bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metastatic breast cancer treated by chemotherapy: Trends in survival and costs in two patient cohorts treated in 1994–1998 and 2003–2006
Authors: Galy G. , Labidi S. , Perol D. , Carol C. , Guastalla J. , Favier B. 
Published: August 2020

6552 Background: Although new chemotherapy agents have been approved during the past decade for the treatment of metastatic breast cancer (MBC), it is unclear whether their use has changed the outcome of patients. This study assessed the clinical and economic impacts of these drugs. Methods: We undertook a retrospective study of women diagnosed with MBC during two periods of time, 1994–1998 and 2003–2006 and compared overall survival data between the two groups. Female patients with MBC were identified from the Centre Léon Bérard (Lyon, France) database. Tumor and treatment characteristics, costs of chemotherapy, and patient outcome were compared using the X2 test, the log rank test, and Cox regression analysis. Overall survival was calculated from the date of MBC diagnosis to the date of death or last follow-up. Chemotherapy-related costs were calculated according to the 2008 pricelist of French cancer centers. Results: A total of 301 MBC cases were identified. The median follow-up of living patients was 3.87 years. No survival difference was observed between the two periods, with a median overall survival of 2.76 years for the 1994–1998 cohort (149 patients) and 2.68 years for the 2003–2006 cohort (152 patients) (HR 1.04, 95%CI 0.70–1.55; p = 0.83). The median number of lines of chemotherapy was similar in the two groups (=3). The median cost of chemotherapy per MBC patient was 3 times higher in 2003–2006 (25,320 €) than in 1994–1998 (8,865 €; p < 0.001). In multivariate analysis, prognostic factors for overall survival were the number of metastatic sites (HR 2.06; p < 0.0001), bone metastases (HR 0.67; p = 0.007), and hormone receptors (HR 0.56; p = 0.002). Survival was identical in HER-2 positive and HER-2 negative patients (HR 0.99; p = 0.99). Conclusions: Despite the implementation of numerous novel chemotherapeutic agents, the overall survival of patients with metastatic breast cancer has not improved over the last decade on the scale of our institution, whereas the costs of chemotherapy have significantly increased. No significant financial relationships to disclose.
Trends in chemotherapy and biologic treatment of U.S. metastatic colorectal cancer patients
Authors: Foley K. M. , Wang P. F. , Long S. , Barber B. , Bagalman E. , Zhao Z. 
Published: August 2020

6553 Background: Several long-standing chemotherapy regimens are available to treat metastatic colorectal cancer (mCRC) including: oxaliplatin plus 5-fluorouracil (5-FU) and leucovorin (FOLFOX); and Irinotecan plus 5-FU and leucovorin (FOLFIRI). More recently, new biologic therapies were approved for use in mCRC. This cohort study examines trends in first-line chemotherapy treatments for newly diagnosed mCRC patients after the introduction of capecitabine (CAP) in 2001 and the biologic therapies in 2004. Methods: Using a large, US-based administrative medical claims database of a national commercially insured population, patients with newly diagnosed mCRC were identified from 2001 to 2005. At least 6-months of patient history prior to mCRC diagnosis were required to confirm patients were newly diagnosed. Patients were followed from initial mCRC diagnosis to death, disenrollment, or 12/31/2006. Results: Total of 3,781 newly diagnosed mCRC patients were identified between 2001–2005. On average over the 5 years, 58% of patients (with annual variation ± 4% points) received chemotherapy/biologic treatment in the year following their mCRC diagnosis; mean days to initiation of chemotherapy treatment decreased from 135 to 62 between 2001–2005. In 2001, FOLFIRI (40%), 5-FU (30%), and CAP (20%) were the most prevalent first-line treatments. In 2005, first-line treatment regimens were more diverse: FOLFOX plus bevacizumab (35%), FOLFOX alone (15%), 5-FU (15%), and CAP (15%) were the most prevalent, while 33% of patients used other treatment combinations. Among mCRC patients diagnosed in 2005, 63% were treated with at least one biologic therapy in the first year after diagnosis (57% received bevacizumab; 26% received cetuximab). Conclusions: While rates of chemotherapy use remained relatively constant between 2001–2005, patients initiated chemotherapy treatment sooner after their initial diagnosis and the standard course of therapy shifted from being FOLFIRI-based to FOLFOX-based. A rapid uptake in biologic therapies occurred. The majority of newly diagnosed mCRC patients were users of biologic therapy within one year following their introduction. [Table: see text]
Breast cancer patients' perceived quality of care: The importance of trust and communication
Authors: Franco R. , Joseph K. P. , Fei K. , Bickell N. 
Published: August 2020

6554 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients’ perceived quality of cancer care matter. We undertook this study to assess predictors of women's ratings of the quality of their breast cancer care. Methods: 210 of 300 eligible women with stage I or II breast cancer at 1 of 8 participating NYC hospitals were enrolled in our survey: 43 (20%) were African-American (AA), 85 (40%) were white, and 63 (30%) were Hispanic and 19 (9%) were other races. All patients were telephone-surveyed to assess care experiences, knowledge, attitudes & beliefs about breast cancer and its treatment. Trust is based on a validated instrument and calibrated to a 100 point scale (Cronbach α = 0.73). A scale of 5 items assessing physician communication was created and calibrated to100 points (Cronbach α = 0.83). Results: Only 55% of women rated their quality of cancer care as excellent. Compared to women who did not rate their care as excellent, those who did had greater trust in their physician (p < 0.0001), better communication with their physician (p < 0.0001), indicated that were treated well by their physicians’ office staff (p = 0.01), and knew which physician to ask when they had questions (p = 0.0001); age, education & income were not significantly related to patient report of excellent care. AA women were least likely to rate their care as excellent (p = 0.004). AA women had lower levels of trust in their physician (p = 0.02). Patients reporting greater levels of communication also had greater trust (r = 0.38; p < 0.0001). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to and how well the staff treated the patient found that being AA (aRR = 0.47; 95% CI: 0.21–0.88), having greater trust (aRR = 1.72; 95% CI:1.49–1.85) and better communication (aRR = 1.38; 95% CI: 1.03–1.65) were significantly associated with patient perception of excellent quality care (p < 0.0001). Conclusions: Greater levels of physician communication about treatment and patient trust of their physician affect women's ratings of excellent cancer care quality. Efforts should be made to improve physician communication about treatment, particularly among AA women, to improve levels of trust and ratings of cancer care quality. No significant financial relationships to disclose.
Differences in uptake of postoperative adjuvant chemotherapy for lung cancer: Results from the Project for an Ontario Women's Health Evidence-Based Report Card (POWER) study
Authors: Barbera L. C. , Krzyzanowska M. , Elit L. , Saskin R. , Bierman A. 
Published: August 2020

6556 Background: The goal of the POWER study is to improve health and reduce inequities among women of Ontario using performance measurement. Indicators are selected to facilitate assessment of care by sex and neighbourhood income. Results pertaining to the uptake of postoperative adjuvant chemotherapy for non-small cell lung cancer (NSCLC) are presented. Methods: An expert panel process was used to identify performance measures feasible to be evaluated from administrative data. Recent evidence suggests that adjuvant chemotherapy after resection of NSCLC is associated with improved survival. This measure was selected the by the expert panel. Data from Ontario Cancer Registry, Registered Persons Database as well as provincial billing and hospital databases was used to evaluate this measure stratified by age, sex, income and region. All adult patients who underwent resection of NSCLC between April 2003 and May 2004 were included in the cohort. Claims indicating chemotherapy administration within 6 months of surgery were considered adjuvant chemotherapy. Results: Overall in Ontario, the use of postoperative chemotherapy in NSCLC was 17.6% (95% CI 15.3%-20.2%) in April 2003 increasing to 32.9% (95%CI 29.8%-36.3%) in May 2004. In May 2004. use of chemotherapy decreased with increasing age: 47% of patients <65 years received chemotherapy versus 27% of patients aged 65–79. There was significant variation by region: in those under 65 years the rate of chemotherapy use among 14 regions ranged between 24–70 percent; in those 65–79 years it ranged between 18–35 percent. There was no difference in chemotherapy use between men or women or by neighbourhood income quintile. Conclusions: Rates of chemotherapy use almost doubled from April 2003 to May 2004, suggesting uptake of the new evidence in the treating community. Age and region-related, rather than sex or income, differences exist in the uptake of this new evidence. Further work is necessary to determine how these differences in uptake affect outcomes. No significant financial relationships to disclose.
Quality not quantity: Key success factors from the first decade of safety reports from the Research on Adverse Drug Events and Reports project (RADAR)
Authors: Bennett C. , Edwards B. J. , Tigue C. C. , Raisch D. W. , Courtney D. M. , McKoy J. M. , West D. P. 
Published: August 2020

6559 Background: RADAR is the only independent academic pharmacovigilance organization funded exclusively by peer-reviewed grants. We describe the role of high quality case reports in the detection of drug safety signals. Methods: RADAR has identified 11 cancer-related adverse drug reactions (ADRs). Initial reports for small numbers of cases were obtained from our own institution, NU, (4 ADRs) or from referral centers (7 ADRs). Clinicians at these centers voluntarily provided brief case reports to RADAR, who submitted detailed case reports to the FDA/manufacturer. Clinicians were promised that patient/provider data would be kept confidential and that these data would be submitted as peer-reviewed manuscripts. Results: See Table. Conclusions: RADAR was successful at signal generation and amplification because it focused on quality, not quantity of case reports. Pharmacovigilance efforts that allow clinicians to complete brief forms, maintain confidentiality of patient and provider, and result in submission of collaborative manuscripts may improve early detection of drug safety signals initiatives in oncology. [Table: see text] No significant financial relationships to disclose.
Are cancer cost-effectiveness analyses presented at major conferences published timely without bias? A systematic review
Authors: Chan K. K. 
Published: August 2020

6560 Background: Cancer cost-effectiveness analyses (CEA) should be published timely without publication bias of studies with more favourable incremental cost-effectiveness ratios (ICER) in order to be informative to policy makers and stakeholders. This study examined the publication pattern of CEA presented in the annual meetings of the American Society of Clinical Oncology (ASCO) and the international annual meetings of the International Society of Pharmacoeconomics and Outcome Research (ISPOR). Methods: Abstracts from ASCO and ISPOR from 1997 to 2007 were reviewed. CEA with primary outcomes as incremental cost per life year gained or quality-adjusted life year (QALY) were included. Data including ICER (adjusted to USD), cancer type, country, and quality indicators were extracted. Publication search was conducted using Medline, HealthStar and EconLit. Time-to-publication analysis was conducted with exploratory analyses on predictors of publication. Results: 137 abstracts were included. Only 48 were published. The actuarial 1-, 2-, 3-, 5-year publication rates were 12%, 25%, 33%, 42%, respectively. CEA using a lifetime horizon (HR = 2.3, p = 0.01) were more likely to be published. There were trends of CEA presented in ASCO (HR = 1.8, p = 0.07) or on breast cancer (HR = 1.7 p = 0.06) towards being published. Favourable ICER and country did not predict publication. Among the 77 cost-utility analyses, when using cutoff at $20,000, $50,000, and $100,000/QALY, 55%, 82%, and 87% were cost-effective, respectively. US abstracts were more likely to report ICER > $50,000/QALY (OR = 4, p = 0.05). Quality indicators such as the use of lifetime horizon, societal perceptive, and probabilistic sensitivity analysis were stated explicitly in only 22%, 17%, and 16% of abstracts, respectively. Conclusions: The publication rate of CEA abstracts was low and not timely for open discussions among stakeholders when making policy decision. While there was no direct evidence of publication bias of favourable ICER CEA on the abstract-to-publication level, very favourable ICERs were reported by most abstracts, which might suggest non-submission of unfavourable ICER CEA for abstract presentation. The overall quality of study design or reporting of CEA abstracts appeared suboptimal. No significant financial relationships to disclose.
Preferences and knowledge gaps among pediatric oncologists regarding the care of childhood cancer survivors: A survey of nearly 1,200 physicians
Authors: Henderson T. O. , Hlubocky F. , Diller L. , Daugherty C. 
Published: August 2020

6561 Background: Pediatric oncologists' attitudes and knowledge about the long-term follow-up (LTFU) care of childhood cancer survivors (CCS) have not been well described. Methods: We surveyed pediatric oncologists' self-reported attitudes and knowledge regarding the LTFU care of CCS. Following a pre-notification letter, surveys with a $5 gift card were mailed to 1,173 U.S. pediatric oncologists in November 2008. A second mailing for non-responders is planned. Results: With surveys still arriving, 536 have been returned (46% response rate). Median age of respondents is 47 years (range: 32–82 years); 56% men; 69% work in a children's hospital; 17% in a cancer center; 3% in a private practice. Respondents have practiced a median 14 years (range: 1–50 years) and see a median of 23 patients/week (range: 0–250 patients/week). 70% of respondents say their center has a LTFU clinic. Choosing from closed-ended responses: 37% say they prefer to follow CCS as long as possible, 21% prefer for the patients to be followed by a physician other than themselves, and 29% are willing to follow them in the absence of a more suitable physician. In describing comfort levels in caring for CCS (1 = very uncomfortable; 7 = very comfortable), respondents were most comfortable with survivors < 21 years (mean 6.2 + 1.4). For CCS >21 but <30 years, respondents were less comfortable (mean 5.0 + 1.5), and were uncomfortable caring for CCS > 30 years (mean 3.3 + 1.7). 84% of respondents report eventually referring CCS to a LTFU program (40%), to a primary care physician (23%) or to an adult oncologist (12%). In a clinical vignette of 29 year old women exposed to mantle radiation and anthracyclines (150 mg/m2) for Hodgkin's lymphoma at 16 years of age: 30% of respondents did not appropriately recommend yearly breast cancer surveillance (based on Children's Oncology Group LTFU guidelines); 41% of respondents did not appropriately recommend cardiac surveillance; and 15% of respondents did not appropriately recommend yearly thyroid screening. Conclusions: Pediatric oncologists express a range of preferences with regard to LTFU of CCS and CCS over 21 years of age. Many appear unfamiliar with LTFU surveillance recommendations. No significant financial relationships to disclose.
A survival-based cost-effectiveness analysis of 5 years of letrozole versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: 76-month update of BIG-1–98
Authors: Karnon J. , Kaura S. 
Published: August 2020

6566 Background: The latest update of the BIG 1–98 study reports a hazard ratio for overall survival (OS) of 0.81 (95% CI 0.69 = 0.94) (censoring TAM patients who crossed over to LET). Previous economic analyses of the aromatase inhibitors extrapolated observed differences in time to recurrence. This study uses observed differences in OS to estimate the incremental cost per life year (LY), and per quality adjusted LY (QALY) gained of 5 years LET versus 5 years TAM in ER+ postmenopausal women, from a UK NHS perspective. Methods: Annual survival probabilities over the first 7 years post-surgery were extracted from updated BIG 1–98 results. Survival was extrapolated to 20 years using data reported by the Early Breast Cancer Trialists’ Group for women receiving 5 years TAM. Equivalent annual survival probabilities were assumed for the LET and TAM groups post-7 years (likely to be a conservative assumption given diverging OS between 5 and 7 years). Costs included those of the interventions and and a wide range of adverse events (AEs). Published five year costs for locoregional recurrence (LR) and metastases (METS) were applied to reported recurrence rates over 9 years. A Markov model applied published utility weights for DFS with AEs, LR, and METS. All costs and health benefits were discounted at 3.5% annually. Results: The reference case results show that over a 20 year period, the discounted additional treatment costs of LET'are £4,427, and AEs incur an additional £88 per patient, while the reduced frequency decreases the cost difference by £807. The total cost difference between LET and TAM is £3,707. The discounted gain in LYs is 0.286. The incremental cost per LY gained for LET over TAM is £12,970. The Markov model estimated a difference in discounted QALYs of 0.297, with an incremental cost per QALY gained of £12,500. Conclusions: The economic analysis of 5 years LET compared to 5 years TAM based on observed differences in OS produces similar results to earlier modelled extrapolations based on differences in time to recurrence. However, the 20 year time horizon used in this analysis is shorter than previous analyses, and so the results may be considered conservative, i.e. LET may be more cost-effective than previously estimated. [Table: see text]
Logical inconsistency in comorbid health state preference assessment for prostate cancer
Authors: Dale W. , Bilir S. P. , Hemmerich J. , Basu A. , Meltzer D. O. 
Published: August 2020

6568 Background: With increasing need for efficient resource allocation, attention is turning to evidence-based decision making and cost-effectiveness analysis (CEA). Policy decisions depend on quality-adjusted outcomes from such analyses. Even small variations in the health state utilities used to quality adjust can have considerable effects, yet measuring utilities accurately is difficult. A particular challenge in the aging population with high cancer risk is maintaining logical consistency when evaluating comorbid utilities. We define this as ensuring that a single health state (SS) is rated no worse than a health state that adds another SS to that first one to make a comorbid health state (CS). Determining why or by whom this condition fails could improve elicitation practices and CEA for cancer and comorbid diseases. Methods: Men were surveyed at the time of prostate biopsy. SS and CS utility values were elicited via the time-trade off method. Demographic information, current health, and scores on anxiety subscales (HADS and MAX-PC) were collected also. The most prevalent health states associated with prostate cancer in the SEER database were chosen for assessment. CS were combinations of the SS “impotence” with each of incontinence, asymptomatic localized disease, and post-prostatectomy. Regression analysis showed the association of other survey elements to utility inconsistency. Mann-Whitney U-tests determined whether utility values differed by consistency. Results: 68% of respondents rated inconsistently at least once. Marriage and anxiety were correlated with rating inconsistently in univariate logistic analysis (p < 0.01, p < 0.05, respectively). Higher education was independently associated with more consistent answers (p < 0.05). Inconsistent raters had significantly lower utility values for all SS, but not for CS (p < 0.01). Conclusions: Over two thirds of men gave at least one logically inconsistent response across the three CS conditions. Being married, feeling anxious, and having less education were correlated with giving fewer consistent responses. Correcting these inconsistencies may change the results of quality-adjusted analyses. Strategies for eliciting more consistent responses are needed to accurately quality-adjust comorbid health states. No significant financial relationships to disclose.
Seasonal mortality in terminally ill cancer patients
Authors: Policzer J. , Kinzbrunner B. , Tanis D. 
Published: August 2020

6575 Background: There is ample evidence that the death rate in elderly patients increases in winter months. The increase in deaths may be amplified in terminally ill patients where place of care home, hospital, or long-term care facility might play a significant role in seasonal mortality. In this paper, we compare seasonal variation in death rates for terminally ill cancer patients to terminally ill patients who are “frail,” i.e., those with neurodegenerative disease, general debility, or chronic heart failure. Methods: We reviewed monthly deaths for Medicare patients age 65 or older with terminal cancer or “frail” patients who were admitted to one of 45 hospice programs and died on service between January 2004 and November 2008. The 72,066 records were analyzed using a three-way analysis of variance (season, place of care, diagnosis) with Bonferroni correction for post-hoc comparisons. Results: Compared to frail patients who died during June, July, and August, the number of deaths of frail patients increased an average of 20% in January, February, and March. This near-sinusoidal pattern was remarkably consistent over a five year period. The effect was most pronounced in patients in nursing facilities, followed by those in hospital, and then by patients receiving home care (all p < 0.005). For cancer patients, this seasonal variation was not observed in any place of care (all p > 0.05). Conclusions: Although frail patients generally have a longer length of stay in hospice than cancer patients hence allowing more opportunity for exposure to infection a number of other factors may serve to insulate cancer patients from seasonal effects. These include a smaller “symptom burden” than frail patients, who frequently have comorbid disease(s) and who are often unable to make their needs known; less compromised immune systems; more aggressive medical treatment; better nutrition; a strong support system (particularly from family and caregivers); and increased sensitivity to factors that may prolong survival, e.g., timely immunizations and even the avoidance of crowds in winter months. No significant financial relationships to disclose.