NCCN Policy Summit: Innovative Solutions to Drive Down Healthcare Costs: Implications for Access to High-Quality Cancer Care.

The cost of delivering high-quality healthcare in America now consumes 17.7% of the nation's gross domestic product according to Centers for Medicare & Medicaid Services National Health Expenditure Data. With costs threatening to disrupt accessible and equitable care for patients, policymakers are reassessing all matters and functions of the healthcare system to excise waste, redundancies, and costly services. To explore this subjects' impact on oncology, NCCN hosted the NCCN Policy Summit: Innovative Solutions to Drive Down Healthcare Costs: Implications for Access to High Quality Cancer Care. This virtual summit featured multidisciplinary panel discussions and keynote addresses. Seeking to address barriers to low-cost, high-quality cancer care, panelists and keynotes presented innovative policy solutions to sustain high-quality oncologic care at lower costs to the health system. This article encapsulates the discussions held during the summit and expounds upon salient points where appropriate.

NCCN Patient Advocacy Summit: Delivering Value for Patients Across the Oncology Ecosystem.

As the oncology ecosystem shifts from service-based care to outcomes and value-based care, stakeholders cite concerns regarding the lack of patient experience data that are important to the patient community. To address the patient perspective and highlight the challenges and opportunities within policy and clinical decision-making to improve patient-centered care, NCCN hosted the NCCN Patient Advocacy Summit: Delivering Value for Patients Across the Oncology Ecosystem on December 11, 2019, in Washington, DC. The summit featured multidisciplinary panel discussions, keynote speakers, and patient advocate presentations exploring the implications for patient-centered care within a shifting health policy landscape. This article encapsulates and expounds upon the discussions and presentations from the summit.

NCCN Policy Summit: Defining, Measuring, and Applying Quality in an Evolving Health Policy Landscape and the Implications for Cancer Care.

Quality measurement is a critical component of advancing a health system that pays for performance over volume. Although there has been significant attention paid to quality measurement within health systems in recent years, significant challenges to meaningful measurement of quality care outcomes remain. Defining cost can be challenging, but is arguably not as elusive as quality, which lacks standard measurement methods and units. To identify industry standards and recommendations for the future, NCCN recently hosted the NCCN Oncology Policy Summit: Defining, Measuring, and Applying Quality in an Evolving Health Policy Landscape and the Implications for Cancer Care. Key stakeholders including physicians, payers, policymakers, patient advocates, and technology partners reviewed current quality measurement programs to identify success and challenges, including the Oncology Care Model. Speakers and panelists identified gaps in quality measurement and provided insights and suggestions for further advancing quality measurement in oncology. This article provides insights and recommendations; however, the goal of this program was to highlight key issues and not to obtain consensus.

The State of Cancer Care in America: Impact of State Policy on Access to High-Quality Cancer Care.

Health policy in America has shifted rapidly over the last decade, and states are increasingly exercising greater authority over health policy decision-making. This localization and regionalization of healthcare policy poses significant challenges for patients with cancer, providers, advocates, and policymakers. To identify the challenges and opportunities that lay ahead of stakeholders, NCCN hosted the 2019 Policy Summit: The State of Cancer Care in America on June 27, 2019, in Washington, DC. The summit featured multidisciplinary panel discussions to explore the implications for access to quality cancer care within a shifting health policy landscape from a patient, provider, and lawmaker perspective. This article encapsulates the discussion from this NCCN Policy Summit.

Advocating for Equity in Cancer Care.

Demographic factors such as race, socioeconomic status, gender identity, area of residence, native language, and cultural barriers have an effect on outcomes in cancer care. To identify unmet needs, challenges, and opportunities in achieving high-quality, patient-centered cancer care for all, NCCN conducted a yearlong environmental scan, which involved stakeholder meetings with patients and patient advocacy groups to discuss these topics. The findings from this scan informed the corresponding NCCN Patient Advocacy Summit: Advocating for Equity in Cancer Care, held in Washington, DC, on December 10, 2018. In addition to the many patient advocacy groups, the summit featured a number of other stakeholders that advocate for equity in cancer care. This article encapsulates the findings of the environmental scan and the discussion from the NCCN Patient Advocacy Summit.

Identification and evaluation of a thinning agent compatible with MegaCell DCS, an animal product-free corneal storage medium.

PURPOSE: MegaCell DCS, an animal product-free culture medium formulated for storing corneas, is superior to the traditionally used MEM (Eagle's) with Earles salts, Hepes, and supplemented with foetal calf serum (2 %), glutamine and an antibiotic cocktail (EB MEM). Because this medium does not prevent corneal swelling, and Dextran T500, which is traditionally used for reversing this process before transplant may have adverse effects on corneas, the purpose of the current investigation was to identify an alternative polymer that is compatible with MegaCell DCS. METHODS: Corneas maintained in MegaCell DCS or EB MEM were transferred to either EB MEM 5 % Dextran T500 or MegaCell DCS containing 5 % Dextran T500, 4 % polyethylene glycol (PEG) 10,000, PEG 35,000 (2 %, 3 %, 4 %) or Poloxamer 188 (4 %). Endothelial cell losses were determined and corneal hydration levels measured. Stromal cell cultures were generated and immunostained with anti α-SMA antibody. Janus Green was used to compare the viability of endothelial cells of corneas maintained in MegaCell DCS and EB MEM and respectively thinned with PEG 35,000 and Dextran T500. RESULTS: The rates of endothelial cell loss from corneas held in MegaCell DCS and thinned in MegaCell DCS containing 5 % Dextran T500, 4 % PEG 10,000 and 4 % Poloxamer 188 for 6 days were similar. When explants of these corneas were cultured myofibroblasts were generated. Although at concentrations of 4 % (w/v) both PEG 10,000 and Poloxamer 188 caused excessive dehydration, the hydration levels of corneas held in MegaCell DCS containing 3 % PEG 35,000 were similar to those of corneas held in EB MEM 5 % Dextran T500. Endothelial cell losses after 6 days were negligible, explants of the corneas generated uniform fibroblastic stromal cell cultures and the extents of Janus Green staining were similar. Over 20 days the inclusion of 5 % Dextran T500 in EB MEM but not 3 % PEG 35,000 in MegaCell DCS, increased the rate of endothelial cell loss. CONCLUSION: PEG 35,000 at a concentration of 3 % w/v does not induce endothelial cell loss and is compatible with MegaCell DCS for thinning corneas prior to transplantation.

Evaluation of Megacell MEM as a storage medium for corneas destined for transplantation.

PURPOSE: Gibco's Minimum Essential Medium with Earle's salts and HEPES supplemented with glutamine, antibiotics (EB MEM) and 2% foetal calf serum (FCS) is used in European eye banks to store corneas. Although FCS is important to endothelial cell survival in this medium, it is a potential biohazard. Megacell MEM, formulated to reduce the FCS requirement of cells by a factor of 5, has therefore been evaluated as a corneal storage medium. METHODS: Corneal stromal and epithelial cells were incubated in Megacell MEM (serum-free or 2% FCS) to assess their viability in these media. Endothelial cell densities of paired corneas held in either EB MEM 2% FCS or Megacell MEM (serum-free or 2% FCS) were measured over 5 weeks. Discs subsequently punched from the centre of these corneas were weighed, dried and reweighed to determine hydration levels. RESULTS: Both corneal stromal and epithelial cells proliferated in Megacell MEM 2% FCS. Relative to EB MEM, 2% FCS Megacell MEM prolonged the viability of corneal endothelial cells and improved their morphological appearance, irrespective of whether it contained FCS or not. This was independent of corneal swelling. CONCLUSION: Serum-free Megacell MEM is a better storage medium than EB MEM 2% FCS for corneas destined for transplantation.

Evaluation of an animal product-free variant of MegaCell MEM as a storage medium for corneas destined for transplantation.

PURPOSE: The traditional medium for storing corneas in European Eye Banks is Gibco's MEM (Eagle's) with Earle's salts and Hepes containing 2% fetal calf serum, glutamine and antimycotics. Although serum-free MegaCell MEM has been reported to be more suitable for this purpose, it contains components of animal origin that potentially pose health risks to corneal recipients. The possibility of removing or replacing these components has therefore been investigated. METHODS: A MegaCell basal medium (DME) and a formulation of this (MegaCell DCS), which contains no components of animal origin, have been prepared. The viability of the endothelial, epithelial and stromal cells of corneas held in these media has been assessed, their stress levels monitored and water content determined. RESULTS: The endothelial cell count and morphology of corneas held in MegaCell DME and DCS for 30 days remained little changed. Their epithelial and stromal cells also retained their ability to proliferate in culture. Neither DME nor DCS prevented corneal swelling but the lack of endogenous MMP-2 activation indicated that the corneas were not subject to metabolic stress. CONCLUSION: MegaCell DCS is an animal product-free medium formulated for corneal storage. The quality of corneas held in this medium is similar to those held in MegaCell MEM.

Changes in cell surface proteins of culturedDrosophila cells exposed to 20-hydroxyecdysone.

Drosophila cell lines have provided popular material for study of the mechanisms by which steroid hormones regulate cellular events. Previous investigations at the organismic or organ level have suggested that ecdysteroids are bound by a cytoplasmic receptor, and that the resulting complex translocates to the nucleus where it results in active transcription of a few genes. The protein products of these primary responding genes then modulate a larger series of secondary transcriptional changes. In cultured cells, other investigators have detected the hormonally-induced synthesis of only 4-5 new polypeptides through 72 h of treatment. Although these proteins may represent the gene products associated with the primary response, this small number of changes is surprising in view of the rapid morphological alteration of the cells and changes in such surface-mediated behavior as substrate adhesion and agglutinability observed within the same time interval. In this report, we show that lactoperoxidase-catalyzed radioiodination followed by 2-dimensional polyacrylamide gel electrophoresis and autoradiography provide an effective protocol for visualizing cell surface proteins of a Drosophila cell line. Among the more than 175 labeled species detected, comparisons of control cells with those treated by 20-hydroxyecdysone for 72 h shows at least 27 differences. We interpret these differences as the result of the secondary transcriptional response to the hormone.