Seniors battling cancer must also battle CMS

[Christine]

Grand Forks Herald

By Valerie Kummer,

Published Sunday, October 21, 2007

ST. PAUL - Lung cancer is one of the major lung diseases the American Lung Association battles. It is estimated that this year alone, 213,380 people will be diagnosed with lung cancer. While we search for a cure to this terrible disease, it is essential that we continue to improve treatment.

Unfortunately, CMS (Centers for Medicare and Medicaid Services) recently established a new policy that undermines the quality of treatment for seniors with cancer. This National Coverage Decision (NCD) applies to erythropoiesis-stimulating agents (ESAs). For those who are unfamiliar with cancer, ESAs help the body make red blood cells, which are frequently compromised during chemotherapy. When red blood cell levels drop to dangerous levels, patients experience anemia and are either treated with ESAs or given a blood transfusion. In the eyes of patients battling cancer, ESAs have dramatically improved their quality of life.

In establishing this policy, CMS ignored FDA recommendations as well as the oncology community and patient advocates who repeatedly warned that such a policy will be bad for seniors with cancer. The American Society of Clinical Oncology, the American Association of Cancer Research, U.S. Oncology and numerous other clinical experts and patient advocates have taken an immediate and vocal stand in defense of ESAs as a vital treatment option that should be left to the discretion of a patient's doctor.

As many as 15 percent of cancer patients with hemoglobin levels above the level specified by CMS as “appropriate” for treatment will be denied ESAs as a result of the NCD. Their risk for a transfusion will jump by as much as 50 percent. Additionally, 70 to 80 percent of patients experience fluctuating hemoglobin levels when they are first introduced to ESAs. Under the NCD, these patients will have four weeks to get their hemoglobin levels below the mandated 10 g/dL before they are denied further ESA treatment. At that point, doctors will have to choose whether to comply with CMS' arbitrary mandates or deliver essential care to their patients.

What will it take to convince CMS that the ESA issue runs deeper than their jurisdiction? Clearly FDA guidelines are no longer enough. Until CMS brings certified specialists and patient advocates on staff to help establish a national policy, Congress must step in to protect patients and ensure that doctors can provide the best care possible to all patients, including seniors. Congress has heard that call and is working right now to overturn the NCD.

Please urge Rep. Earl Pomeroy (D-N.D.) and Sens. Kent Conrad and Byron Dorgan (D-N.D.) to support this effort. It is time once again to allow the experts who have conducted clinical trials and treated patients with ESAs first-hand to make a decision that works for - not against - seniors fighting the battle of their lives against cancer.