oncotype DX

SweetC

I just came from my oncologist and she talked to me about a new test called the oncotype DX. This test accesses the likelhood of a breast cancer recurrence within 10 years. The results of this test can determine what type of treatment I would most benefit from. Whether I should start chemo now or just take a hormone thearpy such as tamoxifin. Has anyone been told about this test. The problem is that since the test is new some insurance companies do not cover it. You would not know if your insurance covers it until you agree to the test. The test uses the tissue collected during my surgery for mastemony. Therefore I would not have to give any further tissue. The test cost about $3600. Now this test can be very benefical in deciding should I take chemo. Therefore I would not be getting overmedicated. I personnaly feel that the test is worth it, because my insurance company could save alot of money if I do not need chemo. So the test would be worth it. My doctor said that if they do not pay it it can be appealed. This can be a long drawn-out process. Again, why subject my body to chemo when the test may show that the chances of recurrence are less than 1 percent in my case. The test may show that I have a high recurrence rate. The the doctor would know what type of treatment and for how long I should take it. I am very confused in what is my decision as to agreeing to the test because if the insurance company does not pay or only pays a percentage I would be responsible for the balance. I do not want the stress of a medical bill. What should I do????

Idalia

Dear SweetC, There will be a time delay between when you request the test and when it will be performed. Tell your doctor's office you need to know if the test will be covered before it is actually done so you can cancel it if you can't afford it. (That is what the billing dept. at your doctor's office is for!) I've never heard of such a test, but think it is a great idea! My first round of chemo therapy was, to quote my onc, 'useless'. I would have liked to have known that before I went thru it!

epgnyc

I think this test is the new wave of the future in cancer treatments that's been in the news lately. I didn't know they were actually offering it yet. Like so many other things, most insurance carriers will not pay for what they deem as "new and experimental." Ridiculous, I know. I would think that if you get the procedure code from your doctor and then call your insurance carrier with it, you will be able to find out if they'll cover it. I've done that before with various procedures and things and it can be very helpful. This way you will be making a truly informed choice. Say for instance the insurance company categorically states it will not pay for the test, then it's up to you to choose whether the knowledge of chemo's benefits for you vs. how much it will cost you out-of-pocket is worth it. If your insurer will cover it, then you won't have to be worrying about it for weeks. The good news is that all these new procedures and tests give us more and better information. The bad news is that it makes our decision-making process that much more difficult. Good luck to you in deciding.

HelenMarie

I hope this helps you, have had the Oncotype DX test.You can ask your health insurance if they will pay, but, if they bulk call this number ( 866-662-6897 )toll free.Genomic Health, Inc. They go by a persons income, if you qualify they will pay the entire bill. In any case, they will help as much as possible. Mine was paid in full, as my husband is retired.I had early stage 1 BC, it didn't spread, no lymph nodes involved, and the onco test came out that I was in the low to moderate risk, I thought that chemo was out, till they found microscopic cells in the blood.I did recieve 4 rounds of chemo ( lost my hair) but, I wasn't sick at all. I am now on my 26th radiation treatment, 7 more to go, and feel fine, tired alot though. Get all the doctors tell you to get, and wipe this cancer out of your body. Fight to get this test, it is your life , not the insuarnces company's! God bless you, and hang in there. Helen

24242

I guess I would like to bring in a different perspective and that is this: When I was diagnosed with stage 3 breast cancer with 11 out of 21 positive nodes there was criteria for whether chemo and radiation were needed. My cancer did not fit any of the criteria set out by the medical community. Radiation is done to protect against cancer seeding itself in the opening that they take it out of us through. They said I would receive very little benefit with radiation yet I felt if there were any benefits I wanted them. My grandmother lasted just more than 10 years after her fight with the same disease even though at that time they said she was cured. She died from her bone cancer.
I look at the treatment phase like insurance, the more you do the longer you are likely to live. Even if the benefit was minimul I wanted it so that I too could look forward to another 10 years or more if I am lucky.
I wanted all I could get, as unpleasant as that was for me, with all the problems I have had, I would do it all the same.
24242

jotaylor

HelenMarie said:

I hope this helps you, have had the Oncotype DX test.You can ask your health insurance if they will pay, but, if they bulk call this number ( 866-662-6897 )toll free.Genomic Health, Inc. They go by a persons income, if you qualify they will pay the entire bill. In any case, they will help as much as possible. Mine was paid in full, as my husband is retired.I had early stage 1 BC, it didn't spread, no lymph nodes involved, and the onco test came out that I was in the low to moderate risk, I thought that chemo was out, till they found microscopic cells in the blood.I did recieve 4 rounds of chemo ( lost my hair) but, I wasn't sick at all. I am now on my 26th radiation treatment, 7 more to go, and feel fine, tired alot though. Get all the doctors tell you to get, and wipe this cancer out of your body. Fight to get this test, it is your life , not the insuarnces company's! God bless you, and hang in there. Helen

I am waiting to see if insurance will pay for the Oncotype DX test,but they probably won't. I have a 1.8-2 cm tumor, grade 2/3, clear margins on rexcision and clear nodes after sentinel node biopsy. I will need radiation for sure, chemo a gray area; hopefully not. How did they find cells in your blood? I didn't know there was a test to do that. Thanks.

gdpawel

Fewer Breast Cancer Patients to Get Chemo

Guidelines unveiled at the Annual San Antonio Breast Cancer Symposium suggest far fewer women getting chemotherapy for their cancers. It calls for choosing a treatment based on each woman's particular type of tumor. Hornone status becomes the single most important factor in picking treatment.

Chemo was described in a media release as being a sledgehammer, killing all rapidly dividing cells whether they are out of control cancerous ones or healthy ones that naturally grow quickly. That's why chemo causes so many side effects.

Dr. Robert Carlson, one of the physicians who led the guideline-writing group, says that several developments in recent years help doctors pick who really needs it. One is the realization that breast cancers have different causes, arise from different types of cells, are driven by different genes, and tend to be different in women before or after menopause. So "one-drug-fits-all" is not the solution.

A new lab test can help doctors sort it out. It is called Oncotype DX. It can measure the activity of dozens of genes and reveal which ones are most active and what treatments would work best. The test is expensive, but many insurers cover it because it often prevents even more costly and unnecessary chemo. Dr. Larry Norton, breast cancer chief at Memorial Sloan-Kettering Cancer Center, compares it to lab tests that pinpoint a germ so the right antibiotic can be prescribed, called Bacterial Culture and Sensitivity Testing (see Chemosensitivity Testing post).

Although the Oncotype DX test hasn't been independently validated by any more than the original laboratory group which published the results, no one is seriously proposing that any of the molecular tests now available (Oncotype DX, EGFR amplification/mutation) should have to be proven 'efficacious', as opposed to merely 'accurate', before they are used in clinical decisions regarding treatment selection.

None of the available laboratory tests used in the selection of treatments for cancer patients have ever been tested for 'efficacy'. This includes estrogen receptor, progesterone receptor, Her2/neu, immunohistochemical staining for tumor classification, bacterial culture and sensitivity testing, CT, MRI and Pet Scans to measure tumor response to treatment. The only data supporting any of them relate to test 'accuracy', and there is a total lack of information regarding test 'efficacy'. (randomized trials with outcome measurements for diagnostic tests)

Cell culture assay tests have been well proven to have predictive 'accuracy' with that of estrogen receptor, progesterone receptor, Her2/neu and the newer molecular tests. In light of the precious little in the way of guidance from clinical trials with respect to best empiric therapy (where the only thing that has been proven to correlate with treatment decisions is reimbursement to the prescribing oncologist) and the importance of basing cancer treatment at least in part on patient preferences, it is entirely reasonable to support judicious application of laboratory tests which have been well characterized with respect to test 'accuracy'. This is a diagnostic test and should be held to that criteria, and not to that of therapy.

This laboratory test is a tool for the oncologist. The oncologist should take advantage of all the tools available to him/her to treat a patient. And since studies show that only 25-30% of patients do respond to chemotherapy that is available to them, there should be due consideration to looking at the advantage of human tissue assay tests to the resistance that has been found to chemotherapy drugs.

Cell culture drug resistance testing is for preventing use of known anti-cancer drugs that are not likely effective in the specific tumor. Cell culture drug sensitivity testing tries to determine specific drug and dose effectiveness. The distinction between sensitivity and resistance is more semantic than substantive.

In virtually all forms of cancer, clinical trials have failed to identify best drug regimens for use in all individuals with a given form of cancer.

Oncologists have been documented to use reimbursement (payment to the oncologist) as the most important criterion for selecting between the large array of otherwise equally acceptable regimens.

The established criterion on which to judge all laboratory tests used to help in the selection of cancer treatment is test 'accuracy' and not test 'efficacy'.

Cell culture assay tests with cell-death endpoints have been exceedingly and reproducibly well established to be usefully 'accurate' in correlation with and predicting for clinical outcomes, including tumor response and patient survival.

Molecular assays have established absolutely no data relating to assay 'efficacy', and with much less data relating to assay 'accuracy' than exist to support the application of cell culture assays.

ASCO is an organization which has been zealous in its support of an inherently corrupt system which won't allow drugs to be chosen on the basis of tumor biology but instead protects the ability of oncologists to choose drugs largely on the basis of profit margin or least inconvenience to research clinics.

There should an expansion of reimbursement to promote even greater utilization and development of laboratory-based mechanisms for improving the match between tumors and an ever-increasing number of partially effective and very expensive drug therapies.

http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20051210/APA/512100677

cctiz

gdpawel said:

Fewer Breast Cancer Patients to Get Chemo

Guidelines unveiled at the Annual San Antonio Breast Cancer Symposium suggest far fewer women getting chemotherapy for their cancers. It calls for choosing a treatment based on each woman's particular type of tumor. Hornone status becomes the single most important factor in picking treatment.

Chemo was described in a media release as being a sledgehammer, killing all rapidly dividing cells whether they are out of control cancerous ones or healthy ones that naturally grow quickly. That's why chemo causes so many side effects.

Dr. Robert Carlson, one of the physicians who led the guideline-writing group, says that several developments in recent years help doctors pick who really needs it. One is the realization that breast cancers have different causes, arise from different types of cells, are driven by different genes, and tend to be different in women before or after menopause. So "one-drug-fits-all" is not the solution.

A new lab test can help doctors sort it out. It is called Oncotype DX. It can measure the activity of dozens of genes and reveal which ones are most active and what treatments would work best. The test is expensive, but many insurers cover it because it often prevents even more costly and unnecessary chemo. Dr. Larry Norton, breast cancer chief at Memorial Sloan-Kettering Cancer Center, compares it to lab tests that pinpoint a germ so the right antibiotic can be prescribed, called Bacterial Culture and Sensitivity Testing (see Chemosensitivity Testing post).

Although the Oncotype DX test hasn't been independently validated by any more than the original laboratory group which published the results, no one is seriously proposing that any of the molecular tests now available (Oncotype DX, EGFR amplification/mutation) should have to be proven 'efficacious', as opposed to merely 'accurate', before they are used in clinical decisions regarding treatment selection.

None of the available laboratory tests used in the selection of treatments for cancer patients have ever been tested for 'efficacy'. This includes estrogen receptor, progesterone receptor, Her2/neu, immunohistochemical staining for tumor classification, bacterial culture and sensitivity testing, CT, MRI and Pet Scans to measure tumor response to treatment. The only data supporting any of them relate to test 'accuracy', and there is a total lack of information regarding test 'efficacy'. (randomized trials with outcome measurements for diagnostic tests)

Cell culture assay tests have been well proven to have predictive 'accuracy' with that of estrogen receptor, progesterone receptor, Her2/neu and the newer molecular tests. In light of the precious little in the way of guidance from clinical trials with respect to best empiric therapy (where the only thing that has been proven to correlate with treatment decisions is reimbursement to the prescribing oncologist) and the importance of basing cancer treatment at least in part on patient preferences, it is entirely reasonable to support judicious application of laboratory tests which have been well characterized with respect to test 'accuracy'. This is a diagnostic test and should be held to that criteria, and not to that of therapy.

This laboratory test is a tool for the oncologist. The oncologist should take advantage of all the tools available to him/her to treat a patient. And since studies show that only 25-30% of patients do respond to chemotherapy that is available to them, there should be due consideration to looking at the advantage of human tissue assay tests to the resistance that has been found to chemotherapy drugs.

Cell culture drug resistance testing is for preventing use of known anti-cancer drugs that are not likely effective in the specific tumor. Cell culture drug sensitivity testing tries to determine specific drug and dose effectiveness. The distinction between sensitivity and resistance is more semantic than substantive.

In virtually all forms of cancer, clinical trials have failed to identify best drug regimens for use in all individuals with a given form of cancer.

Oncologists have been documented to use reimbursement (payment to the oncologist) as the most important criterion for selecting between the large array of otherwise equally acceptable regimens.

The established criterion on which to judge all laboratory tests used to help in the selection of cancer treatment is test 'accuracy' and not test 'efficacy'.

Cell culture assay tests with cell-death endpoints have been exceedingly and reproducibly well established to be usefully 'accurate' in correlation with and predicting for clinical outcomes, including tumor response and patient survival.

Molecular assays have established absolutely no data relating to assay 'efficacy', and with much less data relating to assay 'accuracy' than exist to support the application of cell culture assays.

ASCO is an organization which has been zealous in its support of an inherently corrupt system which won't allow drugs to be chosen on the basis of tumor biology but instead protects the ability of oncologists to choose drugs largely on the basis of profit margin or least inconvenience to research clinics.

There should an expansion of reimbursement to promote even greater utilization and development of laboratory-based mechanisms for improving the match between tumors and an ever-increasing number of partially effective and very expensive drug therapies.

http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20051210/APA/512100677

onco type
I just had the results of my onco type, I scored 25 which is high and could actually had some benefits from chemo but my tumors were so small and were removed entirely so my doctor adamantly said NO to chemo my blood cells were good too - I wouldn't had minded to have few runs of chemo for the peace of mind but i was adviced against it, my insurance covered so far EVERYTHING and we are glad because this test is super expensive - we were pleased with it