PAGE 16 / FEBRUARY 25, 2003

ASCO Leaders Respond to Critique of

‘Chemotherapy Concession’
By Joan Klein lished on the subject of the “chemother- ing extensively from critics who want the lead paragraph in the piece.
apy concession.” The article’s point of to reduce or remove the concession. Although abuses of the system were
n a strongly worded letter to The view was summed up in the headline: “At a time when overall spending given in some detail, an explanation of

I New York Times, ASCO President

Paul A. Bunn, Jr, MD, and
Immediate Past President Larry
Norton, MD, took issue with a January
27th front-page article the paper pub-
“Drug Sales Bring Huge Profits, and
Scrutiny, to Cancer Doctors.”
The article thoroughly covered the
way the system of buying and dispens-
ing chemotherapy agents works, quot-
on prescription drugs is soaring, cancer
specialists are pocketing hundreds of
millions of dollars each year by selling
drugs to patients—a practice that
almost no other doctors follow,” said
how and why it came about was men-
tioned only in passing.
The Jan. 29th letter from Drs. Bunn
and Norton did not deny that abuses
occur, nor did they defend the current
model. “The oncology community
agrees that the system for cancer care
reimbursement needs to be fixed,” they
wrote, but added that changes should
be carried out within the context of
overall reform.
The letter pointed out that high
reimbursement of cancer drugs bal-
ances out underpayment in other essen-
tial areas such as chemotherapy admin-
istration, the costs of equipment and
drug preparation, and psychological,
nutritional, and family counseling.
“Cutting drug reimbursement
without increasing reimbursement for
other necessary patient services will
mean that doctors and hospitals will
not be able to afford to provide life-sav-
ing and life-prolonging outpatient
chemotherapy,” the letter concluded. OT

Dr. Pazdur
continued from page 14

important to patients, but response rate

does not include stable disease, which
is measured in time to progression. The
number of complete versus partial
responders needs to be considered.
Location of response is also important,
as is whether response is associated
with improved symptoms.
Despite a high degree of measure-
ment bias, “response rate is a meaning-
ful endpoint for medical oncologists
and patients because it provides imme-
diate gratification. You can show that
information to patients,” Dr. Pazdur
commented.
Oncology agents that have been
approved on the basis of response rate
and duration of response include gos-
erelin, anastrozole, letrozole, and
toremifene.
Once an afterthought, quality-of-
life measures are increasingly being
considered in the drug approval pro-
cess, he noted. Valid quality-of-life
measures with predefined questions
should be carefully integrated into the
protocol.
In the end, though, survival is still
the most important endpoint, Dr. Paz-
dur said. “Even though the FDA may
accept other endpoints for approval of
a drug, we will probably require that

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