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In laboratory experiments, we can nearly guarantee that the intervention being tested is received, short of human error. We cannot control whether the patient arrives at the clinic, but when we prescribe medications that are given intravenously, we can very accurately record whether the medication was administered. With oral medications, however, there are many black holes both in research and clinical settings, and despite the best efforts to measure adherence, the impact of nonadherence is largely unknown.

In an era when oral drugs are increasingly becoming a part of our approach to care for patients with cancer, adherence to prescribed therapy is essential. Yet the statistics cited by Dr Hansen are a stark reminder that despite our best intentions, cancer patients do not and will not always take oral medications the way in which they are directed. For the clinician, this poses a challenge as to how best to confront this troublesome issue in order to improve outcomes for the patients entrusted to our care. The details of such an effort may vary from cancer center to cancer center.

Table 1
Oral Agents With First-Line Indications in Ambulatory Cancer Treatment
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The proteasome inhibitor carfilzomib is a promising new agent for the treatment of multiple myeloma (MM). Data presented at the 53rd Annual Meeting of the American Society of Hematology (ASH) highlighted a role for this agent in both the frontline and relapsed and/or refractory settings.


It is well documented that healthcare costs and spending have been growing at staggering rates. Healthcare accounts for ~17% of total gross domestic product (GDP) in the United States. In comparison, in 1960, healthcare only accounted for about 5% of GDP. Our current level of spending is nearly double the average percentage of GDP of every other country in the world. Total healthcare spending comes from many sources, including but not limited to hospital care, physician and clinical services, nursing home care, administrative costs, and prescription drugs.

Dr Hansen’s article brings to light financial aspects of healthcare that we do not often consider. A recent economic analysis showed the total cost of cancer care in the US reached $209.9 billion in 2005.1 The high costs of chronic cancer care come in second to cardiac disease (23% and 38%, respectively).2,3 However, increased costs do not yield longer life.

The past decade has seen a dramatic upsurge in the utilization of specialty pharmacies for all types of therapeutic modalities, including those for cancer. The cost of cancer care may rise from about $125 billion in 2010 to $207 billion by the end of the decade.

The evolution of drug research and development toward oral therapies for cancer over the past decade has created a number of questions for the oncology healthcare provider. Will insurance companies pay for these exceptionally expensive medications? How and when will patients receive their medication? Who will be responsible for ensuring patient education and monitoring to maximize safe drug administration and patient compliance?

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