Providers

Many in the endocrinology community still endorse using metformin first in patients with type 2 diabetes, but that isn’t really necessary any more now that sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are available, said Darren K. McGuire, MD, MHSc, professor of medicine in the Division of Cardiology, Dallas Heart Ball Chair for Research on Heart Disease in Women, Distinguished Teaching Professor, at the University of Texas Southwestern Medical Center.

In a debate at the American Diabetes Association 80th Scientific Sessions, Darren K. McGuire, MD, MHSc, professor of medicine in the Division of Cardiology, Dallas Heart Ball Chair for Research on Heart Disease in Women, Distinguished Teaching Professor, at the University of Texas Southwestern Medical Center, will discuss whether sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are ready to be used for primary cardiovascular prevention.

Recommendations that patients with rheumatoid arthritis see an expert within 6 weeks of symptom onset can provide challenges for practices.

American Medical Group Association (AMGA) is asking CMS to permanently extend the telehealth flexibilities it instituted as a result of the coronavirus disease 2019 (COVID-19).

Drugs used to treat rheumatic conditions suppress the rogue immune system, but it has been unclear whether patients using immunosuppressants have an increased risk of a more severe course if they are infected with the coronavirus disease 2019 (COVID-19).

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

When patients present to the emergency department (ED) with sickle cell disease (SCD)–related pain, they often have been experiencing that pain for days, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

More data is needed to get wider acceptance of the use of palliative care services for patients with blood cancers, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Patients with sickle cell disease already face suspicion and biases based on their need for opioids, and African American patients also face additional racial biases, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

There is not a lot of evidence on how well nonpharmacologic treatments work to treat sickle cell disease–related pain, and it can be difficult to get people access to these treatments, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

There are shortcomings in the ways we have approached value assessment to date, writes the executive director of the Innovation and Value Initiative.

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.

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.

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.

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.

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.

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.

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.

Providers have an inefficient business model that’s become so deeply ingrained, they simply can’t fathom how else to do business as the industry shifts to value-based care.

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.

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.

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.

The next era in treating mantle cell lymphoma will use precision medicine to target therapies in a personalized way, said Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at MD Anderson.

The terminology for smoldering myeloma has been around for decades, but more discussion over what it means and who it really applies to is needed, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco, explains how her research into disparities in pediatric acute myeloid leukemia (AML) may help identify the cause of those disparities and how best to intervene in order to improve outcomes for these patients.