Tablet is better all round for cancer patients

A Dose of Influence?

Would a clinical trial to show when drugs are selected with and without the presence of profit differential (which would include oral-dose drugs), clinical outcomes would be the same?

Dr. Neil Love's "Patterns of Care" reported a survey of breast cancer oncologists based in academic medical centers and community based, private practice medical oncologists. The former oncologists do not derive personal profit from the administration of infusion chemotherapy, the latter oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.

The results of the survey could not have been more clear-cut. For first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists (who are motivated to keep off-protocol patients out of their chemotherapy infusion rooms to reserve these rooms for on-protocol patients) prescribed oral-dose drug Xeloda (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug Taxotere (docetaxel).

In contrast, among the commuity-based oncologists, only 18% prescribed the non-remunerative oral-dose drug Xeloda (capecitabine), while 75% prescribed remunerative infusion drugs, and about 40% prescribed the expensive, highly remunerative drug docetaxel.

ASCOs President says that we go by the literature, which has defined which are the best regimens. Well, how does he explain why the academics prescribe oral dose Xeloda to their metastatic breast cancer patients who aren't on their protocols, which keeps them from clogging up their chemo rooms and resources, which they want to use for the patients on their clinical trials, while the community oncologists almost universally prescribe infusion therapy, with the most popular drug being the still on patent Taxotere (docetaxel), which I do surmise has one of the best "spreads" between acquisition costs and average reimbursement.

The academic center-based oncologists are not without collective guilt. They are misguided in not recognizing that they continue to try and mate a notoriously heterogeneous disease into "one-size-fits-all" treatments. They predominately devote their clinical trial resources into trying to identify the best treatment for the "average" patient, in the face of evidence that this approach is non-productive. However, such unsuccessful experiments will never be viewed as such by the people whose careers are supported by these kinds of experiments.

What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.

http://patternsof...itor.htm (figure 37, volume 2, issue 1, 2005)

http://www.nytime...52158400&en=55fd0d687b5771de&ei=5070

http://www.cancer...#Section 297

http://content.he...25/2/437