Oncologists call for easing of PBS cancer drug restrictions during COVID-19


By Mardi Chapman

6 Apr 2020

Professor Eva Segelov

Professor Eva Segelov

Oncologists have called for the Federal Health Minister Greg Hunt to relax PBS restrictions around some cancer therapies during the COVID-19 pandemic.

MOGA has sent the Minister a letter emphasising the substantial impact that the pandemic will have on the care of individuals with cancer and requesting some flexibility with PBS-funded treatment for the duration of the pandemic.

It called for medical oncologists to be able to modify cancer treatment – where an alternative was available – to make patients as safe as possible during the crisis.

The need for more flexibility arose during the development of detailed advice for the management of cancer patients during COVID-19.

Professor Eva Segelov, who led a team of 17 specialists from around Australia and New Zealand on the MOGA-endorsed document, said it became obvious that some of their suggestions for substitutions and alternate regimens were not allowed under PBS rules.

“So I’m really campaigning for sensible alternatives for people with cancer, and other chronic diseases, [for the government] to trust the medical profession …and change the restrictions for this period.”

“That would make it easier, it would keep people out of hospitals, it would rationalise our resources, and it would give people options for less toxic treatment. There are no downsides.”

She said the types of changes were sensible and often had evidence that had arisen after initial PBS listings, but had simply yet to be considered.

They were also likely to be cost effective if they reduced the risk of immunocompromised patients being exposed to the coronavirus, getting sick and having to be hospitalised with COVID-19.

For example, it might be appropriate for patients with prostate cancer to skip required pre-treatment with chemotherapy before hormone treatment.

Other PBS restrictions around prescribing G-CSFs prophylactically to reduce neutropenia, de-escalation from combinations to single agents or recommencing treatment after an extended break might also be relaxed.

Professor Segelov said under the extenuating circumstances the Health Minister should be able to make a blanket rule that effectively said to doctors that “we trust you”.

“You [the doctors] are going to be running our ventilators and make sensible decisions and use evidence where you can and use peer review…”

She said the other alternative was that MOGA supplied a list of specific requests which the federal government could go through one by one.

“And also it’s not just PBS but MBS numbers. For example, Hospital in the Home won’t give subcutaneous Herceptin because they are not reimbursed. So we are making patients come in to have an IV treatment when they could get a subcutaneous injection at home. And it’s all because they don’t get $66 or whatever it is, so the services won’t do it.”

She added that access to some molecular testing, that was not yet funded, might also save a lot of people going on chemotherapy during COVID-19.

“It’s an absolute no-brainer. They have been able to co-opt the private hospitals, they can do many, many things…so I can’t see why they couldn’t do this.”

“We’re all doing what we can to prepare. Like in war time when there is a lot of innovation and society is prepared to move, these measures are sensible anyway, but particularly sensible now.”

Clinicians can contact Professor Segelov for a copy of the recommendations ahead of publication.

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