Findings from small pilot studies suggest that phase II and III clinical trials result in at most modest increases in cost over standard treatment costs. Also, an increasing number of policy makers have decided to support clinical trial reimbursement initiatives. It is hoped that economic data from large observational studies will facilitate widespread and permanent decisions that support reimbursement for phase I, II, and III clinical trial participation.

Changing economic circumstances have brought increased pressure to bear on the traditional revenue sources of oncologists. Practice standards and settings are being challenged to generate cost savings both for third-party payers and for oncology practices. Add to this the growing number of patients older than 65 years, and particularly older than 85 years, and the profession is facing a forced reconsideration of its approach to patient treatment. The current and future training of oncologists needs to incorporate both a multidisciplinary approach of cancer subspecialties and an enhanced ability to evaluate the use and cost-effectiveness of new therapies, second-line and third-line therapies, and palliative treatments.

The implementation of the Patient Protection and affordable care act will change oncology practice in many ways. Innovative payment models, new practice arrangements, and an increased focus on paying for quality and value will change the landscape for oncologists and people with cancer.

the traditional revenue sources of oncologists. Practice standards and settings Physician Reliance Network, Inc., Dallas, Texas.are being challenged to generate cost savings both for third-party payers and for oncology practices. Add to this the growing number of patients older than 65 years, and particularly older than 85 years, and the profession is facing a forced reconsideration of its approach to patient treatment. The current and future training of oncologists needs to incorporate both a multidisciplinary approach of cancer subspecialties and an enhanced ability to evaluate the use and cost-effectiveness of new therapies, second-line and third-line therapies, and palliative treatments.

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The authors recount the history of changes to reimbursement policy to explain how the system arrived at its present state and to suggest how the system might have otherwise evolved.

Considerable attention has been paid to the high cost of cancer care. These medical services are expensive, accounting for 10% of total health care expenditures. Factors contributing to high costs include (1) the likelihood that anticancer treatments will lead to costly medical complications; (2) intensive research and development necessary to ensure rapid introduction of a broad array of treatment options; and (3) specialized facilities required for delivery of care. Such efforts as rationing of care and utilizing practice guidelines have been ineffective in controlling costs. To realize savings, we must develop new therapies with sufficient specificity so that anticancer interventions do not impair the patient's general health. Cancer 1995;76:1886‐7.

The monoclonal antibody (MoAb) 323/A3, an IgG1, was raised against the human breast tumor cell line MCF-7 and recognized a 43 Kd membrane associated glycoprotein. Histochemical studies with the antibody detected 75% of metastatic lymph nodes, 59% of primary breast tumors, and showed some staining in 20% of benign breast lesions. For radionuclide imaging, the MoAb 323/A3 was labeled with both 125I and 111In, via covalently coupled diethylenetriaminepentaacetic acid (DTPA) by the mixed anhydride method. The antibody activity of the DTPA modified 323/A3 was assessed by an immunoassay using viable and fixed MCF-7 target cells. Male athymic nude mice bearing BT-20 human mammary tumors were injected with dual 125I/111In labeled DTPA 323/A3 via the tail veins. The animals were imaged with a gamma camera equipped with a pinhole collimator at 1-3 h, 1, 2, 3, 4 and 5 days after the tracer administration. On day 5 or 6, the animals were killed, and the biodistribution of the radiotracers was determined for the blood, thyroid, heart, lungs, liver, spleen, kidneys, gastrointestinal tract and tumor. Target to blood ratio at 6 days for the 111In tracer was 24:1 in the group with a mean tumor weight of 0.492 g, and 13:1 in another group with a mean tumor weight of 0.1906 g (day 5). However, the 125I activity showed only 3.6:1 and 5.4:1 target to blood ratios in the corresponding groups. The larger tumors localized less 111In tracer (27.13% +/- 7.57% injected dose/g, Mean +/- SD) than the smaller tumors (52.75% +/- 22.25% ID/g).(ABSTRACT TRUNCATED AT 250 WORDS)