And there are doctors who prescribe fourth or fifth line chemotherapy agents to patients whose bodies have been wracked by their first treatments. "The fact is, once you've had one or two lines of treatment, you're much more debilitated, and there's no evidence to suggest these other treatments will work in these situations."
Sledge says ASCO now has its Quality Oncology Practice Initiative certification program for outpatient oncology practices, which inspects those facilities for adherence to more than hundreds of quality measures.
"In many centers, in many nursing personnel have not received appropriate training," he says.
ASCO certified practices must have someone trained in life support on the premises when chemotherapy is given, and must give competency assessments and education to new staff regarding all routes of drug administration, in order to prevent patients from experiencing drug toxicity.
But only 200 practices across the country are certified so far, and thinks payers should demand, before they reimburse clinicians, that they undergo such certification from some organization.
While he can't say that care in non-certified practices is poor, "but what's pretty obvious is that when you look at practices that have instituted (certification protocols), you see significant upticks in treatment plans, followup, and documentation of what the patient has been through. You see rapid and significant increases in safety measures."
Payers should put their feet down and not pay for unnecessary care. Why don't more of them refuse now? And certification and accreditation of cancer hospitals and practices, with solid measurements that we know exist, should be expected and publicized. These would be two great places to start.