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July 1, 2021

The Oncology Care Model at 5 Years—Value-Based Payment in the Precision Medicine Era

Author Affiliations
  • 1Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Tennesee Oncology, Nashville, Tennessee
  • 3Abramson Cancer Center, University of Pennsylvania, Philadelphia
  • 4Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Oncol. 2021;7(9):1283-1284. doi:10.1001/jamaoncol.2021.1512

Cancer is the fastest growing area of health care spending, translating to high financial burden for patients.1,2 Recognizing this, the Center for Medicare and Medicaid Innovation (CMMI) introduced the Oncology Care Model (OCM) in 2015, a voluntary alternative payment model (APM) focused on driving value-based cancer care.

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    1 Comment for this article
    Problems and prospects in cancer genomic medicine in Japan
    takuma hayashi, MBBS, DMSci, GMRC, PhD | National Hospital Ornization Kyoto Medical Center
    In Japan, cancer genomic medicine was performed to a total of 876 cases (229 cases tested by NCC Oncopanel, 647 cases tested by Fundation One CDx) during the two years from June 2019 to May 2021 based on the results of cancer genome tests conducted at national university hospitals. Various antitumor agents were recommended for patients with endometrial cancer (2 cases), cervical cancer (2 cases), ovarian cancer (3 cases), peritoneal cancer (2 cases), pancreatic cancer (3 cases), rectal cancer (5 cases), appendiceal cancer (1 case), small intestinal cancer (1 case), appendix cancer (1 case), breast cancer (3 cases), neuroblastoma (2 cases), Adrenocortical carcinoma (1 case), or thyroid cancer (1 case).

    At the National University Hospital in Japan, in cancer genomic medicine held so far, immune checkpoint inhibition (25 cases), anti-HER2 antibody drug (18 cases), anti-BRAF agent (18 cases), anti-FGFR agent (17 cases), anti-CDK4/CDK6 agent (10 cases) and anti-EGFR agents (10 cases) were recommended for patients with various cancer types and malignant tumors.

    Japan Ministry of Health, Labor and Welfare of has stated the following points as future issues.
    1. In TMB, 10/MB is the cutoff value. However, is this 10/MB appropriate as a cutoff value to judge
    as TMB-High?
    2. As a problem of quality control of samples, there is a concern about DNA fragmentation due to
    long-term storage of samples. As a problem with the sample collection site, there is concern
    about DNA fragmentation due to radiation therapy (RT).

    Since many Japanese pharmaceutical manufacturers are under the umbrella of global pharmaceutical companies with headquarters in other countries, it is not easy to incorporate Japanese patients into clinical trials of new antitumor agents. Also, cancer genomic testing is covered by insurance, but patients have to pay about US $ 1500.

    From September 2021, Foundation One CDx for liquid biopsy sold by Chugai Pharmaceutical Co., Ltd., which is under the umbrella of Roche, will be covered by insurance. As a result, cancer patients will have more options for cancer genome testing. However, Japan Government and the Ministry of Health, Labor and Welfare should consider lowering the insurance points for cancer genomic medicine tests so that many cancer patients can undergo cancer genomic testing.

    It is important to improve the problems that have been recognized in the conventional cancer genome testing and medical treatment. In the future, if it becomes cheaper and the need for tissue collection and pathological tissue becomes less, the cancer genome test is likely to be more accessible for many cancer patients.

    Disclosure of potential conflicts of interest
    The authors declare no potential conflicts of interest.

    We thank all the medical staffs and co-medical staffs for providing and helping medical research at National Hospital Organization Kyoto Medical Center.

    Dr. Hayashi T. and Dr. Konishi I.
    National Hospital Organization Kyoto Medical Center