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Reward Doctors For Whole Patient Care - Not Just Treatments

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National Coalition for Cancer Survivorship Acting President Ellen Stovall emphasized the need for drastic changes in how physicians are reimbursed for care. The panel discussion, titled "Cancer as a Chronic Disease: What Should be Done to Serve Cancer Survivors in 2009 and Beyond?," opened the 14th annual conference of the National Comprehensive Cancer Network and included several cancer experts as well as cancer survivor Elizabeth Edwards and New York Times writer Jane Brody.


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The whole concept of proper genetic markers is not to put patients in the position of having to receive toxic cancer drugs if they're not going to do any good. However, genomics is far too limited in scope to encompass the vagaries and complexities of human cancer biology.

The situation with Erbitux and Vectibix for colon cancer, Iressa and Tarceva for lung cancer, and Herceptin for breast cancer is that all the mutation or amplication studies can tell us is whether or not the cancer cells are potentially susceptible to this mechanism of attack.

They don't tell you if one drug or the other is worse or better than some other drug which may target this. The cell is a system, an integrated, interacting network of genes, proteins and other cellular constituents that produce functions.

No genetic profile can discriminate differing levels of anti-tumor activity occurring among different targeted therapy drugs. Nor can it identify situations in which it is advantageous to combine a targeted drug with other types of conventional cancer drugs.

"Targeted" drugs are poorly-predicted by measuring the ostansible "target," but can be well-predicted by measuring the effect of a drug on the function of live cells, the net effect of all processes, not just the individual molecular targets.

The benefits of newer targeted therapies are marginal. These targeted therapies may impart a clinical benefit by stabilizing tumors, rather than shrinking them (substituting shrinkage for stabilization).

I would not want to be denied treatment with any targeted therapy because of a gene mutation or amplication. Genetic testing is not a clear predictor of a lack of benefit.

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