bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in chemotherapy (CT) utilization for colorectal cancer: A provincial population-based analysis
Authors: Renouf D. J. , Kennecke H. , Gill S. 
Published: March 2020

17014 Background: Significant advances have been made in the treatment of colorectal cancer in both the adjuvant and metastatic setting. The purpose of this study is to examine CT prescribing patterns for adjuvant therapy of colon cancer and metastatic colorectal cancer over the last 15 years in British Columbia, Canada. Methods: All patients (pts) with stage 2 or 3 colon cancer, or stage 4 colorectal cancer at presentation referred to the BC Cancer Agency during a one year period for three time cohorts: 1990, 2000 and 2004, were reviewed. A pt was considered to be treated with CT if they received a cycle of CT within 6 months of referral. Results: A total of 1421 pts were included: stage 2/3 n=915, stage 4 n=506. Chemotherapy utilization increased significantly from 1990 to 2004 for adjuvant CT (1990: 49 (29%), 2000: 129 (45%), 2004: 235 (52%), p<0.001) and for palliative CT (1990: 41(35%), 2000: 100 (51%), 2004 120 (63%), p<0.001). The proportion of pts with stage 2 disease treated with adjuvant CT dramatically increased (1990: 3(4%), 2000: 38 (26%), 2004: 50 (30%), p<0.001). CT utilization was associated with a later time cohort and younger age of presentation ( Table 1 ). The use of palliative CT was significantly associated with male gender (p=0.025). This gender bias was not observed in the adjuvant setting. Among pts >70y, only 25% (99/394) received adjuvant CT [1990: 5(8%), 2000:38 (28%), 2004: 57 (28%] and 31% (50/162) received palliative CT [1990:4 (15%), 2000:17 (24%), 2004:30 (45%)]. Conclusions: In this population-based cohort, adjuvant and palliative CT utilization has increased since 1990 however there is room for improvement. Despite the lack of conclusive evidence, the use of adjuvant CT for stage II disease has increased significantly. Female pts appear less likely to receive palliative CT. Despite evidence that the elderly can accrue similar proportional benefits, the majority of referred pts >70y did not receive adjuvant or palliative CT. Such discrepancies in CT utilization require further investigation. [Table: see text] No significant financial relationships to disclose.
Deferasirox for myelodysplastic syndrome patients with transfusional iron overload: A budget impact analysis
Authors: Mody-Patel N. , Goldberg S. L. , Barghout V. 
Published: March 2020

17019 Background: Myelodysplastic syndromes (MDS) affect 12–20,000 in the US yearly. Blood transfusions, a mainstay of treatment, place MDS patients (pts) at risk for complications of transfusional iron overload (IO). Although recent data suggests iron accumulation significantly reduces survival in low and intermediate -1 risk MDS, incremental cost of adding chelators to health plan formularies are unknown. The economic impact of treating transfusional IO in MDS with two commercially available chelating agents were estimated from a health care plan (hcp) perspective. Methods: An Excel based model was developed to ascertain the incremental cost per treated MDS pt associated with oral deferasirox (DSX) relative to subcutaneous (sq) deferoxamine (DFO). Annual Per Member Per Month (PMPM) cost was calculated by dividing differences in annual expenditures for DSX and DFO by total plan membership. Data from published literature and pivotal clinical trials were used to estimate MDS prevalence and chelation eligibility. Costs associated with infusing sq DFO were based on medical claims analysis from 2001 to 2004. Medication costs were based on wholesale acquisition costs assuming 100% compliance. Sensitivity analyses were performed by varying model parameters. Results: A hcp of one million pts is estimated to have 119 pts with MDS, of which 22% are eligible for iron chelation therapy. The base-case model resulted in an incremental annual saving of $389.48 per treated MDS pt and an incremental budget impact of $0.0 PMPM of the hcp (function of relatively few MDS pts spread over million in hcp) associated with the use of DSX. Overall, 34.2% of DSX cost was offset by the absence of infusion costs, the key cost driver. Sensitivity analyses of varying pt weight and infusion costs showed the model results were robust. Conclusions: The annual budget impact of switching MDS patients with IO to DSX from DFO will potentially result in cost-savings for US health plans. These results should be considered in the selection of chelation therapy. No significant financial relationships to disclose.
Differential delays in breast cancer treatment as a function of racial/ethnic background
Authors: Bustami R. T. , Poletick E. B. , Cosico J. N. , Whitman E. D. 
Published: March 2020

17023 Differential delays in breast cancer treatment as a function of racial/ethnic background Background: Multiple studies have identified differences in breast cancer treatment and outcome due to racial/ethnic and socioeconomic factors. The purpose of this study was to investigate treatment disparities, both actual and temporal (i.e. time delay), in patients newly diagnosed with breast cancer as a function of racial/ethnic background. Methods: Patients at two affiliated hospitals newly diagnosed with breast cancer were identified and classified from discharge billing data. Time to treatment was defined as the time in days between biopsy proven diagnosis and initiation of treatment including chemotherapy, radiation therapy, lumpectomy and mastectomy. Nonparametric Analysis of Variance (ANOVA) using the Kruskal-Wallis Test examined differences between race groups based on median time to treatment. Types of treatment were analyzed by the Chi-Square test. Results: A total of 1217 patients were identified over a five-year period. Racial background was classified as White, African American, or Asian/Other. Lumpectomy was performed in 47%, 41%, and 38%, respectively (p = 0.15), while 24%, 23%, and 18% received a mastectomy (p = 0.51). There were no significant differences between the racial groups for types of therapy received. Results from ANOVA (table) showed statistically significant differences between the three race groups in terms of time to mastectomy (p = 0.003) and time to radiation therapy (p=0.043). Results from pairwise comparisons showed that (1) African American patients had a significantly longer time to mastectomy than Whites (p = 0.002), (2) patients in the Asian/Other group had a significantly longer time to radiation than their white counterparts (p = 0.015). Conclusion: This study demonstrates racial differences in time to non-surgical and surgical treatment in a group of ethnically diverse breast cancer patients. [Table: see text] No significant financial relationships to disclose.
Does qualitative radiologic assessment of tumor response measure up to traditional quantitative scoring methods?
Authors: Gottlieb R. , Litwin A. M. , Mashtare T. L. , Wilding G. , Raczyk C. L. , Taylor J. , Fakih M. G. , Gupta B. 
Published: March 2020

17034 Background: The Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) radiologic metrics are the standards for tumor response to therapy. However these methods are difficult to use and are limited in their prediction of clinical outcome. We hypothesize a simpler qualitative assessment of tumor response by CT is as reproducible and predictive of clinical outcome as the RECIST and WHO methods. Methods: This was a retrospective evaluation of 23 patients (11 males, 12 females, mean age 56.1 years, range 40–81 years) with biopsy proven metastatic colo-rectal carcinoma treated at our institution between 2002 and 2006 who did not have their primary tumor resected. Only patients with two consecutive CT examinations separated by at least three weeks were included. Two board certified radiologists, blinded to the other's reads, independently interpreted all CT examinations measuring up to five hepatic lesions on both CT examinations using RECIST and WHO criteria and qualitatively assessing all hepatic metastases, categorizing them as increased, decreased, or unchanged between scans. Clinical outcome, using time to progression of disease (TTP), was measured, utilizing a Cox proportional hazards model, to compare the predictive value of all three scoring systems for those patients starting first line chemotherapy (11 patients) at the time of our analysis. Results: Qualitative assessment resulted in agreement in 21/23 patients (91.3%, kappa = 0.78) classifying hepatic metastases as any increase (2 patients), any decrease (17 patients), or no change (2 patients) between scans compared with agreement in 20/23 patients (87.0%) for RECIST (kappa = 0.62) and WHO ( kappa = 0.67) methods placing patients into partial response (2 patients by RECIST and WHO), stable disease (17 patients by RECIST, 16 patients by WHO), and disease progression (1 patient by RECIST, 2 patients by WHO)categories by accepted criteria. No significant difference in prediction of TTP between methods was found. Conclusions: Our pilot data suggests our qualitative scoring system may be at least as reproducible and predictive of patient clinical outcome as the RECIST and WHO methods. No significant financial relationships to disclose.
Pharmacoeconomic analysis of a combination of capecitabine (X) with docetaxel (D) and trastuzumab (H) first-line in HER2- positive advanced or metastatic breast cancer
Authors: Bonetti A. , Santoro A. , Cirrincione A. , Giuliani G. , Bell R. 
Published: March 2020

17036 Background: A recently published (Wardley et al ESMO 2006) randomized phase II trial (CHAT) compared XDH with DH. The primary endpoint, overall response rate, was similar with XDH (71%) and DH (73%), while XDH showed superior time to progression (TTP) (hazard ratio [HR] 0.70, p=0.045, median 18.2 vs 13.8 months, respectively) and a trend toward superior progression-free survival (HR 0.72, p=0.06, median 14.8 vs 12.8 months, respectively). Overall survival data are immature. This analysis evaluates potential pharmacoeconomic impacts of adding X to DH. Methods: Direct medical costs during the study were estimated from the Italian health system perspective. Actual doses of both regimens were modeled from trial data. Grade 3/4 adverse events (AEs) and related medications were analyzed to estimate costs of treating major AEs. Other costs relating to laboratory tests and drug administration were assumed to be the same in both arms. Results: Total direct medical costs were slightly lower for XDH: €15250 vs €15570 for DH. As expected, the main cost drivers were drug costs: €14,370 vs €14,690, respectively. XDH and DH safety profiles were different: XDH resulted in more grade 3/4 non-hematologic AEs than DH (total: 77% vs 68%; hand-foot syndrome: 16% vs <1%; diarrhea: 11% vs 4%, respectively), but less grade 3/4 neutropenia (54% vs 77%), complicated neutropenia (20% vs 24%) and febrile neutropenia (14% vs 23%). The estimated mean AE costs per patient were similar in both arms. Conclusion: With the convenience of oral therapy, adding X to DH does not increase the number and duration of infusion visits or increase costs. For patients, physicians and payers, XDH is a good alternative for the treatment of advanced/metastatic breast cancer. [Table: see text]
Epidemiology of cancer in the middle age and elderly populations in a developing economy: Need for proper resource allocation and personnel training
Authors: Alese O. B. , Obamuyide H. A. 
Published: March 2020

17046 Background: Cancer is emerging as a major cause of death in developing countries. In order to prioritize health care resources, the pattern of occurrence and the current surgical treatment of different cancer types must be determined. We retrospectively reviewed the hospital's operating records, to find out the areas of greatest need with respect to cancer types. Methods: We extracted and analyzed relevant data from the hospital's operating records for the General Surgical Divisions (3). The hospital is a tertiary health care centre, serving as referral for more than 10 million people. All the operations done on patients more than 40 years old, from January 2004 to December 2005 (a 24 month period), were included in the analysis. Results: A total of 210 operations were done for general surgical malignancies in the 3 Divisions over the study period. 50% of the patients were between 41 and 60 years of age. 8% were 70 years and older. The majority were female; 72.4%, with a male to female ratio of 1:2.6. More than half of the cases were breast cancers (51.9%). Others were gastrointestinal (30%; colorectal: 24%, stomach: 6%), soft tissue sarcomas (6%), thyroid cancers (3.3%) and salivary glands (3%). 13.8% of the operations were done on emergency basis; in more than half of the colorectal cases who presented in acute intestinal obstruction. Virtually all the breast cancer operations were modified radical mastectomy. Conclusions: Most cancer operations in the middle age and elderly patients are for breast cancers, especially in the female gender. A significant proportion of the emergency operations are done for colorectal cancers presenting with acute intestinal obstruction. Appropriate health care personnel training and adequate resources are urgently needed in these areas, for effective and modern control of an emerging epidemic in developing economies. No significant financial relationships to disclose.
Self-directed learning module for radiation therapy treatment planning
Authors: Campeau M. , Lasalle S. , Lambert C. , Filion É. 
Published: March 2020

17051 Background: Radiation Oncology is a rich and rewarding specialty that requires in-depth understanding of anatomy, physics, dosimetry and oncology. The area of dosimetry is an important and basic fundamental concept to be acquired during residency, and pertinent educational tools are few and far between. The purpose of this project was to develop a self-assessment tool to facilitate radiation therapy treatment planning for non-small cell lung cancer (NSCLC). Methods: We focused our learning module on basic dosimetric and NSCLC treatment planning objectives that radiation oncology residents will encounter during residency. Interactive questions incorporating objective-related concepts were then devised. Treatment planning program templates were developed using the Eclipse software application. Results: A web-based self-directed learning module was developed as the tool's delivery mechanism. The module's questions were divided into the following sections: Chest Anatomy, ICRU Concepts, Beam Modificators, Integrated NSCLC Treatment Plans, Systematic Treatment Planning Approach and Inhomogeneity Corrections. By answering questions via the module, learners receive immediate feedback, corrections and concept-related explanations. A variety of different question techniques were employed, such as multiple choice questions, open-ended questions and associations. Learners are prompted by the system to draw isodoses and volumes on the screen. Other tasks in the module involve identifying structures, setting treatment fields and analyzing dose volume histograms. The website is publicly available in both English and French at: http://www.radiol.umontreal.ca/radio-onco/ . Conclusions: This self-directed learning module is a complementary tool that will help residents gain a solid grasp of NSCLC treatment planning objectives. Other modules covering radiation therapy treatment planning for a variety of anatomical sites, as well as diseases at different stages will eventually be created and added to the website. This educational project aims to facilitate learning and understanding the concepts of treatment planning, according to the different types of cancer. No significant financial relationships to disclose.
The impact of lymph node dissection in patients with colorectal cancer
Authors: Gentry R. W. , Govindarajan R. , Spencer H. J. , Dykstra-Long G. 
Published: March 2020

17055 Background: The role of extended lymphadenectomy on survival of patients with colorectal cancer is unclear. Survival in these patients is inversely proportional to the stage of disease. The prognostic significance of inadequate lymph node dissection is not understood. To understand the impact of the number of lymph nodes removed at the time of surgery on survival, we conducted a retrospective study of patients with colorectal cancer treated at the Central Arkansas Veterans Healthcare System, Little Rock, AR. Methods: Data on 531 patients with a diagnosis of colorectal cancer from January 1991 to October 2005 was obtained from the tumor registry. The number of lymph nodes dissected the number of positive and negative lymph nodes for each patient, treatment received and overall survival was analyzed. The number of resected nodes was grouped as follows: none (LNG0), 1–5 (LNG1), 6–10 (LNG2), and > 10 (LNG3). Log rank test was used to evaluate difference in survival between the groups. Results: There were 451 Caucasians, 80 African Americans, 523 males and 8 females in the study. The median age was 69 yrs (range: 29–100). Rectal cancer patients had fewer nodes dissected compared to colon cancer (p <0.001). There was no survival difference between LNG0, LNG1, LNG2 and LNG3 (p=0.435). The number of lymph nodes removed did not have an impact on survival among those who had node negative disease (0.435) and node positive (0.458) disease. LNG0 patients had the same prognosis as those with node negative disease (P=0.435) who had better survival compared to node positive disease. (p=0.029). However, LNG0 patients had similar survival compared to LNG1 subset of patients and those in LNG3 had a trend towards better survival, though not statistically significant. LNG0 subjects received less chemotherapy (p=0.018) and radiation therapy (p=0.01) compared to those who had lymphadenectomy. Conclusions: The number of nodes removed at the time of surgery did not affect survival in subjects with node negative and node positive disease. Patients who did not have any identifiable nodes at the time of surgery had the same prognosis as those who had node negative disease. Patients with more than 10 negative nodes dissected had a trend towards better survival although not statistically significant. No significant financial relationships to disclose.
Prescription patterns for metastatic breast cancer patients previously treated with anthracycline and taxane: An assessment in a United States managed care database
Authors: Harris L. A. , Yu Y. , Donato B. 
Published: March 2020

17056 Background: There is a scarcity of literature documenting actual prescription patterns for metastatic breast cancer (MBC) patients. The objective of this study was to describe the pattern of dispensing chemotherapy agents among MBC patients previously exposed to anthracycline and taxane in the managed care setting. Methods: Study cohort was extracted from the PharMetrics database between 1/1999 through 6/2005, who were =18 years, enrolled =6 months with =2 ICD-9-CM codes for breast cancer (BC), =1 ICD-9-CM code for distant metastases, and =1 NDC/J-code for anthracycline and taxane. A 21 day treatment interval was assigned to all agents to identify treatment regimens. If types of agents in consecutive intervals were the same, they were collapsed into one regimen disregarding the sequence. Following the reference date, the dispense date of the first anthracycline or taxane prescription, whichever occurred later, the first regimen was treated as reference regimen. Following this regimen, sequential monotherapy or combination therapy was identified in a chronological order. Results: Of the 1,028 who met inclusion criteria, 67% (n=691) did not receive a sequential therapy. Of the 33% (n=337) who did, the first sequential regimen for 177 was monotherapy and 160 combination therapy. The most common agents within the monotherapy regimens were taxanes 28%, capecitabine 20%, and trastuzumab 18%. For combination, taxane/trastuzumab 9.4%, vinorelbine/trastuzumab 9.4%, and carboplatin/taxane 8.8%. Of those who received sequential therapy, 68% were retreated with a taxane; 34% with docetaxel and 46% with paclitaxel. Conclusions: In this study, the majority of the population did not receive sequential therapy. This may have been due to loss to follow up, the duration of the reference regimen (lasting throughout the study period(s) after collapsing), or treatment in the inpatient setting where chemotherapy agents are not identifiable in this claims database. Taxane was the most common agent received in the first sequential therapy, both for monotherapy and combination therapy. A high proportion of patients with sequential therapy were retreated with a taxane. No significant financial relationships to disclose.
Economic burden of brain metastases in breast cancer patients in a US managed-care population
Authors: Amonkar M. M. , Pelletier E. M. , Shim B. 
Published: March 2020

17069 Background: Limited data are available evaluating health resource use and costs of breast cancer (BC) patients who develop secondary brain metastases (BM). This study estimated the economic burden among BC patients diagnosed with incident BM. Methods: Female BC patients aged 18+ years, newly diagnosed with BM between 1/2002 and 12/2004 were identified from a private payer database (PharMetrics, Inc). The index date was the date of the incident BM diagnosis. BC was identified during a 1-year look-back period. BM patients were matched to a control group of BC patients with no evidence of BM during the study period. Patients not continuously enrolled in a health plan for 1 year before and at least 1 month after the index date and those aged 65+ years and not in Medicare Risk were excluded. Paid claims were used to estimate resource utilization and costs. Results: 775 incident and control patients resulted from a 1:1 match (mean age=54 years). At 6 months follow-up (N=398), BM patients had significantly more hospital stays (mean 1.1 vs. 0.5, p<0.001) and remained hospitalized for a longer period (mean 8.0 days vs. 2.5 days, p<0.001) compared to controls. BM patients also averaged more outpatient services, including physician office visits (32.8 vs. 24.3, p<0.001), as well as pharmacy claims (56.0 vs. 39.1, p<0.001). Similar differences were found at 1 year (N=230), with greater mean inpatient, outpatient, and pharmacy services (p<0.001) in BM patients. Average total costs for BM patients at 6 months were $60,045 compared to $28,193 (p<0.001) for controls; this difference was driven by higher mean inpatient ($17,462 vs. $5,362, p<0.001) and outpatient ($26,209 vs. $11,652, p<0.001) costs among BM patients. At 1 year, higher mean total costs persisted in BM patients ($99,899 vs. $47,719, p<0.001). After adjusting for key variables, mean costs for BM patients were 123% higher than those for control group patients. Conclusions: Patients with BC and secondary BM incurred significantly more healthcare resources following diagnosis compared to those with BC but no BM. Mean total costs for BM patients were more than double those of patients without BM at 6 months and 1 year. These findings underscore important economic implications of BM and the call for new therapies that improve outcomes in patients with BM. No significant financial relationships to disclose.