Medicare Moves to Pay for Prostate Cancer Drug Provenge - The Washington Post

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By Rob Stein

The federal health insurance program for the elderly moved Wednesday to pay for an expensive vaccine recently approved to treat men with advanced prostate cancer.

The Centers for Medicare and Medicaid Services proposed paying for the vaccine, known as Provenge, which costs $93,000 a patient. The proposal will be subject to public comment for 30 days, and a final decision will be issued 60 days after that.

“The evidence is adequate to conclude that” Provenge “ improves health outcomes for Medicare beneficiaries” with metastatic prostate cancer, “and thus is reasonable and necessary for that indication,” CMS said in announcing its decision.

Although Medicare is not supposed to take cost into consideration when making such rulings, the decision by CMS to launch a formal examination raised concerns among cancer experts, drug companies, lawmakers, prostate cancer patients and advocacy groups.
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Odds Good for Older Women With DCIS, Early Breast Cancer

By Charles Bankhead, Staff Writer, MedPage Today

A diagnosis of ductal carcinoma in-situ (DCIS) or stage I breast cancer does not reduce survival odds for women older than 67, but diagnosis of a higher-stage malignancy does, an NIH database analysis showed.

Women with DCIS or stage I breast cancer had mortality hazards of 0.9 to 1.0 compared with age-matched women who did not have breast cancer, according to Mara A. Schonberg, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

However, the mortality risk increased by 50% compared with controls with a diagnosis of stage II or higher breast cancer, they reported online in the Journal of Clinical Oncology.

"More women age 67 years and older diagnosed with DCIS or stage I breast cancer and women age ≥80 years diagnosed with stage II disease die of cardiovascular disease than breast cancer," Schonberg and colleagues wrote in the discussion of their findings.
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Cervical Ca Screening Age Limits Questioned

By Charles Bankhead, Staff Writer, MedPage Today

A substantial portion of cervical cancer occurs in women older than 70, raising questions about clinical recommendations to discontinue screening at that age, analysis of an NCI database suggested.

From 2000 to 2006, more than 12% of newly diagnosed cervical cancers were in women ages 70 to 85. The rate was similar to that in age groups more often associated with the disease, according to a study reported here at the Society of Gynecologic Oncology meeting.

Almost 60% of cervical cancer cases in older patients were diagnosed at later disease stages.

That limits their treatment options, said Malgorzata E. Skaznik-Wikiel, MD, of Magee-Womens Hospital in Pittsburgh. "Lack of uniform screening across all at-risk age groups may account for the discrepancy," Skaznik-Wikiel said.
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Study Knocks Diagnostic Value of PSA Velocity

By Charles Bankhead, Staff Writer, MedPage Today

If prostate biopsy is based on PSA velocity alone, the number of unnecessary biopsies would be almost four times the number of additional cancers diagnosed, data from a large clinical trial showed.

In the absence of other predictive factors, PSA velocity would have identified 115 prostate cancers at a cost of 433 unnecessary biopsies, according to Andrew Vickers, PhD, of Memorial Sloan-Kettering Cancer Center in New York City and colleagues.

If used as sole justification for a biopsy, PSA velocity would trigger about one of every seven prostate biopsies, they reported online in the Journal of the National Cancer Institute.

Moreover, adding PSA velocity to a multifactor model resulted in minuscule improvement in diagnostic accuracy, particularly for high-grade cancers.

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Late Breast Cancer Diagnosis In Elderly Leads To Poor Survival

Women over 70 are being diagnosed with breast cancer at a later stage leading to lower survival from the disease in the elderly, new research showed today (Wednesday).

The study, published in the British Journal of Cancer*, also found that older breast cancer patients were less likely to receive the same level of treatment as younger patients.

Scientists said that improving access to treatment, in particular surgery, among the elderly could significantly improve their breast cancer survival.

They found that it was also important for women to report any symptoms to their GP as soon as they noticed them and be aware they could continue to have access to screening.

The research analysed over 14,000 women diagnosed with breast cancer between 1999 and 2007 from Eastern Cancer Registration and Information Centre (ECRiC) and looked at five and ten-year survival for patients in four different age groups.**

The results showed that women diagnosed with breast cancer between 50 and 69 years had an 89 per cent chance of surviving their disease for five-years.***

However this fell to 81 per cent for women aged 70-74 years old and to 70 per cent for women over 80.

Three per cent of women in the 50-69 age group were diagnosed with breast cancer at a late stage.**** These women would have been routinely invited for a mammogram every three years through the national screening programme.

In comparison, eight per cent of women 70-74 and 10 per cent of women over 80 had a late stage diagnosis.

Women diagnosed at a late stage had a 14 per cent chance of surviving their disease for five-years.

Dr Paul Pharoah, a Cancer Research UK-funded scientist and one of the study's authors based at the University of Cambridge, said: "This study suggests that improving the way breast cancer is diagnosed and treated in the elderly could mean fewer die prematurely from the disease.

"The national breast screening programme is very good at picking up cases of breast cancer in 50-70 age group it is aimed at.

"But more needs to be done to raise awareness of the disease in older women who are not automatically invited for mammograms, especially since risk of the disease increases with age."

The research also suggested that older women did not always receive the same level of treatment for breast cancer as younger patients.

Around 96 per cent of women aged 50-69 years old had surgery for breast cancer, but this fell to around 60 per cent for women over 70.

Dr Pharoah said that factors like patient preferences, suitability and other illness could explain the differences in treatment - but only to a certain point.

He added that more detailed diagnoses of breast cancer in the elderly could ensure that older women suitable for treatments like surgery, chemotherapy and radiotherapy received them.

Sara Hiom, director of health information at Cancer Research UK, said: "We know that older people are less likely to survive breast cancer - this study highlights that many factors are at play and that late diagnosis and varying access to treatment, in particular, are playing a key role.

"Late diagnosis in the elderly could also be down to women delaying a visit to the doctor, so it's really vital that women are aware of breast cancer symptoms.

"After they turn 70, many women assume that breast cancer is less of a risk because they are no longer invited for screening but this isn't the case.

"More must be done to ensure that older women are well informed about their breast cancer risk, their option to ask for a mammogram and are consistently offered a full range of treatment options where this might benefit them.

"Further work needs to be done to understand why there are these large differences in breast cancer survival between older and younger women so that we can work to ensure that this gap is closed."

Reference

*Ali, A MG et al., Patient and tumour characteristics, management, and age-specific survival in women with breast cancer in the East of England, British Journal of Cancer (2011)

Notes

**Four age groups were: 50-69 years-old, 70-74 years-old, 75-79 years-old and 80+

***after adjusting for the probability of dying from another illness

****Late stage is classed as stage four breast cancer. This means the cancer has spread to other organs in the body and curative treatment may no longer be possible.

Source:
Cancer Research UK

QuickStats: Annual Number of Patients Discharged from Hospice Care, by Primary Diagnosis (Cancer Versus All Other Diseases)* --- United States, National Home and Hospice Care Survey, 1992--2007

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Morbidity and Mortality Weekly Report (MMWR)

* Primary diagnosis is assessed on admission for hospice-care services. Estimates are based on the number of discharged patients, the majority of whom leave hospice care at death. Some patients might discontinue care while living, some might reenter care, and some might have more than one episode of care in a 12-month period.

The figure above shows the annual number of patients discharged from hospice care, by primary diagnosis (cancer versus all other diseases) in the United States during 1992-2007. Use of hospice care increased from approximately 219,300 discharged hospice-care patients in 1992 to 1,045,100 in 2007. In 1992, three out of four patients (approximately 163,600) had a primary diagnosis of cancer, compared with 55,500 patients with all other diseases. In 2007, less than half of patients (42%) had a primary diagnosis of cancer, for a total of 447,600 cancer patients, compared with 597,500 patients with all other diseases.

Source: CDC. National Home and Hospice Care Survey data, 1992, 1994, 1996, 1998, 2000, 2002, 2004, and 2007. Additional information available at http://www.cdc.gov/nchs/nhhcs.htm.

QuickStats: Annual Number of Patients Discharged from Hospice Care, by Primary Diagnosis (Cancer Versus All Other Diseases)* --- United States, National Home and Hospice Care Survey, 1992--2007

Study Suggests Lower PSA Cutoff for Biopsy

By Charles Bankhead, Staff Writer, MedPage Today

An initial PSA value <3 ng/mL predicted a low risk of prostate cancer and a remote likelihood that a man would die of the disease, results of a large screening study showed.

Fewer than 6% of men developed prostate cancer over an 11-year period following a first-time screening PSA value lower than 3 ng/mL. Subsequently, 23 men died of the disease, resulting in a mortality of 0.15%, Dutch investigators reported in a study that will be presented here at the Genitourinary Cancers Symposium later this week.

The median time to diagnosis of prostate cancer in men with the lowest initial PSA values exceeded eight years, said Monique Roobol, MD, of Erasmus University Medical Center in Rotterdam.

The low cancer risk and prolonged interval to diagnosis have potentially major implications for use of PSA to screen for prostate cancer.

Early Baldness May Have Link to Prostate Cancer

By Michael Smith, North American Correspondent, MedPage Today

Men who start to lose their hair at age 20 may be more likely to develop prostate cancer later in life, a case control study suggested.

The study, involving 388 men with a history of prostate cancer and 281 without, found that those with prostate cancer were twice as likely to have early balding compared with healthy controls, reported Philippe Giraud, MD, PhD, of the Hôpital Européen Georges Pompidou in Paris, and colleagues.

However, the study found no link between hair loss at age 20 and early diagnosis of prostate cancer or tumor aggressiveness, Giraud and co-authors reported online in the Annals of Oncology.

Noting that there's currently no evidence of benefit for general screening for prostate cancer, the investigators suggested that their finding may help identify a subgroup of men who would benefit both from screening and possible early treatment.

FDA Okays First 3-D Mammogram Device

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By Cole Petrochko, Staff Writer, MedPage Today

The FDA has approved the first x-ray mammography device that provides 3-D images of the breast.

Approval of the Selenia Dimensions System was based on two studies asking radiologists to review 2-D and/or 3-D images from over 300 mammographies. Radiologists who viewed the 2-D and 3-D models were 7% more accurate in distinguishing cancerous and noncancerous cases than those who only used a 2-D image, an FDA statement said.
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Protein Related To Aging Holds Breast Cancer Clues

Source: Melissa Marino - Vanderbilt University Medical Center

The most common type of breast cancer in older women - estrogen and progesterone receptor (ER/PR) positive breast cancer - has been linked to a protein that fends off aging-related cellular damage.

A new study led by Vanderbilt-Ingram Cancer Center researcher David Gius, M.D., Ph.D., now shows how a deficiency in this aging-associated protein may set the stage for these tumors to develop.

The findings, published in Molecular Cell, provide information that could assist in the screening, prevention and treatment of these common age-related cancers.

While the young are certainly not spared cancer's wrath, cancer is primarily a disease of aging, with the majority of cases occurring in people over 50.
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Walking May Lower Mortality Risk in Prostate Cancer

By Charles Bankhead, Staff Writer, MedPage Today

Prostate cancer survivors can literally walk themselves to a lower risk of dying of the disease -- with some men achieving an almost 50% lower mortality risk, data from a large cohort study showed.

The study, involving more than 2,000 survivors of nonmetastatic prostate cancer, found those who walked at a normal to brisk pace for at least 90 minutes a week had a 46% lower mortality hazard -- and three or more hours of vigorous physical activity each week lowered the hazard to 49%, according to Stacey A. Kenfield, ScD, of the Harvard School of Public Health, and colleagues.

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Prostate CA Vaccine Stirs Interest, Lawsuits

By Charles Bankhead, Staff Writer, MedPage Today

For the second time in as many months, the Centers for Medicare and Medicaid Services (CMS) finds itself named in a lawsuit related to the agency's handling of the prostate cancer immunotherapy sipuleucel-T (Provenge).

Judicial Watch, a Washington-based public interest group, has sued HHS to gain access to documents related to the CMS decision to conduct a one-year national coverage analysis to assess whether the therapy is "reasonable and necessary," thus qualifying for Medicare coverage.

According to a Freedom of Information Act request filed in last November, Judicial Watch wants access to "all records concerning CMS' national coverage analysis of the vaccine Provenge, including but not limited to the criteria being used to analyze Provenge."

The legal action apparently has evolved from a suspicion that the national coverage analysis is the first step toward cost-based healthcare rationing.

In a statement posted on the Judicial Watch website, representatives of the organization noted that sipuleucel-T "costs $93,000 to administer the three necessary treatments. Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost. Yet, multiple press reports suggest that cost is the major factor in the unusual decision by CMS to undertake a review of the treatment which could signal a move by the Obama administration to begin implementing healthcare rationing based on the cost of treatments."
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Outrage: Choice Between Home and Medical Marijuana Cancer Treatment - AARP Bulletin

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by: Michelle Diament | from: AARP Bulletin

When Robert Jones, 70, was diagnosed with cancer in 2007, he found little relief for the pain that came with his intensive chemotherapy treatments. That is, until his doctor prescribed medical marijuana, which not only eased the pain, but also helped to improve his appetite and limit anxiety.

Today, though Jones' cancer is in remission, he continues to use marijuana to stem the lingering effects of the illness. But he recently learned that the treatment could cost him his home.

In October, the Las Vegas, N.M., resident received a letter indicating that he would no longer be eligible for the federal housing voucher that helps cover his $400-a-month rent. The reason: Though Jones' use of medical marijuana is permitted in New Mexico, the drug is not legal at the federal level, wrote Gilbert Almanza Jr., executive director of the San Miguel County Section 8 Housing Program.

Jones appealed the decision, saying he didn't know what he would do without the voucher. He worried that he would be forced to live in a nursing facility.

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Living Longer Comes With a Physical Cost - NYTimes.com

Image via CrunchBaseBy NICHOLAS BAKALAR

Americans are living longer, but those added years are more likely to be a time of disease and disability.

An analysis of government data has found that while life expectancy has steadily increased over the past decade, the prevalence of heart disease, stroke, cancer and diabetes has also increased, and disability has grown as well.

For example, in 1998 about 16 percent of men in their 70s had a mobility problem — that is, they failed one of four commonly used physical tests. By 2006, almost 25 percent failed at least one.

Writing in the January issue of The Journal of Gerontology B, the authors conclude that people live longer not because they are less likely to get sick, but because they survive longer with disease.
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Age No Barrier to Prostate Cancer Tx

By Todd Neale, Staff Writer, MedPage Today

Decisions about prostate cancer treatment may rely too heavily on age, research suggests.

In a study of nearly 12,000 men, older patients were less likely to get local therapy, regardless of disease risk, Matthew Cooperberg, MD, MPH, of the University of California San Francisco, and colleagues reported online in the Journal of Clinical Oncology.


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Stool Test Called Most Cost-Effective Colon Cancer Screen from MedPage Today

Fecal immunochemical testing every year came out on top in a cost-effectiveness analysis of the major colorectal cancer screening tests in average-risk North Americans, researchers said.

A computer model using published cost and efficacy data for eight different screening approaches indicated that fecal immunochemical testing, or FIT, conducted annually would lead to the fewest cancer cases and deaths and with the lowest cost, according to Braden J. Manns, of the University of Calgary in Alberta, and colleagues.

In a hypothetical cohort of 100,000 average-risk individuals, 1,393 screened with FIT would eventually be diagnosed with colorectal cancer and 457 would die, given mid-range assumptions about cost and efficacy, at a cost of $1,797 per person diagnosed, they reported online in Public Library of Science Medicine.

The same cohort would develop 1,796 to 4,857 colorectal cancers if screened with other modalities -- including fecal occult blood testing, colonoscopy, flexible sigmoidoscopy, CT colonography, two types of fecal DNA testing, and no screening -- and 593 to 1,782 deaths would result, Manns and colleagues determined.

Costs of screening and management would average from $1,864 to $2,667 per person with the other strategies.
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FDA Panel Rejects Prostate Drugs for CA Prevention from MedPage Today

An FDA advisory panel has voted overwhelmingly that GlaxoSmithKline's dutasteride (Avodart) and Merck's finasteride (Proscar) should not be used to prevent prostate cancer because the drugs are linked to a higher incidence of high-grade tumors.

Although the 5-alpha reductase inhibitors were shown to prevent low-risk cancers better than placebo, clinical trials painted a disturbing link between both drugs and an increased incidence of higher-risk prostate cancers.

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Hit to the Wallet Corrects ADT Use for Prostate Cancer from MedPage Today

By Charles Bankhead , Staff Writer, MedPage Today

Medicare accomplished what clinical guidelines and evidence-based medicine couldn't: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.

Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.

"Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy," Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.
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Cancer 'is purely man-made' say scientists after finding almost no trace of disease in Egyptian mummies | Mail Online

Image via WikipediaBy Fiona Macrae

Cancer is a man-made disease fuelled by the excesses of modern life, a study of ancient remains has found.

Tumours were rare until recent times when pollution and poor diet became issues, the review of mummies, fossils and classical literature found.

A greater understanding of its origins could lead to treatments for the disease, which claims more than 150,000 lives a year in the UK.

Michael Zimmerman, a visiting professor at Manchester University, said: 'In an ancient society lacking surgical intervention, evidence of cancer should remain in all cases.

'The virtual absence of malignancies in mummies must be interpreted as indicating their rarity in antiquity, indicating that cancer-causing factors are limited to societies affected by modern industrialisation.'

Dismissing the argument that the ancient Egyptians didn't live long enough to develop cancer, the researchers pointed out that other age-related disease such as hardening of the arteries and brittle bones died occur.
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• Is cancer caused by modern way of life? (respiratorytherapycave.blogspot.com)
• Cancer is purely a man-made condition (topinews.com)
• Cancer is a man-made disease, study claims (msnbc.msn.com)

Screening Continues Even for Terminal Cancer Patients

By John Gever, Senior Editor, MedPage Today

Many Medicare patients with advanced, poor-prognosis cancers still undergo routine screening with tests such as Pap smears, mammograms, cholesterol, and PSA tests -- despite the improbability of such tests being beneficial -- results of a large study showed.

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