CHARLESTON, W.Va. -- "I give the tumor six months to live."
These are the words that we, as physicians, would prefer to use when talking to a patient about their cancer. Despite decades of progress that have seen the death rate due to cancer drop, sometimes dramatically for specific forms of cancer, we are not quite to the point where we are measuring the survival of the tumor, rather than the patient.
However, recent advances in molecular biology may be hastening the arrival of that day. The state of West Virginia has been investing heavily in the possibilities of these technologies. All of the major universities and health-care systems have active translational research institutes, seeking to use these new technologies to deliver better health care to West Virginians. This has also led to greater research collaborations throughout the state.
For instance, the West Virginia Cancer Genomics Network is a major collaborative effort between the Charleston Area Medical Center, Marshall University, and West Virginia University to scour the genomes of the most common cancers for new targets for drugs, and new information that can help doctors know which treatment will be most effective against their patient's cancer.
Further, this technology is reducing the cost of developing new treatments. By enrolling only those patients whose tumors have the drug's target, fewer patients are needed to complete trials. This makes drug research faster and cheaper, and promising new drugs thus reach patients quicker and at less cost.
For some of the most common cancers in West Virginians, lung and colon, Cabell Huntington Hospital / Marshall University are already performing testing that tells doctors if the tumor has specific targets that make it likely, or unlikely, to respond to specific chemotherapy drugs, with West Virginia University soon to offer this testing as well. Indicated for the most advanced and deadly forms of these cancers, these tests offer hope to patients whose tumors are found likely to respond, while avoiding unnecessary side effects from giving drugs to patients whose tumors will not be affected by them. To the health-care system at large, they offer tremendous cost benefits, as the comparatively inexpensive lab test determines the course of care costing many tens to even hundreds of thousands of dollars.
In recognizing the current critical, and increasing, use of these kinds of "personalized medicine" tests, Medicare created new billing codes for the most commonly tested cancer genes. These codes went into effect this year. Medicare selected a method for determining reimbursement for these tests, which, up to this point, did not sufficiently take into account data about the cost of performing these tests. As a result, the current level of reimbursement for several of these well-established tests is below the cost of providing the test -- even for the lung and colon testing currently used on West Virginia patients with the most advanced forms of these cancers.
In the Mountain State, we know better than to be penny wise and pound foolish. By not reimbursing even the cost of providing these tests, Medicare runs the real risk that these tests will no longer be offered -- anywhere. But without this kind of testing, we are back to the treatments of decades past, where tens of thousands of dollars are spent causing patients to suffer side effects of drugs with no chance of impacting their particular cancer. New drugs for our fellow West Virginians with cancer resulting from our millions of dollars of investment in translational research across the state risk being stalled or scuttled if this sets the precedent for our willingness and ability to offer the "personalized medicine" testing that will tell us which patients will benefit from these new drugs. Thus, to save on a few hundreds or thousands of dollars of laboratory tests, Medicare risks quality of care for patients with cancer and tens to hundreds of thousands of dollars of healthcare savings.
Fortunately, Medicare is now aware of the problem. In response to letters from members of the U.S. House of Representatives and Senate, Medicare has expressed the intention to further examine the actual cost of providing this technology. It is our hope that this re-examination will result in reimbursement rates that will allow laboratories across the country to provide this service to our patients.
Representatives David McKinley, Shelley Moore Capito and Nick Rahall, as well as Senators Jay Rockefeller and Joe Manchin, have consistently pledged to ensure that all West Virginians have cost-effective access to the highest quality of health care we can provide. If we wish to continue to provide the cutting edge of cancer care in West Virginia, please remind our elected federal officials of that pledge and encourage our delegation to join their colleagues in Congress and ask Medicare to provide for the cost of this care.
Oakley is an assistant professor of pathology and a doctor at Marshall University.