CANCER THERAPY: WHEN ALL ELSE FAILS: "myChoice HRD"
So a patient with advanced prostate cancer fought like hell for several years by undergoing several courses of hormonal and other chemotherapy. His physician calls the family together for a meeting with the patient. "But doctor are you telling me there is nothing left, I'm a fighter and will try anything with a reasonable chance of slowing this tumor. I still have things I want to do?" Some may proffer a deadly "YES" answer which immediately robs the patient of the will to live.
You should be aware of the movement in medicine of boarding and certifying the new specialty of "Palliative Medicine Specialist". What do these physicians do? They offer certain and comfortable death. They offer sophisticated Hospice care. They compete for early patient care and will instruct you on end of life issues. Sound familiar? Ask Obama who wrote that into the "Affordable Care Act".
I became aware of this new specialty when I attended a yearly meeting at Scripps Medical Center last year. The Palliative Care Specialist from back East was a speaker who was making a plea to the medical oncologist audience that they should immediately call a medical palliative care expert at the first hospitalization of any cancer patient so they could establish a close, early patient-physician relationship. I was shocked that he was invited to speak at a meeting that characteristically discusses the newest cutting edge cancer therapies.
So what's up? Call me a skeptic; I follow the money, government money that is (money we sent them). It is a known fact the most dollars spent for a patient's medical care occur during the last year of life. Medicare is usually the responsible party paying for that year. Medicare is broke! Honestly, very broke! Newest cancer care costs "big time - very big time". Morphine and nausea medicine are both very cheap, can be administered by a physician assistant or nurse and is considered by government bean counters to be "cost-effective palliative therapy".
OK. So what would a knowledgeable oncologist have to offer as a Hail Mary therapy for this patient. One possibility is the newest immunotherapy however that costs $100,000.00 dollars. Who would pay? Medicare doesn't pay for that. Why not? Because they deem that therapy experimental and they will not allow you to try it. You mean a government bureaucrat somewhere in Washington DC decides if I can have that or not? You bet. Another possibility is use of the laboratory test called "myChoice Homologous Repair Deficiency" or "myChoice HRD" for short to decide if select drugs will help. The test is done on older stored or fresh tumor tissue sitting in the pathology lab.
myChoice HRD is being used to predict the likelihood that an advanced cancer patient may substantially respond to platinum and other DNA toxic medications as well as to a new pill called a PARP inhibitor. Three of these PARP inhibitors have been FDA approved for restricted use; primarily in breast and ovary cancer. The cost is approximately $14,000.00 dollars per month. They have been effective in approximately third of prostate cancer patients ready to throw in the towel. My patient insists he have his original tumor tissue tested.
Do you think that the new palliative care specialists knows about that new test? Do you think that your care should be turned over to that new specialist trained in morphine, nausea medication and hand holding? I believe government is ready to insist on it. Those with the gold make the rules. Good bye.
Glenn Tisman, M.D.
You should be aware of the movement in medicine of boarding and certifying the new specialty of "Palliative Medicine Specialist". What do these physicians do? They offer certain and comfortable death. They offer sophisticated Hospice care. They compete for early patient care and will instruct you on end of life issues. Sound familiar? Ask Obama who wrote that into the "Affordable Care Act".
I became aware of this new specialty when I attended a yearly meeting at Scripps Medical Center last year. The Palliative Care Specialist from back East was a speaker who was making a plea to the medical oncologist audience that they should immediately call a medical palliative care expert at the first hospitalization of any cancer patient so they could establish a close, early patient-physician relationship. I was shocked that he was invited to speak at a meeting that characteristically discusses the newest cutting edge cancer therapies.
So what's up? Call me a skeptic; I follow the money, government money that is (money we sent them). It is a known fact the most dollars spent for a patient's medical care occur during the last year of life. Medicare is usually the responsible party paying for that year. Medicare is broke! Honestly, very broke! Newest cancer care costs "big time - very big time". Morphine and nausea medicine are both very cheap, can be administered by a physician assistant or nurse and is considered by government bean counters to be "cost-effective palliative therapy".
OK. So what would a knowledgeable oncologist have to offer as a Hail Mary therapy for this patient. One possibility is the newest immunotherapy however that costs $100,000.00 dollars. Who would pay? Medicare doesn't pay for that. Why not? Because they deem that therapy experimental and they will not allow you to try it. You mean a government bureaucrat somewhere in Washington DC decides if I can have that or not? You bet. Another possibility is use of the laboratory test called "myChoice Homologous Repair Deficiency" or "myChoice HRD" for short to decide if select drugs will help. The test is done on older stored or fresh tumor tissue sitting in the pathology lab.
myChoice HRD is being used to predict the likelihood that an advanced cancer patient may substantially respond to platinum and other DNA toxic medications as well as to a new pill called a PARP inhibitor. Three of these PARP inhibitors have been FDA approved for restricted use; primarily in breast and ovary cancer. The cost is approximately $14,000.00 dollars per month. They have been effective in approximately third of prostate cancer patients ready to throw in the towel. My patient insists he have his original tumor tissue tested.
Do you think that the new palliative care specialists knows about that new test? Do you think that your care should be turned over to that new specialist trained in morphine, nausea medication and hand holding? I believe government is ready to insist on it. Those with the gold make the rules. Good bye.
Glenn Tisman, M.D.
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