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Medicare HMO Costs May Prevent Cancer Patients from Enrolling in Clinical Trials, UPCI Study Finds​

PITTSBURGH, September 23, 2008 — Newly diagnosed cancer patients who are enrolled in Medicare’s Health Maintenance Organization (HMO) plans may be unlikely to participate in clinical trials because of prohibitive costs, according to a study by the University of Pittsburgh Cancer Institute (UPCI). Under these HMO plans, covering people age 65 and older, patients are required to pay both a deductible and 20 percent of the treatment cost. As a result, access to state-of-the-art care is limited for some of society’s most vulnerable members. This research will be announced during the American Society for Therapeutic Radiology and Oncology’s 50th Annual Meeting in Boston.

According to Chyongchiou Lin, Ph.D., lead author of the study and associate professor of health economics in UPCI’s Department of Radiation Oncology, two-thirds of cancer patients are age 65 or older, with 60 percent of new cancers—and 70 percent of cancer-related deaths—occurring in this age group. At the same time, less than one-third of clinical trial enrollees fall into this age group, and patients often cite cost and insurance coverage as barriers to their participation. Because the Medicare HMO payment policy requires significant personal expense, Dr. Lin and her team believe the disparity in clinical trials representation and the payment policy are likely to be related.

“Clinical trials are the cornerstone in finding better, more effective cancer treatments,” said Dr. Lin. “The National Cancer Institute (NCI) has made clinical trial participation a national priority, yet current Medicare reimbursement policies present a participation barrier for a large number of patients, cutting them off from cutting-edge treatments. The current policy should be re-examined to be consistent with NCI initiatives.”

The study shows the overall proportion of newly diagnosed cancer patients who had consultations and were insured by Medicare HMOs increased from 21 percent in 2003 to 27 percent in 2007 in five hospitals participating in the UPMC McKeesport Radiation Oncology Community Outreach Program (ROCOG). ROCOG involves a consortium of hospitals in western Pennsylvania and is funded by NCI’s Radiation Research Program and the Cancer Disparities Research Partnership, focusing on improving access and outcomes for underserved populations with cancer. The research team in the lead community hospital participating in the program found in 2007 that patients eligible for innovative clinical trials often opted out of enrolling in a “Medicare Qualifying” clinical trial due to the financial burden of participating.

The abstract, “Does Medicare HMO Reimbursement Policy Hinder Clinical Trial Participation?” will be presented at a poster discussion session at 1:45 p.m., Tuesday, Sept. 23.

Founded in 1984, the University of Pittsburgh Cancer Institute became an NCI-designated Comprehensive Cancer Center in only six years, a record time. UPCI, the only cancer center in western Pennsylvania with this elite designation, serves the region’s population of more than six million. Presently, UPCI receives a total of $174 million in research grants and is ranked 10th in funding from NCI.

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