Bailes J S
Texas Oncology, PA, Dallas 75231.
Semin Oncol. 1994 Dec;21(6 Suppl 14):34-7.
Cancer is unique because its management depends on novel therapies to a greater extent than most other diseases. State-of-the-art care requires access to physicians and facilities that specialize in cancer treatment; however, such access may be blocked by the gatekeeper in the managed care setting. One possible solution to this problem lies in the use of specialists to determine access to tertiary care facilities. Managed care facilities also may limit access to the comprehensive drug therapy required by cancer patients, often by restricting off-label drug uses. To solve this problem, criteria should be developed for the use of novel cancer therapies, such as whether off-label uses are supported by major medical compendia or peer-reviewed medical literature. Finally, managed care organizations may deny coverage of state-of-the-art care associated with clinical trials, which may limit the patient's ability to participate in clinical trials. Managed care organizations should cover such costs if they meet certain criteria, such as absence of clearly superior treatment. To provide comprehensive, state-of-the-art care for cancer patients, managed care organizations and oncologists must collaborate and find solutions to their mutual problems.
癌症具有独特性，因为与大多数其他疾病相比，其治疗在更大程度上依赖于新型疗法。最先进的治疗需要有专门从事癌症治疗的医生和设施；然而，在管理式医疗环境中，这种途径可能会被把关人阻断。解决这个问题的一个可能办法是利用专科医生来确定进入三级医疗机构的途径。管理式医疗设施还可能限制癌症患者所需的综合药物治疗，通常是通过限制药品的非标签使用。为了解决这个问题，应该制定使用新型癌症疗法的标准，比如非标签使用是否得到主要医学药典或同行评审医学文献的支持。最后，管理式医疗组织可能会拒绝为与临床试验相关的最先进治疗提供保险，这可能会限制患者参与临床试验的能力。如果符合某些标准，如不存在明显更优的治疗方法，管理式医疗组织就应该承担此类费用。为癌症患者提供全面、最先进的治疗，管理式医疗组织和肿瘤学家必须合作，并找到解决彼此共同问题的办法。
