Bakersfield center uses 'game changer' cancer drug
By Caitlin Rearden, Eyewitness News Published: Feb 6, 2014
Dr. Ravi Patel called new breast cancer drug Palbociclib "a game changer."
Palbociclib was developed by University of California, Los Angeles scientists. Bakersfield's Comprehensive Blood & Cancer Center is participating in a clinical trial that began in 2010, testing the effectiveness of the new drug on some breast cancer patients.
The trial is for Stage 4 hormonally positive breast cancer patients, which is about 60 percent of all breast cancer patients. Normally, with this type of cancer, the patient is treated with a Food and Drug Administration-approved hormone drug that would help keep the cancer from spreading by targeting the hormones that cause it, however often times those cells become resistant to the hormone drug. When paired with the hormone drugs, the Palbociclib essentially blocks those pathways where the cancer would spread, thus stopping it. The patients continue to take the drug as long as it is working.
"Patients who were not on the drug had control of their disease only for six months or so, but if they were on Palbociclib, the experimental drug, they had a better chance, almost 24 months or longer for control of their disease," said Patel of Bakersfield's CBCC.
Bringing Cancer Patients Joyous Relief (Video)
BAKERSFIELD, Calif. - Volunteers are working hard to bring a Bakersfield grandmother some joy as she battles cancer.
"This is not our first step with it. And we were devastated by the news," said Raymond Saldana, owner of Wood Masters Design.
Saldana spent four years caring for his young son, who's cancer is now in remission and over the last year, he's been helping his 62-year-old mother through her own cancer fight.
“She's an awesome person. I never met no one like her, and we couldn't of picked a better person to do this for, she's well deserves this," he said.
Saldana owns wood masters design and is working with the doctors at the comprehensive blood and cancer center on "Kitchens 4 Cancer," a new program surprising cancer patients with a kitchen make-over.
"Cancer is a very difficult journey, filled with a lot of difficulties. You go through treatment, the diagnosis is difficult, you go through a variety of disappointments and sometimes you land on a few happy landings," said Dr. Ravi Patel, medical director of Comprehensive Blood and Cancer Center.
Loved ones arranged a week's retreat for Munoz, and while she's out of town, volunteers are re-designing her kitchen, adding new cabinets and flooring. It's a 25-thousand dollar job being done, free of charge.
"Bakersfield is a very kind and very giving community and so it's not a single individual, but a entire team that has contributed to make this success happen," said Patel.
Carmen Munoz is expected to be back home this weekend where she will be greeted by loved ones, volunteers and of course a brand new kitchen.
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Federal Budget Cuts Impact Cancer Care for Senior Citizens
BAKERSFIELD, Calif. (KBAK/KBFX) — Those federal budget cuts triggered by so-called "sequestration" are impacting some of the most vulnerable cancer patients. As of April 1, Medicare payments are being cut for chemotherapy drugs, and experts say that could be very disruptive to older patients.
At the Comprehensive Blood & Cancer Center in Bakersfield, Dr. Ravi Patel told Eyewitness News oncologists must pay a fixed amount for the drugs, and the reduced payments aren't enough.
"It will cause a significant disruption," Patel said on Tuesday. His clinic will see the reduced payments in a couple weeks when they get reimbursements for cancer patients they treated as of April 1.
Under Medicare, community cancer clinics are reimbursed for chemotherapy drugs based on an "average sales price," plus an additional 6 percent for administrative costs like handling and storage.
But, under the budget cuts just triggered by sequestration, that administrative cost is being cut by 2 percent. Patel said oncologists already don't get enough reimbursement to cover the real cost of some cancer drugs, the added cut in the administration payment is critical.
"We have, year after year, been figuring out how to absorb the cost " Patel said. "But, you reach a certain point where it can be difficult to do it."
Across the country, some community cancer clinics are reportedly starting to turn away Medicare patients.
"In the absence of government action to stop the dismantling of community cancer care, practices signaled they will have no choice but to adopt emergency measures to deal with the sequester cut to cancer drugs," says a statement from three national oncology organizations.
The groups, and Patel said clinics could absorb cuts to payments for their services, but they can't cover the cuts applied to the "fixed, pass-through costs" of chemotherapy and other cancer-fighting drugs.
Patel said the average cancer practice sees some 100 to 200 patients a day, he also says more than 60 percent of cancer patients are on Medicare.
If the community cancer clinics can not continue treating the Medicare cancer patients, experts say these seniors will have to get care at hospitals instead.
"They have some slight leniency on the way they are reimbursed for drugs," Patel told Eyewitness News. "So, it is possible that maybe they can absorb the cost." Patel said CBCC works with the Dignity Hospitals in Bakersfield, and they'll work together to see that the patients get care.
But, Patel also hopes there could be an exemption for the sequestration cut in Medicare drug payments. He wants the cuts reversed.
"It is worth it for us to do a letter-writing campaign," Patel urged. He wants legislators and Congressmen to be alerted that the change will cause a hardship on patients.
Patel said anyone interested in getting more information on the letter-writing campaign can call the CBCC office at 862-7120.
Dr. Patel said CBCC is developing a package for their patients who will be affected by the Medicare payment changes. And, he promises those people will get help.
"The patients, understandably, are very fearful about this, and they have to be," Patel said. "But, somehow, some where, we would make sure that the patients are taken care of."
Poll Reveals Where People Go for Care
Two hours might seem like a long way to drive for an eye doctor appointment, but Taft’s Lizz Horton says it’s worth it for her.
Horton takes her 8-year-old daughter, Reanna Rowland, south for eye care and is planning to take her son, Jaxon Horton, 4, next month.
“When it comes to the eye, I won't ever take my kids anywhere else,” Horton said of traveling to UCLA to see her prefered ophthalmologist.
Horton isn’t alone in her willingness to travel several hours for health care. A telephone study of nearly 700 Kern County residents last year found that people head outside the county seeking treatment for a variety of aliments. The study was funded by The Californian along with a local hospital and health insurance provider.
Survey participants listed cancer, orthopedic issues and learning disabilities as the conditions for which they most frequently venture outside the county to find care. Nearly 30 percent said their family has sought care for cancer elsewhere, though one doctor said that number seems unrealistically high.
“Compared to before, the trend has turned. There are so many people staying here,” said Dr. Ravi Patel, managing partner and medical director of the Comprehensive Blood and Cancer Center in Bakersfield. “Very few people will think about actually going elsewhere.”
Cancer patients might leave town for a surgery or another opinion but, Patel said, most return to Kern for their cancer care.
“There's not 30 percent of the cancer patients that can afford (to leave the county for care) based on our insurance demographics,” Patel said.
Asked where they would go if they needed medical treatment at a facility outside the area, 75 percent of those who had sought care elsewhere said they would go to Los Angeles; one in three said Fresno.
Young, less affluent Hispanics were more likely to say they would opt for Fresno, while older, affluent, long-time Kern residents indicated a preference for Los Angeles, according to the study.
Survey takers were not asked one pressing question, due to time limitations: Why they head out of town. Follow-up studies to answer that are planned.
Whatever the reasons, Gary Frazier, Bakersfield Memorial Hospital’s vice president of strategy and business development, said a certain number of people will leave their immediate area for care in any city.
Others may need a specialist that isn’t available in Bakersfield or have multiple aliments that need addressing.
And then there’s the fact there are large academic medical centers — with prestigious names and reputations — just two hours away. Patients may think of those places when they first receive a diagnosis.
“Once we know that there's this (medical problem) — heart, brain, lung, you name it — our thought is, ‘We've got to go to the one place that can cure this thing in one full swoop,’” Frazier said.
But later, he said, people realize their treatment requires multiple visits and follow-up care and their mindsets change.
“Then you start thinking practically, is there a local option?” Frazier said.
He said one of the challenges to keeping people in the area may be lack of awareness about which speciality care is available locally, such as pediatric cardiology.
WHY GO ELSEWHERE?
Several locals who faced serious illness said they traveled for medical care for different reasons, including poor experiences with local providers and referrals from local physicians.
Horton said that before she was referred to UCLA by a local doctor, a Bakersfield practitioner told her that Reanna, who was 5 at the time, was blind in her right eye and that couldn’t be corrected. Instead of being round, Reanna’s right pupil is shaped like a key hole and the iris isn’t formed all the way around it, a condition known as a coloboma.
But today, Horton said Reanna has 20/40 to 20/50 vision in her right eye with glasses, an improvement gained using an eye patch and glasses.
“She does competitive gymnastics right now and I don't know if she would have been able to do that if she was totally blind in one eye,” Horton said.
Horton has been striving to get her son seen at UCLA for a different eye problem. For a while it appeared the visit would not be covered by insurance, but Horton was still willing to make the drive and spend several hundred dollars out-of-pocket.
For special conditions, Horton said, she would rather go somewhere where doctors have seen a lot of something unusual in a more populated area than get treatment where doctors may only have seen the problem a handful of times. For primary care, her family travels a shorter distance to Bakersfield.
“I feel like there is good health care in Bakersfield,” Horton said.
Others don’t have the same confidence in local care. Another health care traveler, Cheryl Simpson, said she now leaves town for all her care, with the exception of dental and chiropractic appointments. She started traveling to Cedars-Sinai in 2009 for breast cancer treatment and has continued to make the trek for other treatments.
“(Traveling for cancer care) was hard and it was costly but I felt like the cost of not going was much more,” said Simpson, who is married to a Californian graphic artist.
Simpson said she spent time in a Bakersfield hospital for polymyositis, a painful muscle disease, earlier in 2009 before she learned she had cancer, but doctors didn’t diagnose her cancer during her hospital stay. She later visited her doctor a couple times for a pain in her left armpit before a biopsy eventually revealed the cancer.
A co-worker recommended Cedars-Sinai and Simpson decided to undergo all aspects of her treatment there, including a double mastectomy, reconstruction surgery, chemotherapy and radiation. The hospital’s treatment plan gave her hope and Simpson said she had confidence in her providers there.
Before she had cancer, Simpson said she didn’t have any reason to question her doctors because she went to the same physician from birth until he retired. Now, she researches her doctors thoroughly and isn’t shy about telling others where she would and wouldn’t recommend getting medical care.
“It’s like when you go to a restaurant and the food’s really good, you tell everybody. When you go to a restaurant and the food’s really bad you tell everybody,” Simpson said. “When I go to some place and they don’t treat me well in the medical field, I tell everybody.”
Chris Bailey, a registered nurse, said the three local physicians she visited for a painful back problem gave her names of doctors that were out of town.
“We had trouble finding a physician that was covered by my insurance and then finding somebody that was recommended,” Bailey said.
Last year, she traveled to Torrance to have back surgery by a doctor with whom she had previously worked. Bailey has had other medical procedures done in Bakersfield and said she doesn’t doubt the quality of care here, but that in this case traveling seemed like the best option.
“From everyone I talked to, most people who have good results leave Bakersfield to have back surgery,” she said.
Several local cancer patients said a collaboration between academic medical centers and Bakersfield doctors provided them the right mix of treatment.
“Instead of it being about ego or control, it was about doing what's best for the patient,” said Bakersfield resident Tim Ross, whose wife, Donna, was treated at Comprehensive Blood and Cancer Center.
The Rosses decided to move back to Bakersfield from the Bay area last year after Donna underwent treatment for a cancer that impacted multiple organs in San Francisco last spring.
They said they were told by an oncologist at the Bay area facility that Donna wasn’t strong enough for a more intense treatment and that nothing else could be done. The hospital referred them to CBCC, which coordinated a treatment plan with USC.
“I think the reason she's still alive today is that Dr. Patel thought she was strong enough to receive aggressive treatment,” Tim said.
Donna had surgery out of town but did her chemo in Bakersfield, a treatment the Rosses described as so taxing she wouldn’t have been able to travel for it.
Tim, who grew up in Bakersfield, said times have changed since the 1970s and ‘80s when there was a feeling that if you were really sick, you were better off going to Los Angeles, Santa Barbara or San Diego to get care.
“The old joke was, you know Bakersfield has good medical care if you're not too sick,” he said.
Now, Tim said, Bakersfield has also become a medical destination.
IN SEARCH OF SPECIALTY CARE
Hospital executives from north and south of Kern said patients come to their facilties to receive care for complex illnesses and multiple conditions that they might not be able to find in Bakersfield.
Santiago Munoz, chief strategy officer for UCLA Health System, said UCLA often provides services including opthalmology, bone marrow transplant, oncology and solid organ transplants for Kern patients.
“On any given day, we likely see a few patients from the Kern County area and they’re likely receiving specialty services that many folks travel for,” Munoz said. “It’s certainly no reflection on communities like Bakersfield and Fresno.”
Parents of children in need of specialized care may also find themselves traveling to get to the right specialists in the Fresno or Los Angeles area. Kern County children make up about 10 percent of the total volume of inpatient days at Children’s Hospital Central California in Madera, said Steve Cade, the hospital’s director of business development. The children’s hospital serves a region ranging from southern San Joaquin County to Kern, so many of its patients travel for care.
“We definitely see more children come in from that entire 45,000-square-mile area than we did 10 years ago,” Cade said.
From 2000 to 2010, the hospital saw about a 17 percent increase in the number of children seen from Kern County, a jump that the hospital’s public relations manager, Jill Wagner, said could be following along with population growth or the specialists the hospital offers.
The out-of-town hospital administrators were quick to compliment the care available in Bakersfield and say that many people do stay close to home for their care.
Cade said there’s “a great health care system down there” and that the hospital tries to partner with health care providers in Bakersfield so children don’t have to travel. He pointed to the example of one of the hospital’s pediatric gastroenterologists who goes to Bakersfield three days a week to see patients there.
But executives also pointed out that very specialized care is costly to provide, requiring a large population center, research and staff to support it; so it makes sense to centralize those kinds of services.
“We wouldn’t have the resources to support transplant programs in every city,” Munoz said.