Medicare now denying certain cancer treatments

[NancyL555823]

I am a senior, AARP member, a pharmacist, and still working in a hospital oncology department. I have been specifically working in oncology for around the last fifteen years.

Unfortunately, as we get older, our chances of having a cancer diagnosis increase.

Elderly Medicare patients that have worked their entire lives and paid into the Medicare system are now being denied treatments that are part of standard, specific to their disease state protocol, better tolerated by their age group, and life extending just because they are now requesting that certain genetic markers be present before approval. Most of these are immunotherapy treatments, one being Keytruda. FDA has approved these medications for several types of cancer because they have been shown to work, and the tumors are seen as highly susceptible to immune attack.

 These medications have been added as a part of the treatment protocols for these cancer types.

The cancer treatment medications are part of specific protocols listed in the NCCN guidelines. Patients go through evaluation in the protocol process, may have done well or had problems, and then need to move to the next treatment option or management.

This is why research is done (to bring new, better treatment options and extend life) and protocols are set. Real World Data plays a part in establishing these protocols. It shows what works and how to incorporate the findings into treatments.

Putting it in simple terms, treatment selection is very complicated and requires time spent developing a care plan for each individual, their tumor type, and identifying their other health issues that need to be addressed. Besides, what are the guidelines address, like for tumor types, drug interactions, side effects, etc., outlying considerations include age, tolerability, expected response, success, and compassion being the biggest ingredient. These decisions are weighed by the provider and the team. Try to help: do no harm.

We look for remission or tumor size decrease and slowed growth, but at the end of the designated treatment time, one needs to look at the maintenance treatment in the protocols that are best for the individual patient. The immunotherapy medications are high on the list. Patients who have already been on these medications and done well are having their treatments stopped. The choice at that point is to go to a more severe treatment plan that will lead them to hospice. This is already happening.

Who is making these decisions? This is elder abuse and clearly an unethical, nonscientific, compassionate decision. Let’s try to stop it quickly.

[GailL1]

@NancyL555823 

The decision is being made by Science - the standards for older adults haven’t changed for many years.

NCCN.org - Older Adult Oncology- Guideline

Overly cautious - perhaps but that is also because there is little data from clinical trials on this advanced age group.  Plus there are so many variable in older adults and their various chronic illnesses and physical condition.  

I am also pretty sure that Keytruda is pretty much always discontinued after 24 months since after that time they suspect that adverse conditions begin to occur.

Read the article in the NCCN - dated 09/2021- they have always recommended a Geriatric Assessment along with other reviews of the advanced age patient - in the beginning and then again before any other treatment is started, if it is - 

[JamesL772796]

Thank the new FDA head  and RFK

[GailL1]

@JamesL772796 

Good Grief - The Guideline for Older Adult Oncology 

National Comprehensive Cancer Network.org - Older Adult Oncology