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Improving the Quality of Care: NCCN Guidelines for the Treatment of MPNs

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Published on November 10, 2016

World-renowned MPN expert Dr. Ruben Mesa of Mayo Clinic discusses the recently updated NCCN guidelines that help advise doctors around the world on how to treat MPNs. Watch to hear Dr. Mesa's explanation of how these are used in practice and how the guidelines have evolved over time.

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Transcript | Improving the Quality of Care: NCCN Guidelines for the Treatment of MPNs

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Dr. Mesa:

Always a pleasure, Andrew.  Thank you for having me.  

Andrew Schorr:

Thank you.  So Ruben directs the cancer operations at Mayo Clinic Scottsdale, and, of course, is a leader throughout the Mayo Clinic in oncology, but MPN is his specialty.  And, of course, he works with other experts around the world to help really make sure that we get the best care. 

Ruben, recently you've had new guidelines that help advise doctors around the world as the way to treat these illnesses.  So what are these guidelines?  Whose guidelines are they?  What difference does it make?  How new are they?  

 

Dr. Mesa:

Sure.  So they are brand?new guidelines.  There's a group called the National Comprehensive Cancer Network, which is an affiliation of the 25 NCI comprehensive cancer centers that largely set guidelines for how physicians in the U.S., and used largely outside of the U.S. as well, treat individual diseases.  So for many years there have been guidelines in breast cancer, colon cancer, prostate cancer, etc., but there's never really been for MPNs. 

So up to this point in time it's been a little bit opinion?based.  Your doctor reads a review article, you know, and they follow whatever that one individual stated.  These guidelines are with 25 of us, I chaired those guidelines, but many of the MPN experts, well known to Patient Power, Dr. Verstovsek, Dr. Snyder, Dr. Gotlib, Dr. Stein, you know, on and on, contributed..

Andrew Schorr:

My doctor, Dr. Jamieson. 

Dr. Mesa:

Dr. Jamieson, who is the vice?chair of the panel, all came together to have evidence?based guidelines as to how we diagnose, how we assess and then how we treat MPNs.  And then in the treatment we first published these guidelines in myelofibrosis, and then in 2017 there will be the guidelines in polycythemia vera and in essential thrombocythemia. 

Andrew Schorr:

So what does that mean for a patient, where they go, maybe at a community oncology center, there are actually guidelines, sort of recommendations of the world experts on how to proceed? 

Dr. Mesa:

Correct.  So there are guidelines both on how to proceed.  Your physician clearly always still has their own discretion as to how they treat you with individual factors, and the guidelines, you know, state what are the factors they need to consider and what are the decision points.  

It's very relevant, because they're looked at by insurance companies in terms of what care to reimburse.  Do they reimburse for a bone marrow, don't they?  Do they reimburse for molecular testing, or do they not?  Where does a bone marrow transplant fit in?  Also Medicare or CMS look heavily at the guidelines for their coverage decisions regarding care.  

So, one, it's a guideline really for physicians and we hope is particularly helpful to improve the quality of MPN care by decreasing some of the heterogeneity that people can experience.  But, two, hopefully make things simpler in terms of the appropriate coverage for the care that's required. 

Andrew Schorr:

All right.  Let's talk about that.  That came up for me.  Dr. Jamieson wanted me to have sort of a molecular workup for my myelofibrosis, and I got a message back that my insurance company didn't want to pay for it, and now there's an appeal going on.  So assuming that that was appropriate, that testing, these guidelines can help say to the insurance world, this is the standard that we experts agree on, and it should be covered. 

Dr. Mesa:

That's exactly correct.  And the guidelines are a dynamic set of guidelines, so as new information comes out, information from this year's ASH, information from clinical trials, they are updated on a fairly frequent basis to really reflect what is the standard of care at that moment in time.  So that particular issue, regarding the broader molecular panels, you know, in particular we think it's a strong consideration for people in which stem cell transplantation is a possible option depending upon how they proceed.  

That may evolve over time.  Even around the molecular testing, we are having an evolving understanding as to how the presence or absence of additional somatic mutations such as ASXL1 and others how they impact our decisions in terms of care.  

Andrew Schorr:

Hmmm.  So it sounds like this is a big deal. 

Dr. Ruben Mesa:

So we think it's a really big deal for a couple reasons.  One, to really try to improve quality across the board, you know, for MPN care in the U.S.  And, two, to really have an evidence?based analysis here in the U.S.  What do we really consider the standard of care, and then as we look at new therapies coming down the pike, if they are approved, how do they impact those decisions that we make?  

Andrew Schorr:

Wow.  Well, I want to thank you for your leadership always.  This gentleman goes all over the world speaking, and now with his colleagues, the specialists in MPNs working together to help inform the medical community and the insurance community and us patients so there's a standard that can be followed so we get the best care.  Ruben Mesa, thank you so much…

Dr. Mesa:

Great.  Thank you, Andrew. 

Andrew Schorr:

…for all you do at the Mayo Clinic and wherever you go and being with us once again on Patient Power. 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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