Healthcare experts at the Mayo Clinic Institute for Value-Based Medicine® event, hosted by The American Journal of Managed Care (AJMC), tackled two pressing issues in cancer care: the role of cannabis in symptom management and the escalating costs of cancer treatments.
Cannabis in Cancer Care Management
Marie Parish, PharmD, BCOP, a gastrointestinal oncology pharmacist at Mayo Clinic, reports daily inquiries from patients and providers about incorporating cannabis into cancer symptom management. With Minnesota's recent legalization of recreational marijuana in 2023, following its 2014 medical legalization, understanding cannabis use has become increasingly important.
Parish outlined three cannabis strains with distinct profiles: Cannabis sativa (higher THC:CBD ratio), Cannabis indica (higher CBD:THC ratio), and Cannabis ruderalis (low THC content). She typically recommends indica for its sedating properties, pain management benefits, and appetite stimulation effects.
Currently, three FDA-approved synthetic cannabis products exist, with nabilone and dronabinol specifically approved for chemotherapy-induced nausea and vomiting (CINV). A 2020 study showed promising results for THC:CBD combinations in CINV management, with 25% of patients reporting complete response compared to 14% in the placebo group.
Escalating Drug Costs and Policy Solutions
S. Vincent Rajkumar, MD, highlighted the critical issue of cancer drug costs, with new treatments approaching $200,000 annually. He emphasized how recent policy changes, including the Inflation Reduction Act, are beginning to address these challenges.
Key developments in drug pricing reform include:
- Medicare's new authority to negotiate drug prices 7-11 years post-launch
- Mandatory rebates for price increases exceeding inflation
- A $2,000 out-of-pocket cap on Medicare Part D drugs starting January 2025
- Growth in nonprofit generic and biosimilar manufacturers
Accelerated Approval Pathway Concerns
The panel, including Clayton Irvine, PharmD, and Chelsee Jensen, PharmD, expressed concerns about the FDA's accelerated approval pathway. Research indicates that 22% of cancer drugs approved through this pathway between 2013 and 2017 were subsequently withdrawn.
Jensen proposed linking drug pricing to demonstrated effectiveness, suggesting lower initial prices until confirmatory trials are completed. Irvine advocated for financial penalties when manufacturers withdraw products, emphasizing accountability in the drug development process.
The experts stressed the importance of cost transparency and physician involvement in treatment cost discussions. They called for reforms in patent protection, generic drug market entry, and pharmacy benefit manager practices to address the ongoing challenges in cancer care affordability.
