Pharmacy & Therapeutics - December 2008 - (Page 723)

MEETING HIGHLIGHTS: Ophthalmic Summit and Onmark Forum Early in the disease, you can assess symptoms accurately, but with more advanced disease, the nerve endings begin to die and some patients experience less discomfort. Under treatment, the nerves can come back, increasing symptoms. This makes establishing endpoints for the clinical trials and getting subsequent approval by the regulators very challenging. said, “We have to educate them … to get these novel therapies approved.” Dr. Rittenhouse’s final message was upbeat, despite the obstacles. With about 25 agents in the ophthalmic pipeline, she said that successful treatments were on the horizon. REFERENCE Part of the solution, she suggested, is to work closely with the FDA throughout the approval process and to inform regulators about the complexities of the disease and its treatment. She 1. Yeh PT, Yang CM, Huang JS, et al. Vitreous levels of reactive oxygen species in proliferative diabetic retinopathy. Ophthalmology 2008;115(4):734–737.e1. Electronic version, January 4, 2008. Onmark National Payor/Provider Forum The nation’s leading oncology providers, as well as pharmaceutical manufacturers and health insurance executives, united in San Francisco in September to discuss solutions to improve patient care while controlling costs. McKesson, a health care services company, played a key role along with its group purchasing organization, Onmark. The forum featured presentations by United Healthcare, the American Society of Clinical Oncology, Memorial Sloan-Kettering Cancer Center, the Cancer Clinics of Excellence, and the University of Texas Health Sciences Center. Onmark, the forum host, is a McKesson Specialty Care Solutions Company. “Physician Extenders” Needed for Workforce Gap • Douglas W. Blayney, MD, Medical Director, Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Mich. Although the death rate from the common cancers, such as lung, colorectal, prostate, and breast, and other uncommon cancers has been decreasing, this favorable momentum in oncology care is threatened by a looming workforce gap, according to Professor Blayney, incoming president of the American Society of Clinical Oncology (ASCO) for 2009 and 2010. He noted that many factors are behind the decline in the death rate, including effective tobacco control strategies, better hormonal and chemotherapeutic treatments, and improved targeting of therapies. Mortality rates in the U.S. are particularly impressive, compared with non-U.S. rates. For example, the breast cancer mortality rate in the U.S. is at about 38%, about 7% lower than the rate in the United Kingdom (U.K.), despite the U.K.’s universal health care coverage and relatively homogeneous population. A Less Productive Workforce and an Aging Population The aging of the oncology care workforce is an emerging problem, Dr. Blayney said. A Rand Corporation survey commissioned by ASCO showed that younger oncologists are less productive than older ones. In the U.S., male oncologists 45 to 64 years of age in private practice conduct an average of 103.1 visits per week; male oncologists outside that age range, however, conduct only 83.9 visits weekly. In academic settings, the number of visits is lower (63.9 for the older physicians vs. 44.5), and fewer visits also take place among female oncologists in either age group. With the capacity for conducting visits projected to rise by only about 14% in the next 15 years while the demand for visits is surging up- ward with the aging population by about 48% in the same time frame, the Rand report concluded that no single potential remedy would fully close that gap. The lower lifetime productivity of younger oncologists, along with better therapies expanding the ranks of cancer survivors, can only confound the problem. The situation, Dr. Blayney said, leads to a clear conclusion: “There will be changes in our care model. We have to do our work in more efficient ways.” Many oncologists will increase their reliance on “physician extenders,” such as nurse-practitioners and physician assistants, to arrange patients’ schedules, administer chemotherapy infusions, assess side effects of treatment, and manage symptoms and complications through both face-to-face and telephone contacts. These extenders will also write chemotherapy orders and perform procedures. At his own institution, Dr. Blayney said that this extender group is “experienced and loyal;” about half of them have three to 10 years of oncology experience, and half have worked solely in their careers for the University of Michigan. ASCO data, however, show only a minority of physician assistants working in internal medicine and only 1% of nurse-practitioners specializing in oncology. The advantage of expanding the oncology clinical workforce through more use of physician extenders is that they will enable practitioners to see more patients and offer their services more effectively, he added. The scope of the practice and privilege of nurse-practitioners and physician assistants is established by state law. Clearly, Dr. Blayney said, there is room to establish best practices and to engage in training and continuing education for them. Both ASCO and the University of Michigan have expressed interest in moving forward in these arenas. “Given enough flexibility by payors,” he concluded, “I think we can offload some of the work currently done by oncologists to our collaborators who are trained professionals.” continued on page 732 Vol. 33 No. 12 • December 2008 • P&T® 723

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Pharmacy & Therapeutics - December 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Interpreting Estimates of Treatment Effects Chemotherapy Foundation Symposium XXVI: Innovative Cancer Therapy for Tomorrow Third Annual Onmark National Payor/Provider Forum Fourth Annual Ophthalmic Drug Development and Delivery Summit Classification and Pharmacological Management Of Obesity CE Test and Forms Season’s Greetings: Thanks to Our Readers and Reviewers

Pharmacy & Therapeutics - December 2008

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