Breast cancer

Widespread changes to oncology items proposed by MBS Review Taskforce

The MBS Review Taskforce has released a large number of proposed changes to oncology items in areas such as chemotherapy management, tumour markers and diagnostic imaging.

Its reports, released a few days before Christmas, contain recommendations from numerous Taskforce’s clinical committees including medical oncology, pathology and nuclear medicine.

Significant changes include an overhaul of existing items 13915– 13942  for the medical management of antineoplastic agents to abolish the different benefit levels depending on the route of administration or duration of a single treatment.

The Taskforce say this is needed to reflect the increasing use of new agents that are less cytotoxic such as monoclonal antibodies, and the fact that drug delivery is now often done by nurses rather than oncologists.

Inappropriate use of MBS items for tumour markers is another area of concern, according to the reports, which recommend rewording item descriptors to specify which cancer and stage of disease a marker is indicated for.

The report from the Nuclear Medicine Diagnostic Imaging committee says all MBS PET items require a significant overhaul, to bring them into line with UK and US guidelines. This would allow patients with pancreatic cancer and recurrent breast cancer, to be eligible to get their scans done on Medicare.

Other changes in diagnostic imaging will see breast ultrasound and biopsy items combined, restrictions on diagnostic mammograms and widening the age of eligibility for breast MRI scans from under 50 to under 60 years of age.

The Diagnostic Imaging Committee also recommends new MBS items for MRI evaluation of rectal, liver and cervical cancer staging, a new item for whole body MRI for children with disseminated malignancy and a new MBS item for DEXA for patients with breast cancer being treated with aromatase inhibitor therapy.

Other recommendations include:

  • Introduce a new oral chemotherapy item.
  • Abolish separate billing for long-term implanted drug delivery devices  such as portacaths and PICC lines.
  • PSA testing restricted to one test every two years.
  • Ease the MBS criteria for additional ‘pathologist determinable’ cancer tests on biopsies such as tumour immunohistochemistry and HER2/EGFR testing in lung cancer).
  • Expand the MBS item for Selective Internal Radiation Therapy (SIRT) beyond liver tumours to include other cancer types.

However the release of large numbers of MBS item revisions by the MBS Taskforce has drawn protest from the AMA, which said in November that clinicians and professional groups had not been given enough time to consult on the numerous changes.

The AMA also complained that the Taskforce’s reports were being kept out of the public domain and circulated to only select groups for short periods.

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