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In Reply

The University of Texas at Austin and the Health Science Center, San Antonio, TX

Steven M. Grunberg

Fletcher Allen Health Center, Burlington, VT

Paul J. Hesketh

Caritas St Elizabeth's Medical Center, Boston, MA

Mark G. Kris

Memorial Slone-Kettering Cancer Center, New York, NY

Dr Fox's heartfelt concern for the patient who could not afford to pay for the antiemetics of choice recommended in the American Society of Clinical Oncology (ASCO) Antiemetic Guidelines¹ graphically illustrates the harsh inequities that exist in our health care distribution system. These guidelines fulfilled the mandate of ASCO to provide evidence-based, best practice recommendations as to the most effective antiemetic treatment options.

The financial issues surrounding antiemetic therapy in oncology are complex and constantly changing. Twenty-two years ago, a letter was written to a medical journal to question the high cost of a new antiemetic—metoclopramide.² Times change. Due to research, patent expirations, and other changes in the medical marketplace, this drug is now universally available and one of the least costly in all of oncology. With the imminent arrival of generic intravenous ondansetron, this scenario is about to be repeated. Institutional antiemetic guidelines themselves can improve access to best therapy. Establishing institutional antiemetic guidelines has been shown to control costs while expanding use to include additional patients for whom the guidelines recommend treatment.³ Our hope is that these guidelines recommendations will be one part of the solution to the difficult problem highlighted by Dr Fox.

Authors' Disclosures of Potential Conflicts of Interest

Although all authors completed the disclosure declaration, the following author or immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Authors Employment Leadership Consultant Stock Honoraria Research Funds Testimony Other James M. Koeller MGI; GlaxoSmithKline MGI Steven M. Grunberg Merck; GlaxoSmithKline; Helsinn; Solvay Schering Merck; GlaxoSmithKline; MGI Pharma MGI Pharma Merck; Helsinn Paul J. Hesketh Merck; GlaxoSmithKline Merck; GlaxoSmithKline; MGI Pharma Merck Mark G. Kris Merck and Company; MGI Pharma; sanofi-aventis; GlaxoSmithKline Merck and Company

REFERENCES

1. Kris M, Hesketh PJ, Somerfield MR, et al: American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006. J Clin Oncol 24:2932-2947, 2006[Abstract/Free Full Text]

2. Nelson EA: Cost of antiemetic agents. N Engl J Med 307:225, 1982

3. Nolte MJ, Berkery R, Pizzo B, et al: Assuring the optimal use of serotonin antagonist antiemetics: The process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center. J Clin Oncol 16:771-778, 1998[Abstract]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Koeller, J. M. Articles by Kris, M. G. Search for Related Content PubMed Articles by Koeller, J. M. Articles by Kris, M. G. Social Bookmarking                            What's this?