NCCN News

NCCN Unveils Evidence Blocks for CML and Multiple Myeloma

NCCN, a not-for-profit alliance of 26 of the world's leading cancer centers, today unveiled its new value initiative—the NCCN Evidence Blocks, published within new versions of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Chronic Myelogenous Leukemia (CML) and Multiple Myeloma.

“In cancer care, the most important value perspective is that of the individual patient,” said Robert W. Carlson, MD, chief executive officer, NCCN. “NCCN Evidence Blocks will educate providers and patients about the efficacy, safety, and affordability of systemic therapy, serving as a starting point for shared decision-making based on the individual patient's value system.”

The announcement was made at the NCCN 10th Annual Congress: Hematologic Malignancies at the San Francisco Marriott Marquis. The NCCN Annual Congress focuses on the increasingly complex treatment of hematologic malignancies and new approaches that have been incorporated into patient management, including the use of drugs, biologics, and diagnostics.

The NCCN Evidence Blocks are published in a new version of the NCCN Guidelines and are intended as a visual representation of five key value measures that provide important information about specific Guidelines recommendations:

  • Efficacy of regimens,
  • Safety of regimens,
  • Quality and quantity of evidence for regimens,
  • Consistency of evidence for regimens, and
  • Affordability of regimens.

In a rapidly evolving field like oncology, thousands of new publications are released each year, adding to the existing body of knowledge and resulting in improvement in outcomes. In publishing the NCCN Guidelines, panel members are able to integrate new findings with existing information to determine what the evolving standard of care should be for a given disease state. Implicit in the evaluation of each treatment is the efficacy and expected associated toxicities, as well as the quality, quantity, and consistency of the evidence supporting the recommendation.

By adding affordability to NCCN's existing criteria for evaluating treatment options, patients will be empowered to identify, alongside their physician, optimal treatment based on clinical and economic considerations that are of most value to them. The affordability measurement represents an estimate of overall total cost of a therapy, including but not limited to acquisition, administration, in-patient versus outpatient care, supportive care, infusions, toxicity monitoring, antiemetics and growth factors, and hospitalization.

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NCCN EVIDENCE BLOCKS CATEGORIES AND DEFINITIONS

Citation: Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 13, 11; 10.6004/jnccn.2015.0171

“Some patients will want an emerging therapy even with limited data; others will be most concerned about the expected side effects of the treatment indicated in the safety column. Still others may be very sensitive to cost,” Dr. Carlson said. “By considering the attributes of the range of possible therapies, the health care provider and the patient can discuss the benefits and drawbacks of each option and come to a decision most acceptable to the individual.”

By the end of 2015, NCCN expects to publish NCCN Evidence Blocks for systemic therapies (not surgery or radiation therapy) in the NCCN Guidelines for Breast, Colon, Non-Small Cell Lung, and Rectal Cancers; NCCN Evidence Blocks for systemic therapies are expected to be contained within the complete library of NCCN Guidelines by the end of 2016.

In addition to the usefulness of the conversation that the affordability dimension produces, the design of the resulting NCCN Evidence Blocks, with its signature blue squares, provides oncologists a valuable reference.

“In an age of visual information, the NCCN Evidence Blocks are a time-saving tool for efficient scanning and interpretation of multiple therapy options in an efficient format,” said Dr. Carlson.

The concept of NCCN Evidence Blocks was first announced in March 2015 during the NCCN 20th Annual Conference: Advancing the Standard of Cancer Care in Hollywood, Florida.

The NCCN Guidelines are the recognized standard for clinical policy in cancer care and are the most thorough and most frequently updated clinical practice guidelines available in any area of medicine. Available free of charge to registered users of NCCN.org, the NCCN Guidelines cover 97 percent of all patients with cancer.

In the near term, NCCN will continue to publish two sets of NCCN Guidelines: those including NCCN Evidence Blocks and those published without. The NCCN Evidence Blocks are not currently published in the NCCN Guidelines for Patients, and are intended for use in the United States only.

For more information about NCCN Evidence Blocks, visit NCCN.org/EvidenceBlocks and follow NCCN on Twitter: @NCCNNews, #NCCNValueChat.

Save the Date! NCCN Patient Advocacy Summit to Explore Patient Perspectives of Value in Cancer Care

Please join NCCN on Tuesday, December 1, 2015, at The National Press Club in Washington, DC, when NCCN holds its 6th Annual Patient Advocacy Summit: Value in Cancer Care – Patient Perspectives.

This event will provide a forum for discussion of challenges and obstacles that impact and hinder patient access to appropriate care, offer a chance for the oncology community to discuss cost and payment for medical interventions, and provide an opportunity to address how patients define value in cancer care.

Access to appropriate cancer care is of vital importance to all people with cancer and their families. The inability to obtain the right cancer care in a timely manner can have devastating results—medically, psychologically, and financially. Therefore, it is critical that patients have access to provider networks that include oncologists and cancer centers and that these are located in reasonable proximity to the patient. However, to help control costs, many plans limit access to the kinds of specialists cancer patients need, leading to adverse effects on people with cancer and their caregivers.

The Access to Cancer Care segment will feature a keynote address from Loyce Pace, MPH, LIVESTRONG Foundation, followed by a roundtable discussion including the following panelists: Amanda Bennett, author of The Cost of Hope and Washington Post columnist; Bonnie Miller, RN, BSN, OCN, FAAMA, Fox Chase Cancer Center; and Ms. Pace. Network adequacy and access, formulary access, out-of-network referrals, and the resulting high cost sharing are all possible topics for discussion.

While value is often an elusive concept, it is particularly so when applied to cancer care. Most simply, value is usually understood as the outcome when benefits exceed cost. The Institute of Medicine (IOM) defines value as “best care for lower cost.” But, defining benefits and costs relative to cancer care is extremely difficult. Exactly which costs should be considered, and who determines what benefit is? Less expensive care does not contribute to value if the quality of care is insufficient.

Alan Balch, PhD, Patient Advocate Foundation will present a keynote address to commence the summit's second segment, Defining Value in Cancer Care, followed by a roundtable featuring Dr. Balch; Robert W. Carlson, MD, NCCN; and Shelley Fuld Nasso, National Coalition for Cancer Survivorship. The panel discussion will address current efforts to define value in the treatment of patients with cancer.

The rising cost of cancer care is creating a huge burden on patients and on the U.S. health care system as a whole. Cancer care is expensive and the related expense continues to rise faster than the overall rate of health care expenditures in the United States—more than 15% annual versus 3%. Innovation, which leads to new diagnostics and treatments in oncology and, ultimately, improved outcomes, also comes at a cost. In particular, drug prices for new treatments are escalating at an alarming rate.

The day's final roundtable, titled, Cost of Cancer Care and the Patient Impact, will feature Dan Klein, Patient Access Network Foundation; and Leonard Saltz, MD, Memorial Sloan Kettering Cancer Center. The panel will focus on how drug costs, patient assistance programs, indication- and performance-based pricing, and biosimilars are directly impacting people with cancer.

Please continue to check back for updates to the agenda and additional speakers and panelists. For more information and to register for the event, visit NCCN.org/Policy.

Recap of NCCN Policy Summit: Value, Access, and Cost of Cancer Care

Value is not a simple term to define in cancer care. Though value is often understood as benefits of treatment or quality of care weighed against the economic cost, it has been less clear which costs and benefits must be considered. The combination of increasingly unsustainable rises in the costs of cancer care, the accelerating pace of expensive innovations in oncology, and persistent hope for rescue in patients with life-threatening disease require solutions that incorporate and promote value.

To address mounting concerns about value and access in oncology care, NCCN, as part of its Oncology Policy Program, hosted its Policy Summit: Value, Access, and Cost of Cancer Care, on September 11, 2015, at The National Press Club in Washington, DC.

Moderated by Scott Gottlieb, MD, American Enterprise Institute of Public Policy, this summit provided health care providers, government and regulatory organizations, managed care organizations, pharma-biotech companies, and patient advocacy groups with a forum to explore the convergence of access, value, and cost, and the impact of these three elements on the care of people with cancer. The summit featured three roundtable discussions following the NCCN Work Group reports on access, value, and cost.

During the summit's opening presentation, Maggie Egan and Sharon Stranford, PhD—both cancer survivors—described their experiences as patients at City of Hope Comprehensive Cancer Center, noting the unique attributes at City of Hope that heightened their experience at City of Hope compared to local community hospitals. Among considerations for patients to make when choosing a treatment setting, Ms. Egan and Dr. Stranford noted the importance of specialized staff oncologists and radiologists, localized accommodations for out-of-town patients, and the inclusion of the patient's complete caretaker team in treatment decision-making and implementation.

Following a presentation from Robert Diasio, MD, Mayo Clinic Cancer Center, on NCCN's Work Group Report on Access, the day's first panel discussion, The Impact of Access on the Treatment of Cancer, featured the following panelists: Elizabeth Carpenter, Avalere Health; Dr. Diasio; Kavita Patel, MD, The Brookings Institution; Mike Taylor, AON Hewitt Health and Benefits; and Julie Wolfson, MD, MSHS,University of Alabama at Birmingham Comprehensive Cancer Center. Mr. Taylor and panelists discussed the impact employers have on ensuring their employees have access to academic cancer centers. The need for further education of employers around the necessity for adequate cancer care in their health plans was emphasized.

Stanton Gerson, MD, Case Comprehensive Cancer Center, presented the NCCN Work Group Report on Value, followed by the second panel, The Value Proposition. Panelists included Joseph Alvarnas, MD, City of Hope Comprehensive Cancer Center; Gwen Darien, Cancer Support Community; Dr. Gerson; Mike Kolodziej, MD, Aetna; and David Rubin, Memorial Sloan Kettering Cancer Center. Ms. Darien discussed how patients view value differently and often in a very personal context compared to other stakeholders and used the Cancer Support Community's Cancer Experience Registry to provide data on how patients view value.

The final NCCN Work Group Report on Cost, presented by Barbara Parker, MD, UC San Diego Moores Cancer Center, was followed by The Cost Conundrum, featuring the following panelists: Steve Miller, MD, Express Scripts; Dr. Parker; Gayle Petrick, Patient Advocate Foundation; Michael Rabow, MD,UCSF Helen Diller Family Comprehensive Cancer Center; and Warren Smedley, MSHA, University of Alabama at Birmingham Comprehensive Cancer Center. Much discussion focused on the high cost of drugs and the use of formularies and the future use of indication-based formularies and pricing. Panelists also examined the high cost of end-of-life care and efforts to reduce costs in this area of care.

A detailed paper about the Work Group meeting and policy summit will be published in the winter of 2016. For more information about the NCCN Oncology Policy Program, visit NCCN.org/policy.

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