THE RAPID REPORTER
Association of Community Cancer Centers 33rd Annual National Meeting
March 28–31, 2007
Rockville, MD%u25BA Hospice Care Delayed by Targeted Cancer Drug Discoveries Oral administration changes perceptions of severity, outcome of illness.
New cancer treatments, which enable patients to take drugs orally instead of by intravenous infusion, are impacting the way terminal cancer is viewed by patients and doctors.
“A better understanding of the recentlyapproved oral agents for cancer is making us lean more toward oral administration and away from intravenous infusion, but we’re changing more than that,” Dr. Alice P. Chen of the National Cancer Institute’s Investigative Drug branch said. “We’re changing patient care trends. Patients are always looking for signs that their disease isn’t terminal, and admission to a hospice confirms it is. Putting patients on oral medications when the response rate may be one percent or less delays acceptance of the terminal nature of the disease and of hospice care.”
Dr. Chen shared her observations during a presentation at the Association of Community Cancer Centers 33rd Annual National Meeting in March.
Hospice providers, she said, are already reporting a ‘backlash’ of sorts from the newly approved oral chemotherapies. “Fewer side
effects and the ability to take medications at home may reinforce a longstanding reluctance to accept that death is approaching,” she said. “Patients may defer enrolling in hospice, or clinicians may wait to refer patients while they try a newer oral medication at the patient’s request.” Patients may suffer needlessly without palliative care and both they and their families have much less time to establish a relationship with the hospice as a result.%u25BA Counterfeit Drugs: Biopharmaceuticals Not Immune to Crime Rising costs, availability of oral versions, likely to heighten risk.
Biologic drugs, including cancer treatments, are not immune to the attempts of counterfeiters who try to pass sophisticated-looking fakes offas the real thing, according to one large community cancer services provider.
“Historically, oncolytic agents have been infusible or injectable drugs,” Rolando DeCardenas, vice president of pharmaceutical distribution for US Oncology said at the Association of Community Cancer Centers meeting. “But now that many are available in tablet form, they could potentially be easier to counterfeit.”
Counterfeiters have already infiltrated the biologic cancer therapy market, as illustrated by a spate of adulterated drugs in 2002. Among the list of adulterated pharmaceuticals that year was Procrit (epoetin alfa). Several cases of the Ortho Biotech drug, used to treat chemotherapy-associated anemia, were replaced by vials containing an extremely diluted version which could have caused patients to be underdosed had the fakes not been discovered.
The high price of some of the newer anticancer biologics makes them a target for counterfeiters who, as in the Procrit example, literally water them down and sell them at full price to unsuspecting cancer care centers. “Oncology drugs represented about $40 billion in sales in 2005 and 2006,” Mr. DeCardenas says. “This area is expected to grow to even larger.”
Mr. DeCardenas said oncologists at cancer centers should insist drugs be purchased directly from manufacturers. “It is difficult to tell at the oncologist level if a drug has been adulterated,” he said. “More sophisticated counterfeiters use equipment that makes pills and bottles appear remarkably authentic. These drugs are then sold at steep discounts to secondary wholesalers.” Cancer centers may be tempted to buy from secondary wholesalers rather than manufacturers for lower prices, he said, but these price breaks are rarely passed on to patients.
US Oncology recently implemented an “electronic pedigree” system which tracks the movement of oncology drugs through the supply chain, from plant to patient. Further down the road, Mr. DeCardenas predicts scannable radio frequency identification tags (RFID) will track drug delivery, allowing the recipient to immediately see the drug’s up-to-the-minute travel history.%u25BA Genetic Counseling Seeks a Niche in Community Cancer Care More referrals can translate into more lives saved, geneticists say.
As more genetic mutations associated with the potential development of certain cancers are discovered, some genetic counselors say society isn’t keeping up with science.