suppressor genes.

          The nice (maybe “nice” is the wrong word) thing about hereditary cancers is that they may be more preventable. We can identify at-risk patients, and then attempt to prevent the cancer. For example, 5-10% of breast cancers are hereditary and 100% of those cancers are preventable. Another example is colorectal cancer where 5% of CRC cancers are hereditary and 80-90% of those cancers are preventable.

          Importantly, it is becoming increasingly recognized that genetic evaluation, when appropriate, should be done soon after diagnosis in order to optimally manage the patients who have genetically based cancer.

          Dr. Geier spent some time discussing Lynch Syndrome as it relates to management of hereditary cancers. Lynch Syndrome is caused by an inherited defect in any one of several “mismatch repair” genes (MMR). Five genes are currently available for clinical testing:

          • MLH1 (most common gene involved)
          • MSH2 (second most common, often associated with sebaceous neoplasms)
          • MSH6 (excess of uterine cancers)
          • PMS2 (new, prevalence and features uncertain)
          • EPCAM (not MMR, but adjacent to MSH2)

          These MMR genes normally correct DNA mismatch mutations that occur during DNA replication. Cancer occurs when a sufficient number of these mutations occur in critical genes – it’s just a matter of time.

          The problem is that Lynch Syndrome creates genomic instability, which greatly accelerates the timeline from colon polyp to CRC for example. Instead of the usual 7-10 years, it may be only 1-3 years from polyp to CRC. As you can tell, a clean colonoscopy every 10 years is not sufficient to catch CRC in these people, and frequent screening is very important in this group of people.

          So how do we diagnose Lynch Syndrome:

          • Tumor Testing
            • Microsatellite instability
            • Immunohistochemistry for MMR proteins
            • Useful for automatic screening of all CRC patients at the pathology level
          • Germline DNA Testing
            • Direct DNA analysis of one or more of the five genes
            • This is the only way to diagnose Lynch Syndrome

          Ideally, physicians and other care givers will screen for Lynch Syndrome. However, traditional dependence on providers to identify these patients has been largely ineffective, probably for the following reasons:

          There is a wide spectrum of cancers and physicians

          Providers underestimate the prevalence of these syndromes

          Too much reliance on the “slam dunk” family history

          Too little attention to the phenotype that is typical for Lynch colon cancer

          The bottom line is that these syndromes are more common than most realize, and they are easily missed. Physicians need to pay attention to family history of cancers other than CRC such as uterus, ovary, gastric, pancreas, and urothelial cancers. There should be universal IHC screening for MMR proteins on all CRC and endometrial cancer patients. Genetic testing should be considered soon after diagnosis, and along those lines rigorous application of “red flags” will capture the majority of families.

          Integrating Palliative Care and Oncology

          Rebecca Bechhold, MD, Oncology Hematology Care

          Dr. Bechhold describes integrated care as palliative care + oncology care, and integrated care includes: 1) an extensive discussion of the goals of care and 2) superb symptom management.

          Did you know that the US spends 2X more than any other country on cancer care, and that 20-30% of $55 billion in cancer care is spent in the last 6 months of life, without any evidence of improvement in quality of life? How about this one – did you know that a cancer diagnosis is the most common cause of personal bankruptcy in the US, regardless of insurance coverage?

          There is a need for integrated care because the survival time in many cancers is so limited in late stage disease. We have also seen that palliative chemotherapy frequently causes hospitalizations, and that any end of life conversation with a doctor has been shown to lower costs in the last week of life. For these reasons, and because patients express feelings of abandonment when oncologists are not part of their end of li...

          Read Entire Blog

          COA Meeting Day #1 - Best Of The Day

          While attending the annual Community Oncology Alliance (COA) meeting in Orlando I’ve been absorbing content, networking at the breaks, and interviewing faculty. All of it has lead to a lot of new insights that I thought I’d try and summarize here. Note that I’m really only hitting some highlights, and there is nothing like being part of a meeting to really digest all the presentations, especially talking to presenters to put everything presented into context.

          The Emperor of all Maladies: A Biography of Cancer

          Siddhartha Mukherjee, MD, PhD

          The keynote speaker at the meeting was Siddhartha Mukherjee, MD, PhD, the Pulitzer Prize winning Author of The Emperor of All Maladies: A Biography of Cancer. Dr. Mukherjee. Assuming you’re a stakeholder in the cancer industry, it is a book you have to read. Hard for me to do justice here, but Dr. Mukherjee does a terrific job of laying out the history of cancer, all the way back to mummies in fact, through to recent history and today’s understanding of the molecular basis of the disease, and finally looks forward into the future of the disease.

          Dr. Mukherjee began his talk with a surprise for the audience, announcing that for past couple of years he has been working with Ken Burns  on a documentary based on his book. He shared the trailer with us, the first time it has been seen in a public forum.

          Now onto the meeting - I’ll try and share a few of the things I learned and found interesting.

          Molecular Profiling and Circulating Tumor Cells: Challenges as Declining Reimbursement and Clinical Policies Collide

          John Powderly, MD, President, Carolina BioOncology Institute

          The clinical track began with John Powderly, MD, President, Carolina BioOncology Institute presenting his experience with Circulating Tumor Cells (CTCs) and clinical trials at the Carolina BioOncology Institute. The CBI is heavily involved in research, including >40 early phase trials opened since 2005. They have studied products such as ipilimumab, panitumumab, PD1, aflibercept, and so on. Importantly, Dr. Powderly discussed the importance of companion diagnostics, and in particular their experience working with CTCs.

          Companion diagnostics, and their use in clinical trials, are benficial because they match the drug to the patients most likely to benefit, can provide a better clinical response, improvement in attrition rates, and if successful are more likely to get the product approved. For the drug developer, having a companion diagnostic can extend the drug’s life cycle thus producing higher revenue. Dr. Powderly calculates that companion diagnostics can save drug companies as much as $1.8 billion in waste associated with developing drugs without companion diagnostics.

          Dr. Powderly shared his experience with CTCs, what he calls the substrate of personalized medicine. After providing the scientific rationale for CTCs as a surrogate marker, Dr. Powderly was pleased to announce that they had some success presenting CTC data in prostate cancer patients at the recent ASCO GU meeting. Using prostate specific membrane antigen (PSMA) as a marker, they delivered an experimental antibody drug conjugate and saw a significant reduction in CTC percentage, perhaps indicating that they have identified a new prostate cancer marker and perhaps showing that CTCs can be used a surrogate.

          Next Dr. Powderly shared the problem they had with CTCs on the business end. Originally they were on the frontier, bought a veridex machine, and were reimbursed enough with standard codes to make the machine slightly profitable. In 2008 Medicare called CTCs investigational (despite a FDA approval) and reimbursement vanished until Medicare created a NDC code but at that point reimbursement was less than the cost of the test. In the long run the Institute had to change the model and only offer CTC testing in clinical trials where the test is specified as part of the protocol and paid for. Unfortunately a testament to one of the problems with personalized medicine today – a lack of infrastructure  and standardized systems to support development and clinical trials.

          Novel Opportunities for Engagement Utilizing In-House Pharmacy Services

          Angel Aslo, Pharmacy Director, The Zangmeister Center, Columbus, OH

          Ray Bailey, Pharmacy Director, Florida Cancer Specialists

          First a few facts:

          • The cancer drug category is experiencing a 32% - 42% growth rate
          • Oral oncolytics represent 35% of the oncology pipeline
          • FDA approvals of oral oncology meds is surpassing the IV approvals

          As the shift toward oral chemotherapy grows, so does the need for efficient in-house pharmacy functions. In this presentation the faculty discussed their unique pharmacy logistics, and contrasted them between the largest independent practice in the country – Florida Cancer Specialists -  and a stand alone multidisciplinary cancer center – The Zangmeister Center in Columbus, OH.

          Both presenters talked about “speed to thera...