Interviews

Ibrutinib quickly became the de fact standard of care to treat chronic lymphocytic leukemia, but the high price presents a problem for the US healthcare system, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Toxicities like cytokine release syndrome, along with other factors, limit widespread use of CAR T-cell therapies, said Reona Sakemura, MD, PhD, postdoctoral researcher at the Mayo Clinic.

The integration of real-world data into clinical research may mark a shift away from clinical trial information, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

Improving recognition of the link between heart failure and diabetes can promote preventive care for at-risk patients, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.

Patients had never been particularly enthusiastic about using opioids to treat their pain related to sickle cell disease, but they are more cautious now, especially as they are often meet with suspicion of addiction, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

Co-pay accumulator adjustment programs are meant to ensure that individuals are responsible for the full amount of their insurance deductible, which should help promote healthcare consumerism, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Managing people with sickle cell disease and complex chronic pain is difficult and requires some trial and error, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

As new therapies come to market for pediatric acute myeloid leukemia, there will be a lot of questions to answer regarding dosing and where these drugs are used in the patient journey, said Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia.

Patients with myelofibrosis can see their quality of life impacted in a range of ways with various symptoms, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Minimal residual disease (MRD) may be prevalent in clinical trials and discussed at conferences, but it is not really used widely in practice, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Population health models that include social determinants of health can help employers design more strategic benefits that will provide an effective solution for all individuals who receive that insurance, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

While ibrutinib is a major breakthrough in treating chronic lymphocytic leukemia, it is associated with financial burdens and medical concerns for the older patients being treated, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Diabetes Can Break Your Heart is an important initiative that highlights the vital need for heightened education on the link between diabetes and heart failure, especially with American Heart Month looming, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.

Research has shown that fedratinib favorably impacts health-related quality of life for patients with myelofibrosis across the board, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Making benefit design more nuanced through the inclusion of employee variables could help increase the impact of value-based insurance design for employers, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

As a result of the opioid epidemic, there have been instances where it has been difficult to treat patients with pain related to their sickle cell disease because of new policies in place intended to curb addiction and overdoses, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia, highlights the coming advances in pediatric acute myeloid leukemia (AML) that she is the most excited for.

While minimal residual disease (MRD) has been a topic of research for at least a decade, right now it is more top of mind than ever before for people treating cancer, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

An array of different techniques, including direct primary care, are being used by employers to manage healthcare costs while keeping care affordable for employees, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Quality of life is an important end point in clinical trials, and it is important to discuss that with regulatory agencies, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

There are numerous conditions, including many rare and difficult to recognize disorders, which can be mistaken for MS, said Andrew Solomon, MD, associate professor of neurological sciences and division chief of multiple sclerosis at Larner College of Medicine, The University of Vermont, Burlington, Vermont.

Since there are aspects of care in clinical trials that might not be mandated, research is being done to see whether there are socioeconomic disparities for things like supportive care for children with cancer, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

In research presented at the 61st American Society of Hematology Annual Meeting and Exposition, Abby Statler, PhD, MPH, MA, research associate, Cleveland Clinic, and her colleagues found that African Americans with acute myeloid leukemia (AML) may be excluded from clinical trials due to renal dysfunction, despite it having no impact on AML outcomes.

Employers’ decisions around purchasing healthcare plans should focus on a broader measure of value, including employee productivity, not just cost, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Thomas Frisell, PhD, coordinator of the Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden, discusses whether patients with multiple sclerosis (MS) have an elevated risk for cardiovascular disease.

So far, minimal residual disease (MRD) has not been used much outside of clinical trials, but researchers are testing how it might be used to guide decisions in clinical practice, said Lindsey Roeker, MD, clinical fellow at Memorial Sloan Kettering Cancer Center.

Symptoms are not random chance—they have a real link to biological drivers of the disease and understanding them is important, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.