From James H. Essell, MD, a medical oncologist, hematologist and bone and marrow transplant specialist at OHC

April 24, 2019

OHC, one of a select few certified independent cancer practices in the country, is offering CAR-T cell therapy for adult blood cancer patients who have exhausted all other treatment options. OHC is bringing hope with this cutting-edge therapy. Patients outside the Cincinnati market are coming to OHC to be evaluated and for second opinions.

Recently, The Columbus Dispatch, the local newspaper in Columbus, Ohio featured an interview by James H. Essell, MD, OHC transplant specialist, about CAR-T cell therapy. OHC experts have been treating patients since last fall and are seeing positive results. To learn more about CAR-T and meet with an OHC doctor, please call 1-888-649-4800 or click here.

Column: Clinic is safe, convenient setting for cancer therapy
The Columbus Dispatch, April 2019

As a physician, I know all too well that there’s nothing easy about receiving a cancer diagnosis. Patients are always eager to start the most effective treatment as soon as possible, and it’s my job to determine the best path forward and stand with them along the way. The good news is that there are promising clinical trials for new cancer treatments being conducted in Ohio and across the country. In hospitals and community settings alike, the science and technology are advancing every day.

As a doctor who conducts clinical trials in the community setting, it’s vital for my patients that the government not unintentionally limit access to care by covering only treatments performed in hospitals. One of the most promising new treatments is known as chimeric antigen receptor T cell therapy. The way CAR-T works is a patient’s own immune-system cells are removed, re-engineered in a lab to fight cancer and then returned to the patient. We already have seen positive outcomes from patients treated with CAR-T across the country.

CAR-T cell research and development continues to evolve at a rapid pace and treatment is expected to transition to the outpatient setting in the future. This would result in more Americans having access to this innovative treatment. However, the Centers for Medicare and Medicaid Services recently released a proposal that would cover CAR-T only when it is conducted in hospital settings. This is short-sighted for several reasons.

First, it’s important to understand that community oncology clinics have significant experience and capabilities in complex treatments, and are highly capable of administering CAR-T treatment. In fact, many community clinics, including mine in Ohio, have been conducting scientific research, including Phase I-IV clinical trials, for many years. Care for stem-cell and bone-marrow transplant patients, which is similar in complexity to CAR-T treatment, is also effectively provided in the community setting.

Further, community clinics that already have experience with clinical trials are well-suited to put in place clinical protocols to predict and mitigate potential post-treatment complications. They also have the experience and efficiency needed to meet data collection and reporting requirements. Put simply, these facilities are already operating at a high level and conducting lifesaving treatments every day. If a community oncology clinic is able to meet government safety criteria, then there should be no need to limit CAR-T coverage to hospitals.

Second, by covering only CAR-T performed in hospitals, CMS’ proposal would potentially put cancer patients in a position where they face difficulty finding a provider. Many patients prefer to receive care in the community setting because it allows them to stay close to their homes, families and support networks; this rule would force these patients away from their preferred care setting at perhaps one of the most difficult times of their lives. Further, community-based practices have a proven ability to coordinate interdisciplinary care and close monitoring and follow-up of patients. During the first 30 days after CAR-T infusion, patients require regular follow-up by their care team.

The convenience of receiving care in a community setting could have a positive impact on not only the patients’ treatment process, but also their recovery. Additionally, studies on cancer treatments already show that cost of care and the rate of emergency department visits are lower for patients in the community setting, and this rule would force patients into the higher-cost hospital setting.

By covering CAR-T in hospital and nonhospital settings alike, the government can ensure that it is not limiting patient access to promising cancer care. This science and technology is evolving by the day, and it’s important that we are not unintentionally denying future patients the treatment they need. We have a responsibility to help more, not fewer, Americans facing a difficult cancer diagnosis access this lifesaving treatment.

James H. Essell, MD, is a medical oncologist, hematologist and bone and marrow transplant specialist at OHC who also serves as the medical director of the Blood Cancer Center in Cincinnati.

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