Cancer treatments are evolving but the high costs coupled with high copays and coinsurance of new approaches has been a challenge, forcing many patients to choose less effective or inconvenient treatment routes.
When most people hear the word “chemotherapy” they think of intravenous chemotherapy, also known as IV chemotherapy or infusion chemotherapy. IV chemotherapy requires a cancer patient to visit a clinic or other medical office and receive drugs through a needle that is attached to an IV bag containing the medication.
Oral chemotherapy is a lesser known but rapidly growing treatment approach that delivers the cancer drug through a pill the patient swallows. Oral chemotherapy allows patients to receive their treatment at home and some newer cancer drugs are only available in pill form.
While intravenous chemotherapy is largely covered by insurance programs, oral chemotherapy is costly and can be challenging to afford.
“One oral chemotherapy drug can cost as little as $200 a month or as much as $17,000 a month,” says Director of Pharmacy Services and Research at Dayton Physician Network Joshua Cox, Pharm.D., BCPS, R.Ph. “Beyond that, prescriptions typically have no out-of-pocket cap so patients have to pay for the drug every time they pick it up.”
The cost of oral chemotherapy drugs has prohibited some patients from taking them. As many as 10% of patients fail to pick up their prescription medication to begin treatment because they are unable to cover the cost.
Cancer treatment is dynamic in that as a patient responds or doesn’t respond to certain drugs, their treatment protocol and prescriptions change. This can leave patients who are being treated through oral chemotherapy with leftover pills.
“For years, we’ve had patients bring in expensive oral chemotherapy medications they’re no longer using and ask if they can donate them to patients who are unable to afford them,” says Dr. Cox.
“However, legislation has historically prevented us from re-administering these drugs and the pills would end up in the trash.”
Cox is currently serving his second term as a member of the State of Ohio Board of Pharmacy. In the third quarter of 2019 Cox and his fellow board members started reviewing statutes around drug repository programs that would enable pharmacies to accept unused cancer medications donated by patients and dispense them to other patients in need.
“The Board of Pharmacy reviewed the statutes that were passed by state legislators, and we were able to change the rules to allow for drug repository programs to now include cancer drugs,” says Cox. “These actions created the possibility for cancer drug recycling programs to exist in the state of Ohio.”
The revised code for operating a drug repository program went into effect on October 3, 2019 and Dayton Physician’s Network was the first network in the state of Ohio to adopt a cancer drug recycling program.
Making a difference
“The Dayton Physician Pharmacy Team started accepting oral chemotherapy drugs in October 2019 and was very quickly receiving tens of thousands of dollars of donated drugs into our inventory,” says Dr. Cox. “We have now re-dispensed tens of thousands of dollars of those drugs to patients in need.”
Dayton Physician’s Network is leading the way in innovating not only the way patients have access to medications but also the way to high quality and high value care through comprehensive cancer treatment programs that include an integrated hematology and oncology team, chemotherapy classes, and after hours cancer care.
“The cancer drug recycling program is providing treatment to cancer patients who otherwise would not have received these medications due to an inability to pay,” says Cox. “It is making a huge difference in our community.”
“I want people who are currently being treated for cancer or those who have a loved one who is being treated to know this program is out there so if they identify an opportunity to donate, they know where to take unused medications,” says Cox. Any patient with unused oral chemotherapy drugs can donate to a pharmacy with a cancer drug repository like the one at Dayton Physicians Network.
“I also want anyone who is receiving treatment for cancer and in a situation where they are struggling to pay for medications to know this program is available,” says Cox. “Cost should no longer be a reason a cancer patient does not get the treatment they need.”
At Dayton Physicians Network the safety and well-being of our patients, staff, visitors, and the community is our top priority. To help you learn more, here is some basic information about the disease.
Dayton Physicians Network is committed to your safety and well-being.
- In order to safeguard the health and safety of all patients we are no longer allowing patients to be escorted or accompanied by caregivers within our facilities. Exceptions will only be made for patients with severely limited mobility, neurocognitive disorders and those who are unable to consent for themselves.
- No one under the age of 18 will be permitted in the facility.
- Please call us prior to your visit if you have any symptoms with the onset of fever, cough and shortness of breath.
- Dayton Physicians Network will continue to screen patients upon arrival at the respective campus. We will ask a series of questions and your temperature will be measured. If you answer yes to any of the questions or have a fever, we will provide you with instructions on how to proceed.
- We are asking all patients to bring a mask if they have one available.
- Our offices may look a little different due to social distancing as we are utilizing decals on floors and chair spacing in waiting areas.
Questions about Coronavirus 2019 (COVID-19)?
If you have questions regarding COVID-19, please call the Ohio Department of Health (ODH) hotline at 833-427-5634.
What is coronavirus?
The novel coronavirus, or COVID-19, is a new virus and disease unknown before the outbreak began in December 2019.
What are the symptoms of COVID-19?
Symptoms of COVID-19 can range from mild to severe, with the majority being mild. The symptoms may appear two to 14 days after exposure and include:
- Shortness of breath
- Flu-like symptoms
What should I do if I have these symptoms?
If you are experiencing symptoms of COVID-19, call your primary care provider. Please do not go directly to your doctor’s office or emergency department without calling first, since many can isolate at home without being evaluated in person.
What can I do to prepare?
There are some steps you can take to prepare your family for COVID-19. Here is a checklist from the Ohio Department of Health to help you prepare.
How can I protect myself?
The best ways to protect yourself are by washing your hands with sanitizer or using soap and water for at least 20 seconds; not touching your eyes, nose, or mouth with unwashed hands; and avoiding contact with people who are sick.
If you are sick, stay at home, avoid contact with others, and cover your mouth and nose when you sneeze or cough.
The CDC continues to advise that the best way to prevent illness is to avoid being exposed to this virus. “Social distancing” means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. Social distancing is not the same as self-quarantine or isolation, two other practices being utilized to minimize the coronavirus spread. The key difference is that a quarantine or isolation restricts the movement of people within a certain area or zone to limit transferring and spreading an infection. Social distancing places no such locational constraints, rather it is a behavioral practice to lower the risk in most circumstances. Clearly, there are instances where it’s hard to keep a certain kind of distance from other people — when traveling via public transportation, for example, or using an elevator. Accessing public services like the post office, the bank or a grocery store can also be challenging, as can socializing in public settings. Social distancing in these cases means doing the best that you can — be that with regards to personal space or related personal safety strategies. Some things you can reasonably include the following:
- Take everyday precautions to keep space between yourself and others; at work this includes replacing face-to-face communications with phone calls, conference calls, email and jabber whenever possible.
- When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
- Avoid crowds as much as possible.
- Avoid cruise travel and non-essential air travel.
- Stay home as much as possible to further reduce your risk of being exposed.
- Consider ways of getting food brought to your house through family, social, or commercial networks.
There are always trade-offs in life.
It’s been one of Jay Morgan’s favorite sayings, but it resonates now more than ever.
He can’t do all the things he used to enjoy doing, like running a 5K at age 70 in under 30 minutes. He still runs 5Ks, it just takes him 45 minutes now. But he’s alive and well after a stage four, terminal cancer diagnosis last year – a trade-off he’s happy to have made.
What started as routine blood work for a renewal of a life insurance policy quickly turned into a series of events that forever changed his life.
PSA, or prostate-specific antigen, is a test used to determine the health of the prostate gland. Ten years ago, Jay had the test done and his numbers were around 4, Jay recalls. “Not bad for someone who was 61, I thought,” he said.
He’d been offered to have the test repeated at checkups over the years, but declined.
“Not because I was scared,” Jay said. “Pretty much just the opposite. I was pretty active, lifting weights, running 36 5Ks each year. My feeling was that I was sort of invincible and that I wouldn’t have to worry about something like prostate cancer.”
After a standard visit from a nurse from the insurance company to collect health results for his renewal policy, he received a report that said all his various functions were great, but his PSA numbers were off the chart.
“At first I was really irritated,” Jay remembers, after reading the letter that said the company only rejects about four percent of applicants. “I thought, show me someone who is 70 years old and in better shape than I am and I’ll get their autograph.”
Jay took action and scheduled an appointment with his family doctor where he was told his PSA results were “phenomenally high” and he was recommended to a urologist, Dr. Key at Dayton Physicians Network.
Dr. Key conducted more work and the results were the same – extremely high levels of PSA in his blood. In fact, he went from a reading of 4.16 to 437 – no decimal points – in just ten years.
At one point, before Jay knew his numbers, he had asked what PSA reading would be considered dangerous. That number was 20.
It didn’t take long for Jay, a career trained mathematician, to understand that his reading was more than 202 of the number considered serious.
“He looked at me like he was the grim reaper,” Jay recalls about his first appointment with Dr. Key.
Initially, Jay was told he had two years to live with such a serious diagnosis.
“That’s tough,” Jay said with a pause. “I was somewhat in shock about that and anxious – very, very anxious.”
At the same time as his diagnosis, pressure from his enlarged prostate was compressing his urethra making urination difficult before it became nearly impossible – a complication that is seen in some cases of prostate cancer.
It became so uncomfortable, he ended up in the ER where over 1500 cc of urine were removed from his body. The average bladder holds between 300-400 cc. He was told he was lucky his bladder didn’t burst and sent home with instructions to see his urologist ASAP.
So in addition to dealing with facing his mortality, Jay was forced to catheterize himself more than 300 times over the next four months.
With his bladder health restored, Jay began cancer treatment. Drugs to promote bone growth and halt testosterone production and four chemotherapy pills became part of his daily regimen.
And the results are staggering. His PSA has dropped every three months. His most recent reading: 0.31.
Besides an aspirin or two maybe once a year, Jay had never taken pharmaceuticals or prescription drugs for ailments. Now he’s on a cocktail of meds keeping him alive.
“I don’t like taking the drugs and I don’t like the side effects,” he said about hot flashes and a significant decrease in energy levels. “When I do exert myself I become very fatigued, and much more tired than I ever was before.”
“But it’s worth the price,” Jay said about the trade-off.
An outpouring of positive support from friends and family, the extraordinary care team at Dayton Physicians Network and a positive attitude are what Jay credits to his remarkable progress.
“The incredible love and support from my family and friends – it was simply overwhelming,” Jay commented.
“My wife was my guardian angel – I truly did not know she loved me that much,” he said, of Lynn, his wife of 38 years. “I don’t know how I would have gotten through this if it hadn’t been for her. She has been simply amazing.”
Today, Jay’s outlook is far better than it was 18 months ago when he received his diagnosis. But with no cure for stage four prostate cancer, he will live with this disease for the rest of his life.
“My fondest hope, although I’m not sitting on the edge of my seat waiting for it, is that cancer research does literally, truly cure it,” Jay said about prostate cancer. “I’m sure that will happen someday, whether I’m around at that point I don’t know.”
Cure or not, Jay has made an astonishing turnaround.
“I think it’s safe to say I’m the poster patient for Dr. Key,” Jay said. “His cancer treatment plan had incredible results.”
At a recent prostate cancer 5K, Jay had the opportunity to introduce his son, daughter and grandson to Dr. Key. “I introduced him as the person who saved my life,” Jay commented.
If you are thinking about getting a vasectomy, you are not alone. Each year, more than 500,000 men in the U.S. choose vasectomy as permanent birth control. During vasectomy, each vas deferens (the two tubes that move sperm) are sealed off. This blocks sperm from reaching the semen that is ejaculated from the penis. After a vasectomy, the testicles still make sperm but they are absorbed by the body. A vasectomy prevents pregnancy better than any other method of birth control, except abstinence. Only 1 to 2 women out of 1,000 will get pregnant in the first year after their partners have had a vasectomy.
Your doctor can perform a vasectomy in an office or hospital. Vasectomy is a minor surgery that should take about 20 minutes. One urologist who performs vasectomies tells his patients: “take a long hot shower the morning before with a lot of soap. And make sure you have a bag of frozen peas and a couple of rented movies at home.”
Before the vasectomy, your scrotum will be shaved and cleaned. Usually local anesthesia is used. So you will be awake but should not feel any pain. Some patients may also be given medicine to reduce anxiety. With a standard vasectomy, the urologist makes one or two small cuts in the scrotum. One vas deferens tube is cut and tied or sealed with heat. The tube is replaced inside the scrotum. The procedure is then repeated on the other side. Lastly, the skin is closed with stitches that dissolve and do not have to be removed.
Another popular option is a no-scalpel vasectomy. In this procedure, a small clamp with pointed ends is used to puncture the skin. Then each vas deferens is lifted out, cut, sealed and then put back in place. A no-scalpel vasectomy works just as well as a standard vasectomy. Some benefits of a no-scalpel vasectomy are less bleeding, swelling and pain. There is also a smaller hole in the skin.
Vasectomy is a minor surgery that should take about 20 minutes
About 1-2% of men may have ongoing pain or discomfort after a vasectomy. The pain is most often treated with antiinflammatory drugs, like ibuprofen. Exact causes of pain is not known, but in some cases, additional medical or surgical treatment may be needed.
Otherwise, the risk of bad side effects after a vasectomy is very low, but may include:
- Bleeding under the skin, which may cause swelling or bruising. (Call your doctor if your scrotum swells a lot soon after your surgery.)
- Infection at the site of the cut. It is rare for an infection to occur inside the scrotum.
- A small lump forming because sperm leaks from a vas deferens into nearby tissue. This is usually not painful. If it is painful, it can be treated with rest and pain medicine. Sometimes, surgery may be needed to remove the lump.
- Swelling of the vas deferens
- In rare cases, the vas deferens may grow back together, which would allow the man to have children again.
Older studies suggested a risk of prostate cancer and heart disease years later in men who have had vasectomies. But many years of research since then have found no link between vasectomy and these health problems.
More than 500,000 men have vasectomies in the U.S. each year.
Your scrotum will be numb for one to two hours after a vasectomy. Put cold packs on the area. (The bag of frozen peas mentioned before works well.) Lie on your back as much as you can for the rest of the day. Mild discomfort or pain is normal after a vasectomy, and should be treated with pain relievers. Wearing snug underwear or a jockstrap will help ease discomfort and support the area.
You may have some swelling and minor pain in your scrotum for a few days after the surgery. You may be able to go back to work in one or two days. It depends on how you feel. But you should avoid heavy lifting for a week. You can have sex again as soon as you are comfortable, usually within a week. But keep in mind that the vasectomy is not effective from day one. Sperm may still be in the semen for many months after a vasectomy. It takes about 20 ejaculations or three months to clear the sperm from the tubes. However, results vary for different men. Most often, your urologist will test your sperm count three months later. This is done to make sure your semen is clear of sperm. Until the sperm count is zero or there are very few non-moving sperm, sex without another method of birth control may lead to pregnancy.
After recovering from a vasectomy, a man and his partner should notice no difference during sex. An uncomplicated vasectomy does not cause erection problems. Ejaculation and orgasm should feel the same. The amount of semen does not decrease more than five percent. The only change your partner may be able to feel is a lump at the vasectomy site if one has formed.
THINGS TO THINK ABOUT
The choice to have a vasectomy is a very personal one. Talk with your partner, and think about what is best for you and your family. Be sure to bring up any questions you may have with your health care provider.
Below are some things to keep in mind:
- Vasectomy is safer and cheaper than tubal ligation (blocking the fallopian tubes to prevent pregnancy) in women.
- The one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods, such as condoms or the pill.
- A vasectomy does not protect against sexually transmitted diseases (STDs). Use condoms to protect against STDs.
Lastly, it is important to note vasectomy is a permanent method of birth control. This may be a plus or a minus based on your own situation. You should not have a vasectomy if you may want to father children in the future. While it is possible to have a vasectomy reversed, this is more complex and costly. Also, reversing or “undoing” a vasectomy does not always result in pregnancy. So it is important to think through all your choices carefully before deciding to have a vasectomy.
In English: http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
In Spanish: http://familydoctor.org/familydoctor/es/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
National Library of Medicine, Medline Plus
In English: http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm
In Spanish: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/002995.htm
Urology Care Foundation
For more facts about testicular cancer and other urologic health problems, please visit the Urology Care Foundation’s website, UrologyHealth.org.
Hospital Again Ranks as Top Hospital in Dayton Area
Congratulations on a great accomplishment to: Premier Health, Miami Valley Hospital, and Dayton Physicians Urology division!
Miami Valley Hospital ranked sixth among all Ohio hospitals in the latest annual rankings released by U.S. News & World Report. The hospital, which is part of Premier Health, again had the best performance among all hospitals in the Dayton metropolitan area.
Miami Valley Hospital with Dayton Physicians Network also ranked 47th in the nation in urology care.
For more information visit: https://health.usnews.com/best-hospitals/rankings/urology/ohio
The entire United States is experiencing a shortage of Urologists. There should be approximately 17,000 Urologists based on our population. Currently there are less than 10,000 active Urologists in the United States and over the next two years that number will decrease to 8,000 due to retirement. In order to address this shortage and continue to give you and our community the best possible urologic access and care in Southwest Ohio, we have developed collaborative health care provider teams in Urology. These collaborating teams will consist of our physicians and our specialty trained nurse practitioners to provide ongoing care for you.
Our collaborating teams of Physicians and Nurse Practitioners are listed below:
- Dr. David Key and Heather Shoup, CNP
- Dr. Mark Monsour and Rachel Perretta, CNP
- Dr. Blake Anderson and Kelsey Patterson, CNP
- Dr. Michael Yu and Bonnie Loesch, CNP
- Dr. Erik Weise and a soon to be announced Nurse Practitioner
We are excited to offer you this innovative model of Urology Collaborative Care and we look forward to seeing you in the office. As we transition to this new model, you may receive a phone call to change your appointment. We apologize for any inconvenience as we work hard to accommodate as many patients’ needs as possible to provide the best care and access.
For appointments at Dayton Physicians Urology, please contact our call center at (937) 293-1622.
We appreciate the opportunity to care for you.
Dayton Physicians Urology Team
Dr. Satheesh Kathula was a representative at a Capitol Hill meeting organized American Association of Physicians from Indian Origin. He met with several US congressmen including Rep. Phil Roe of Tennessee, Rep Joe Wilson of South Carolin, Rp. Ami Bera of California and discussed with them on the following health care issues mainly affecting community oncology care:
- The consequences of pharmacy benefits managers (PBMs) on community oncology care, which are not only more expensive, but have delays in mailing life saving drugs.
- Lowering the Cost of Prescription Drugs: The exorbitant cost of prescription drugs is a critical health care issue, as some life-saving drugs are too expensive for many patients.
- How hospitals get preferential reimbursement over independent practices (340B) which is driving the healthcare cost up.
In mid-April was the Ohio Urologic Society Annual Meeting in Columbus. At this meeting, Dayton Physicians Network’s Blake Anderson, MD took part of a panel about Management of Complex Stone Disease. The moderator for the discussion was Sri Sivalingam and other panelists were Mantu Gupta, MD, Smita De, MD, PhD, Michael Sourial, MD.
Dr. Anderson said “I really enjoyed being on the moderator panel for management of complex stone disease.” In the discussion several cases were presented and the panelists all weighed in on different approaches. One case discussed was, how to treat 10 cm of bladder stones in a man with BPH (enlarged prostate). Also discussed, was a case of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones.
All the Panelists noted that there were multiple options for treatment but many factors had to be considered. Below is Dr. Anderson take on the discussion, treatment options, and considerable factors.
“How to treat 10 cm of bladder stones in a man with BPH (enlarged prostate. Options are: shockpulse and laser lithotripsy, then holmium laser enucleation of the prostate.
For the bladder stone cases in general, I am in favor a of combination approach to obstructive prostate tissue under the same anesthetic when feasible as bladder stones typically only form in the setting of obstruction. KUB should be done or can check scout film of CT if that has already been done to see if bladder stones are visible, if not may contain uric acid and preoperative medical therapy with potassium citrate could significantly decrease stone burden.
Kidney stone cases were numerous, incomplete left duplex kidney with large upper pole stone burden, difficult renal access and discussed special techniques to do this and accomplish PCNL.
Another case was of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones, discussed ureteral stents or bilateral nephrostomy tubes as options, each with own advantages but both effective in prior studies. This decision involves a lot of patient specific variables, stone size, stone location, anticoagulation status and other anatomic considerations. In patients with low urine pH and low stone Hounsfield units on CT, especially in setting of recent chemotherapy, suspicion for uric acid stones should be high and stone dissolution therapy should be considered (medication, potassium citrate, raises urine pH and can dissolve uric acid stones).”
As an oncologist of 15 years, my work has been transforming. I have been a part of many cancer journeys, the fright and the fight, the hurt and the healing, the stress of finances and the journey of hope. I often succeed in the fight for my patients, but sadly even in this era of modern medicine and advanced research, I have to idly stand by and watch a few succumb.
I have humbly accepted the nomination to be a candidate for The Leukemia & Lymphoma Society’s (LLS) Man & Woman of the Year, 2019 fundraising campaign. The generous funding of LLS to my own patients has enabled them to receive the latest treatments without the stress of losing their homes. A young patient of mine is now undergoing CAR-T-cell immunotherapy, and due to the innovative therapies of LLS research, will survive in spite of recurrent aggressive Non-Hodgkin’s lymphoma. Since 2000, over 40% of all U.S. Food & Drug Administration (FDA) approved cancer drugs were for blood cancer, some even used to treat other forms of cancer and non-malignant diseases. A “win” for blood cancers, therefore, is a win for the cancer community overall. I run this campaign along with my patients Cynthia, Betty, Jeff, Ken, Chalonda, John, Edward, Tatyana, Bobbie, Toni, Jowana, Minnie, Patricia, Essie, Joan & many more; I run in honor of Tim, Anita & Donna.
I dream to erase the connotation of death from the word cancer one day. Every dollar raised in this campaign funds the work of LLS. Cancer research has come a long way. In the 60s, a blood cancer patient’s survival rate was 3%; today, it is 90%. Although 90% is remarkable, someday that 10% must be accounted for. With your support we are well on our way to making that someday today.
Please join the team and help us to cure every cancer patient. Donations can be made starting on February 28, 2019 through May 11, 2019 via credit card at https://pages.mwoy.org/soh/dayton19/jkoduri
or by mailing a check made out to LLS with Team Koduri in the memo and send it to 1029 Whispering Pine Lane, Dayton Oh 45458. Click here to know the impact of your donations. Thank you in advance for helping save lives through your generosity.
Jhansi Koduri, MD
Associate Professor, Wright State University
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