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ASCO 2017: Improving the Patient-Doctor Immunotherapy Discussion

Tony Hagen @oncobiz
Published: Monday, May 22, 2017

Oncologists are less willing to talk about immunotherapy options than patients would like, and new clinical trials are increasingly concentrated in certain geographical areas, affecting access to care, according to a sampling of abstracts in the care delivery category at the 2017 ASCO Annual Meeting, to be held June 2 to 6 in Chicago.

The studies also examine the degree to which oncologists’ prescribing patterns are affected by pharmaceutical industry payments and how patient choices about treatment location would be affected by greater awareness of chemotherapy drug shortages and drug substitutions.

Communication between patients and doctors on immunotherapy is hampered by patients’ preconceptions, according to a study from the Winship Cancer Institute and Emory University School of Medicine.1 The authors said the communication barrier most frequently cited by physicians was patients’ misconceptions about immunotherapy’s effectiveness.

Fifteen oncology physicians who provide immunotherapy and 18 oncology patients who received immunotherapy were surveyed. They provided responses based on a 1-to-5 impressions scale, with 5 being the most positive; and a 1-to-5 potential-to-be-cured scale. Results of the survey supported the belief that patients were very hopeful about immunotherapy’s potential to overcome their disease: the average score patients gave on the impressions scale was 4 and on the potential-to-be-cured scale, 3.9.

The researchers were curious about the state of communication on immunotherapy, given that it is a promising new therapeutic approach in cancer treatment and few guidelines exist on what should be communicated between physicians and patients. Provider and patient preferences for information as well as barriers to communication were identified.

Patients said they were most interested in discussing treatment options, benefits, treatment logistics, and side effects with their providers. Providers said they felt the most important topics to discuss with patients were side effects, a realistic view of benefits, and treatment logistics. Whereas half of patients wanted to discuss treatment options, just 1 physician mentioned discussing options.

Pharma Payments and Prescribing Patterns

Oncologists who receive pharmaceutical industry payments prescribe more of those company’s drugs, according to a study from The University of North Carolina at Chapel Hill.2 Researchers found that general payments, for meals, speaking fees, and lodging correlated with increased prescriptions, although less-consistent results were found for manufacturer research payments to oncologists.

The study began with the premise that financial relationships between physicians and pharmaceutical companies are numerous and have the potential to inappropriately affect prescribing patterns. “Oncology may be an ideal setting to study the influence of industry payments on physician drug choice given the high levels of competition for market share and high prices commanded by orally administered oncologic drugs,” the authors wrote.

The researchers examined data from the Medicare Part D Prescriber file and the Open Payments federal resource for information on payments that drug and device companies make to physicians for travel, research, gifts, speaking fees, and meals. Open Payments also provides information on physician ownership interests in pharmaceutical companies.

The researchers narrowed the study to the prescription of on-patent drugs for metastatic renal cell cancer (mRCC) (sunitinib, sorafenib, and pazopanib) and chronic myeloid leukemia (CML) (imatinib, dasatinib, and nilotinib). “The primary, binary independent variable was receipt of payments from a manufacturer of 1 of these drugs in 2013; the primary dependent variable was choosing that manufacturer’s drug in 2014,” the authors wrote.

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