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Susan Smith-Harmon

Susan Smith-Harmon

Doctors: Too few cancer patients enroll in studies

Wednesday, 29 January 2014 02:11 Published in Health & Fitness
One of every 10 clinical trials for adults with cancer ends prematurely because researchers can't get enough people to test new treatments, scientists report.
 
The surprisingly high rate reveals not just the scope and cost of wasted opportunities that deprive patients of potential advances, but also the extent of barriers such as money, logistics and even the mistaken fear that people won't get the best care if they join one of these experiments.
 
"Clinical trials are the cornerstone of progress in cancer care," the way that new treatments prove their worth, said Dr. Matthew Galsky of the Icahn School of Medicine at Mount Sinai Hospital in New York.
 
When an experimental drug or other treatment fails to make it to the market, people often think it didn't work or had too many side effects, but the inability to complete studies can doom a drug, too, Galsky said.
 
He helped lead an analysis of 7,776 experiments registered on Clinicaltrials.gov, a government web site for tracking medical experiments, from September 2005 to November 2011. All were mid- or late-stage studies testing treatments for various types of cancer in adults.
 
About 20 percent of the studies were not completed for reasons that had nothing to do with the treatment's safety or effectiveness (legitimate reasons for ending a study early). Poor accrual — the inability to enroll enough patients in enough time to finish the study — led to nearly 40 percent of premature endings.
 
Company-sponsored studies were less likely to be completed than those sponsored by the government or others. Late-stage cancer trials can cost companies "tens to even hundreds of millions of dollars," and that money is wasted if no clear answer on the drug's value is gained, said Dr. Charles J. Ryan, a cancer specialist at the University of California, San Francisco.
 
He heads the program for a conference later this week in San Francisco where Galsky's study will be presented. It was discussed Tuesday in a telebriefing by the American Society of Clinical Oncology, an organization for doctors who treat cancer.
 
Ryan and Galsky said they hoped the study would spur more research on why more patients don't participate. In most cases, the treatment being tested is provided for free, but there can be other costs such as lab tests. Some states require insurers to cover these additional costs, but others do not, so money may be one hurdle for patients.
 
Some doctors do not strongly encourage patients to participate in studies, and sometimes patients fear they'll get a dummy treatment instead of real medicine. However, in cancer clinical trials, ethical standards require that all patients get the current best care, plus a chance at an experimental treatment.
 
"Patients still have concerns about getting a placebo, but they're always going to get at a minimum the standard of care," said Shelley Fuld Nasso, head of the National Coalition for Cancer Survivorship, a patient advocacy and education organization.
 
Doctors need to encourage more patients to participate, and clinical trial designers need to make sure they are testing key questions and treatments to honor the contributions of study participants, she said.
 
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Online:
 
Cancer patient info: http://www.cancer.net
 
Decision-making guide: http://bit.ly/L67zkT
 
Clinical trials: http://www.clinicaltrials.gov
 
WASHINGTON (AP) — It seems to be something of an occupational hazard for President Barack Obama: When he talks about his health care law, he's bound to hit a fact bump sooner or later.
 
So it went Tuesday night, when he declared Medicare premiums have stayed flat thanks to the law, when they've gone up. As for an even bigger theme of his State of the Union address, the president's assertion that "upward mobility has stalled" in America runs contrary to recent research, while other findings support him.
 
A look at some of the facts and political circumstances behind his claims, along with a glance at the Republican response to his speech:
 
OBAMA: "Because of this (health care) law, no American can ever again be dropped or denied coverage for a preexisting condition like asthma, back pain or cancer. No woman can ever be charged more just because she's a woman. And we did all this while adding years to Medicare's finances, keeping Medicare premiums flat, and lowering prescription costs for millions of seniors."
 
THE FACTS: He's right that insurers can no longer turn people down because of medical problems, and they can't charge higher premiums to women because of their sex. The law also lowered costs for seniors with high prescription drug bills. But Medicare's monthly premium for outpatient care has gone up in recent years.
 
Although the basic premium remained the same this year at $104.90, it increased by $5 a month in 2013, up from $99.90 in 2012. Obama's health care law also raised Medicare premiums for upper-income beneficiaries, and both the president and Republicans have proposed to expand that.
 
Finally, the degree to which the health care law improved Medicare finances is hotly debated. On paper, the program's giant trust fund for inpatient care gained more than a decade of solvency because of cuts to service providers required under the health law. But in practice those savings cannot simultaneously be used to expand coverage for the uninsured and shore up Medicare.
 
___
 
OBAMA: "Today, after four years of economic growth, corporate profits and stock prices have rarely been higher, and those at the top have never done better. But average wages have barely budged. Inequality has deepened. Upward mobility has stalled."
 
THE FACTS: The most recent evidence suggests that mobility hasn't worsened. A team of economists led by Harvard's Raj Chetty released a study last week that found the United States isn't any less socially mobile than it was in the 1970s. Looking at children born between 1971 and 1993, the economists found that the odds of a child born in the poorest 20 percent of families making it into the top 20 percent hasn't changed.
 
"We find that children entering the labor market today have the same chances of moving up in the income distribution (relative to their parents) as children born in the 1970s," the authors said.
 
Still, other research has found that the United States isn't as mobile a society as most Americans would like to believe. In a study of 22 countries, economist Miles Corak of the University of Ottawa found that the United States ranked 15th in social mobility. Only Italy and Britain among wealthy countries ranked lower. By some measures, children in the United States are as likely to inherit their parents' economic status as their height.
 
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OBAMA: "We'll need Congress to protect more than 3 million jobs by finishing transportation and waterways bills this summer.  But I will act on my own to slash bureaucracy and streamline the permitting process for key projects, so we can get more construction workers on the job as fast as possible."
 
THE FACTS: Cutting rules and regulations doesn't address what's holding up most transportation projects, which is lack of money. The federal Highway Trust Fund will run out of money in August without action. To finance infrastructure projects, Obama wants Congress to raise taxes on businesses that keep profits or jobs overseas, but that idea has been a political nonstarter.
 
The number of projects affected by the administration's efforts to cut red tape is relatively small, said Joshua Schank, president and CEO of the Eno Center for Transportation, a think tank. "The reason most of these projects are delayed is they don't have enough money. So it's great that you are expediting the review process, but the review process isn't the problem. The problem is we don't have enough money to invest in our infrastructure in the first place."
 
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OBAMA: "More than 9 million Americans have signed up for private health insurance or Medicaid coverage."
 
THE FACTS: That's not to say 9 million more Americans have gained insurance under the law.
 
The administration says about 6 million people have been determined to be eligible for Medicaid since Oct. 1 and an additional 3 million roughly have signed up for private health insurance through the new markets created by the health care law. That's where Obama's number of 9 million comes from. But it's unclear how many in the Medicaid group were already eligible for the program or renewing existing coverage.
 
Likewise, it's not known how many of those who signed up for private coverage were previously insured. A large survey released last week suggests the numbers of uninsured gaining coverage may be smaller. The Gallup-Healthways Well-Being Index found that the uninsured rate for U.S. adults dropped by 1.2 percentage points in January, to 16.1 percent. That would translate to roughly 2 million to 3 million newly insured people since the law's coverage expansion started Jan. 1.
 
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OBAMA: "In the coming weeks, I will issue an executive order requiring federal contractors to pay their federally funded employees a fair wage of at least $10.10 an hour, because if you cook our troops' meals or wash their dishes, you shouldn't have to live in poverty."
 
THE FACTS: This would be a hefty boost in the federal minimum wage, now $7.25, but not many would see it.
 
Most employees of federal contractors already earn more than $10.10. About 10 percent of those workers, roughly 200,000, might be covered by the higher minimum wage. But there are several wrinkles. The increase would not take effect until 2015 at the earliest and it doesn't apply to existing federal contracts, only new ones. Renewed contracts also will be exempt from Obama's order unless other terms of the agreement change, such as the type of work or number of employees needed.
 
Obama also said he'll press Congress to raise the federal minimum wage overall. He tried that last year, seeking a $9 minimum, but Congress didn't act.
 
___
 
REP. CATHY McMORRIS RODGERS of Washington, in her prepared Republican response: "Last month, more Americans stopped looking for a job than found one. Too many people are falling further and further behind because, right now, the president's policies are making people's lives harder."
 
THE FACTS: She leaves out a significant factor in the high number of people who aren't looking for jobs: Baby boomers are retiring.
 
It's true that a large part of the still-high unemployment rate is due to jobless workers who have given up looking for a job. There are roughly three people seeking every job opening, a circumstance that can discourage others from trying. But one big reason people aren't seeking employment is that there are so many boomers — the generation born in the immediate aftermath of World War II — and therefore more than the usual number of retirements.
 
 ___
 
Associated Press writers Ricardo Alonso-Zaldivar, Christopher S. Rugaber, Joan Lowy, Sam Hananel and Tom Raum contributed to this report.
 
EDITOR'S NOTE _ An occasional look at political claims that take shortcuts with the facts or don't tell the full story.
   The St. Louis Major Case Squad is looking for a person of interest in the death of a Swansea, Illinois man.
   Police say a friend had called and asked them to check on 61 year old David Daughtrey.  Police arrived at Daughtrey's home in the 200 block of Mimosa Avenue and found him dead inside.  Investigators aren't calling his death a homicide, but say it is "suspicious."  
   Daughtrey's adult son, Jarad Daughtrey also lived in the home.  Police are calling him a "person of interest" in his father's death.  Police believe he may be driving his father's black, black Chrysler Town and Country van, with handicapped/military tags and Illinois plate number W280371.
   Anyone with information is asked to call the Major Case Squad at (618) 234-3291.

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