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Emerging HDRP Priorities and ASCO Presentations

The popularity of health services research was again evident at the health services research and quality of care oral abstract session on May 30, 2015.  About half an hour into the session a crew of conference employees arrived to seat attendees, as the Chicago fire marshal has prohibited standing in the back of conference rooms.  Every seat was taken when they finished.

The session was organized into three sub-sessions with three presentations and a discussant in each.  The presentations were universally well-done and interesting.  In the interests of brevity, I am going to focus on one presentation of each sub-session.

The first sub-session focused on patient-level interventions.  Note that promoting such interventions is a priority for our new program, as represented by the creation of our Health Systems and Interventions Research Branch.  My early career involvement in assessing physician-level barriers to clinical trial enrollment, plus my more recent involvement in the NCI Community Oncology Research Program (NCORP), caused me to be specifically interested in observational study of a “cancer care equity program” implemented at Massachusetts General Hospital.  The program sought to reduce indirect financial barriers to clinical trial enrollment, such as travel and lodging.  Ryan Nipp and his co-authors reported an increase in clinical trial enrollment from the year before to the year after program implementation, particularly among racial minorities and patients living more than 50 miles away.  I hope the group moves forward to a randomized controlled trial designed to be translatable to and sustainable at other institutions.

The second sub-session focused on costs of care.  Peter Bach of Memorial Sloan Kettering Cancer Center served as the discussant and posed some provocative questions.  The focus of his presentation was his assessment that we as a society have accepted the following priorities in evaluating oncology drugs:  efficacy then toxicity then cost.  Dr. Bach wonders why we as a society accept this.  He also asked why we are unable to say no to drugs based on their price.  This particularly resonated with me because of a conversation I overheard on a hotel shuttle the day before.  Someone I do not know, from an unnamed biotech company, was discussing the cost of a new product.  They stated “we do not intend it to be cheap” and went on to say that they plan to make it more expensive for use in children than in adults.  Our hope is that our new Program will be able to promote research to better understand how policymakers and society make decisions about drug availability and treatment.

The third sub-session was focused on decision-making.  As the leader of the NCI team responsible for a RFA targeting physician and system roles in continuing non-evidence-based care, I was particularly interested in the presentation by Allison Lipitz Snyderman of Memorial Sloan Kettering.  She and her co-authors conducted an analysis of SEER-Medicare data showing a patient is three times more likely to receive unnecessary imaging if the physician’s immediately prior patient had received such imaging.  They concluded that physician “habit” is an important driver of unnecessary care.  The discussant, Caprice Greenberg of the University of Wisconsin, noted the need to look to behavioral science to help understand how to address these “habits.”  Again, this is another priority area for our Program, which expanded to include several colleagues from our sister program in behavioral research.

What were you struck by at this session?

Ann M. Geiger, MPH, PhD; Acting Associate Director

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