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Tarceva, No!!! Assisted Suicide, Yes!!!!

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Drug company supplies cancer drug Oregon Health Plan won't

By The Associated Press

EUGENE, Ore. — After weeks of bad news, things turned Barbara Wagner’s way this week.

Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, Wagner was notified that the Oregon Health Plan wouldn’t cover it.

It would cover comfort and care, including, if she chose, doctor-assisted suicide.

Then on Monday a representative of the pharmaceutical company Genentech called Wagner and offered the medicine for free.

Wagner said she didn’t know whether to laugh or cry, so she did both.

Treatment of advanced cancer meant to prolong life, or change the course of this disease, is not covered by the Oregon Health Plan, said the unsigned letter Wagner received from LIPA, the Eugene company that administers the plan in Lane County.

Officials of LIPA and the state policy-making Health Services Commission say they’ve not changed how they cover treatment of recurrent cancer.

But local oncologists say they’ve seen a change and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

It doesn’t adhere to the standards of care set out in the oncology community, said Dr. John Caton, an oncologist at Willamette Valley Cancer Center.

Studies have found that chemotherapy can decrease pain and time spent in the hospital and increases quality of life, Caton said.

The Oregon Health Plan started out rationing health care in 1994.

Conditions such as pregnancy, childbirth and preventive care for children lead the list. At the bottom are uncovered procedures such as cosmetic surgery.

“We can’t cover everything for everyone,” said Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, which administers the Oregon Health Plan.

“Taxpayer dollars are limited for publicly funded programs. We try to come up with polices that provide the most good for the most people. Most cancer treatments are high priority on the list,” Shaffer said.

But the intent of the list was to exclude coverage of treatments that are futile, or where potential benefit is minimal in relation to expense.

Dr. David Fryefield, medical director of the Willamette Valley Cancer Center in Eugene, said Oregon Health Plan policies and the priorities, definitions and tests, are 15 years old.

As of now any treatment that doesn’t provide at least a 5 percent chance of survival after 5 years won’t be approved.

Last fall the commission said coverage of palliative care for patients with advanced cancer would not include chemotherapy or surgical intervention intended primarily to prolong life or alter disease progression.

“We wouldn’t consider that to be a change in policy,” he said. “They wanted to point out examples of things that wouldn’t be covered to be more explicit. Palliative care is intended to relieve symptoms ... for patients with a fatal prognosis.”

Dr. Som Saha, a Portland internist and chairman of the Health Services Commission, said chemotherapy is rarely the only way to relieve symptoms.

Cancer drugs can cost $6,000 a month, oncologists say. Tarceva, the drug that Wagner’s oncologist prescribed, costs $4,000 a month.

Fryefield said chemotherapy today often falls in a gray area between comfort care and a cure.

Commission members say the health plan also must consider those who lack even basic care.

Wagner said she was devastated when she found out the plan doesn’t cover Tarceva.

“I think it’s messed up,” Wagner said, bursting into tears.

“The letter said doctor-assisted suicide would be covered. To say to someone, ‘we’ll pay for you to die, but not pay for you to live,’ it’s cruel,” she said. “I get angry. Who do they think they are?”

Dr. John Sattenspiel, senior medical director for LIPA, said that at some level doctor-assisted suicide could be considered as a palliative or comfort care measure. “We had no intent to upset her, but we do need to point out the options available to her under the Oregon Health Plan,” he said

Wagner, 64, lives in a low-income apartment in Springfield with her dachshund, Chachi. She’s a divorced mother, grandmother and great-grandmother, retired from driving a school bus and waiting tables.

She quit smoking when she was diagnosed about two years ago. Her oncologist, Dr. Jae Lee, treated the cancer with chemotherapy and radiation, and it went into remission, she said.

In early May, a CT scan showed it was back, and Lee prescribed Tarceva.

Studies show that one-year survival for patients who took Tarceva was 31.2 percent.

Lee said Wagner has already lived much longer than a typical lung cancer patient and said he thinks Tarceva would help.

Lee appealed to Genentech, which markets Tarceva in the United States.

On Monday, Genentech was told it would cover the drug for a year, at which time she could reapply.

“It’s fantastic,” she said. “I can’t wait to start the medication.”

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Thank you for exposing THEM !! This is unbelievable. It reminds me of how Ford once calculated the cost between fixing the problems with the Pinto, and the cost of paying all the lawsuits from the deaths incurred from rear end collisions!!

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I've always been impressed by Oregon's assisted suicide law (the only state in the Union that has one, I believe) as I believe that should be a choice for terminally ill patients who have reached a point where buying time would not include quality time.

I had no idea, however, that Oregon does not provide comfort care for the terminally ill and am shocked that is the case since it is comfort care that buys the very quality time we are all seeking.

To advise a patient IN THE SAME LETTER that comfort care is not provided, but that assisted suicide is, is HEINOUS!


Life is a Terminal Condition

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To advise a patient IN THE SAME LETTER that comfort care is not provided, but that assisted suicide is, is HEINOUS!

I SO agree with you, Carole. It's heinous.

By that line of thinking, there could be folks needing first line therapies that wouldln't be covered depending on a doctor's choice of words. I know Mom's treatment was considered, "Palliative" from the beginning. But she was still doing agressive chemo and hoping for remission.

This makes me Angry.

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