bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of febrile neutropenia and myelosuppression in patients receiving FOLFOX/FOLFIRI in gastrointestinal cancer treated with same-day (SD) pegfilgrastim/pegfilgrastim-CBQV (PFG).
Authors: Shoua Basel , Mahmoudieh Mahta , Scott Aaron James , Hollings Jerrelee , Shroff Rachna T. , McBride Ali 
Published: September 2021

311 Background: The National Comprehensive Cancer Network (NCCN) guidelines and the manufacturers of PFG recommend administration at least 24 hours after chemotherapy (CTX). Administering SD PFG carries the potential risk for exacerbation of neutropenia based on analyses in lymphoma and breast cancer regimens; however, little data exists on infusional fluorouracil and SD PFG administration. The availability of biosimilar PFG and increased utilization of growth factors during the COVID-19 pandemic has led to changes in practice for SD PFG administration. This study explored the incidence of febrile neutropenia (FN) and myelosuppression with FOLFOX and FOLFIRI regimens in Gastrointestinal malignancies (GI) to address the safety of SD utilization of PFG. Methods: Patient data was extracted through electronic health records search of ICD-9 and ICD-10 codes for GI malignancies and treated with FOLFOX or FOLFIRI-based regimens from November 2013 to May 2021. SD administration was defined as administration of PFG within 15 minutes after fluorouracil pump disconnect. The primary endpoint of our study was to evaluate the incidence of FN across all CTX cycles for up to four cycles, in SD PFG administration. Secondary outcomes included chemotherapy induced neutropenia (CIN), hospitalizations, and CTX dose reduction or delay. Results: Three hundred and thirty-nine patient charts were reviewed with 55 patients meeting the inclusion criteria. In our study cohort, 72.7% received FOLFOX and 27.2% received FOLFIRI-based regimens. Out of all 194 CTX cycles, 136 (70.1%) cycles received pegfilgrastim and 58 cycles received pegfilgrastim-cbqv (29.9%). Two patients had grade 3/4 CIN (1%), with both cases resulting in FN (1%). Both FN cases resulted in hospitalizations, and dose delays or reductions. Investigation of FN incidences revealed that both patients received CTX with active infections, one case with a urinary tract infection and the other with a chronic gangrene infection. Conclusions: Our study results suggest that SD administration of PFG can be as a safe and effective alternative to 24-hour post-chemotherapy administration in patients receiving FOLFOX or FOLFIRI-based regimens. The incidence of FN was noted to be minimal in our study. Furthermore, no noted increase in myelosuppression was seen in our analysis, as compared to previous studies in breast cancer and lymphoma-based regimens. SD administration not only minimizes travel burdens on long-distance patients but also has allowed for reduction in infusion appointments and therefore possible exposure to the SARS-COV2 virus during the 2020-2021 pandemic. Future prospective studies are warranted in order to elucidate the risk of FN and myelosuppression in patients undergoing chemotherapy for GI malignancies with SD PFG administration.
Disruptions in cancer screening and diagnoses during the COVID-19 pandemic in 2020.
Authors: Staib James , Catlett Kierstin , DaCosta Byfield Stacey 
Published: September 2021

315 Background: The pandemic resulted in reductions in cancer screenings, potentially compromising the ability to detect cancers early. We add new data to this growing research, and report screening and cancer diagnosis (Dxs) rates for four cancer types: breast (BC), cervical (CC), colorectal (CRC), and lung (LC). To learn whether home-based cancer screening options for colorectal cancer exhibited similar patterns, we examined screening rates for fecal occult blood (FOBT), fecal immunochemical (FIT), and Cologuard (CG) tests. Methods: We conducted retrospective analyses using de-identified medical claims data (2018-2020) from a national US health insurer. To assess screening rates, no indication of cancer Dxs prior to screening event were included. BC screenings (BCS), LC screenings (LCS), and CRC screenings (CRCS) were identified from CPT and HCPCS codes for digital mammography, low dose CT-scans (LDCT), colonoscopies, and home-based CRC tests. CPT, HCPCS, and ICD-10 codes defined CC screenings (CCS). Cancer Dxs were defined if individuals had ≥1 claim with an ICD-10 cancer code and no prior cancer dx within 24 months of continuous eligibility. Advanced cancer Dxs (ADxs) were defined if a malignancy code on a claim with a date of service (DOS) within 60 days of diagnosis DOS was present. Screening and Dxs changes were compared circa mid-March (5 weeks prior and 5 weeks after). Adjustments were made for changes in enrollment. Results: The table summarizes screening changes. Dxs decreased circa shutdown in LC, BC, CS, and CRC by -40%, -61%, -55%, -55%, respectively. Compared to 2019, DXs decreased in LC, BC, CS, and CRC -19%, -16%, -6%, -18%, respectively. Compared to 2019, ADxs in LC, BC, and CRC were -14%, -9%, -8%, respectively. CS exhibited an increase in ADxs by 2%. Conclusions: The pandemic impacted cancer care for multiple cancer types. Dxs and ADxs decreased during the pandemic except advanced CS. While cancer screenings increased after the shutdown, only LCS and Cologuard returned to pre-pandemic levels by the end of 2020, though these had low utilization even in the periods prior to the pandemic. Limitations include that administrative programs supporting home-based tests (e.g. FIT and FOBT) may not generate claims, and procedures received may have been incorrectly coded. Future studies will assess the clinical impact of missed care and whether certain groups were disproportionately impacted.[Table: see text]
Utilization of a prognostic question as a trigger for palliative care consultation.
Authors: Begnoche Megan H. , Guyer Dana 
Published: September 2021

325 Background: The Lifespan Cancer Institute (LCI) initiated ClinicalPath in 2018 as an evidence-based decision tool to support oncologists in providing high quality care. The prognostic question used by the decision tool, “would you be surprised if this patient died in the next year,” is a validated question for predicting poor prognosis for patients with stage III, IV or extensive stage cancer. The palliative care (PC) team hypothesized that if an oncologist answered “no, I would not be surprised,” the patient would benefit from a PC consultation. The LCI prioritized efforts to provide PC upstream in the disease process by reviewing the “would not be surprised” patients and offering consultation to the ordering oncologist if deemed appropriate by the PC physician. Methods: Patients navigated through ClinicalPath from Jan to Dec 2019 were analyzed to allow for one full year after the last navigation for those marked as “would be surprised” and “would not be surprised,” and frequency of PC consultation was evaluated. Results: 729 patients triggered the prognostic question in 914 total navigations. Of those navigations, oncologists selected “I would not be surprised if patient died within the next year” 54% of the time. In 45% of decisions, the oncologist selected “I would be surprised if patient died within the next year,” suggesting that the oncologist expected the patient to live a year or more. 53% of the patients were categorized as Stage IV or extensive stage. The most common diseases were gastrointestinal malignancies, followed by thoracic and then neuro-oncology. Among the patients whose oncologist selected “I would be surprised,” 36% of patients had died within 365 days of the decision, 13% died more than a year after and 51% are still alive. Among the patients whose oncologist selected “I would not be surprised,” 60% died within 365 days of the decision and an additional 16% have since died, with 24% still alive at this time. PC consultation increased since initiation of the palliative physician conducting prognostic clinical review. In a review from Nov 19-April 20 (1157 visits) and Nov 20-April 21 (1656 visits), overall PC visits increased by 43%. Conclusions: LCI’s data aligns with prior published data that suggest the prognostic question is valid. We further examined if this question could be used as a screening tool to initiate a PC consultation since patients with a poor prognosis benefit from PC. 56% of patients navigated through the system had a PC consult at some time during their disease course, and 54% of those patients saw PC as an inpatient only. A simple screening process for those patients that were navigated to “I would not be surprised” is a way of providing earlier integration of PC. This prognostic question, which relies heavily on oncologist “gut feeling “or “intuition,” is a helpful indicator that PC consultation is appropriate and can be used effectively to ensure earlier integration of PC for oncology patients.
The value of pathways on drug costs.
Authors: Csik Valerie Pracilio , Ramirez Michael J. , Binder Adam F , Handley Nathan 
Published: September 2021

327 Background: Oncology care represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending. As a participant in the Oncology Care Model, drug costs represent a majority of our total costs. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. Our NCI-designated cancer center implemented pathways in July 2018 to reduce care variation and decrease costs. Methods: We reviewed costs related to pathway utilization over a two year period, analyzing differences in total annual drug cost for patients in three categories: On-Pathway (aligned with pathway recommendation), Off-Pathway (not aligned with recommendation), and No Pathway (not used). Per Member Per Month (PMPM) costs were calculated and a weighted average applied to account for changes in annual drug costs. Results: PMPM drug costs decreased -8% in year 1 (FY19) and -4% in year 2 (FY20) when pathways were used (On- and Off-Pathway). When pathways were followed (On-Pathway) in making treatment decisions, the drug costs were 11% lower than when pathways were not used. The annual impact on drug costs when pathways were used amounted to $2.45 million in year 1 and $1.77 million in year 2 (Table). Conclusions: Pathway use reduced drug costs, a significant variable in oncology value-based care models. This finding highlights the value of clinical decision support tools in reducing care variability, a known contributor to health care costs, in making treatment decisions. Further assessment is needed to determine if these results are similar at other cancer centers to fully realize the impact of pathways on drug costs.[Table: see text]
Trends in total and out-of-pocket cost of cancer care around the first year of diagnosis for the four most common cancers among privately insured nonelderly adults: 2009-2016.
Authors: Shih Ya-Chen T. , Xu Ying , Bradley Cathy , Giordano Sharon H. , Yao James C. , Yabroff K. Robin 
Published: September 2021

5 Background: To provide a comprehensive evaluation of the trends in treatment pattern, total and out-of-pocket (OOP) costs of cancer care for in the period between 2-month before and 12-month after cancer diagnosis for the privately insured non-elderly adults diagnosed with female breast, colorectal, lung, or prostate cancer. These four cancers represent the four most prevalent cancers in the United States and the 14-month duration captures the most expensive care phase in the cost trajectory of cancer. Methods: We constructed incident cohorts using claims data from the Health Care Cost Institute between 2009 and 2016. We identified treatment modality (cancer-related surgery, systemic therapy, radiation, and other hospitalizations) and calculated associated total and OOP (sum of deductible, coinsurance, and copayment) costs from payment variables. For each cancer, we examined healthcare utilization and cost trends based on the year of diagnosis and conducted logistic regressions to assess the trend in utilization and generalized linear models to evaluate the trend in costs. All estimates are reported in 2020 US dollars. Results: The cohorts consisted of 105,255 breast, 23,571 colorectal, 11,321 lung, and 59,197 prostate cancer patients. Between 2009 and 2016, use of systemic therapy and radiation significantly increased, except for lung cancer. Cancer surgeries significantly increased for breast and colorectal cancer but decreased for prostate cancer, whereas hospitalizations for reasons other than cancer declined for all cancers (p < 0.001). Costs increased for nearly all treatment modalities except for systemic therapy in colorectal and radiation in prostate cancer. Total mean costs per patient had the largest increase in breast cancer (29%, $109,544 to $140,743), followed by lung (11%) and prostate (4%) cancer. Cost increase in colorectal cancer was not statistically significant (P = 0.089). Similar trends were found in median costs. Although not every cancer had significant increase in total costs over time, OOP costs increased > 15% for all cancers, with deductibles accounting for an increasingly proportion. Conclusions: Rising costs of cancer treatments, compounded with increasing cost-sharing increased OOP costs for privately insured, non-elderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform.
Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer (PaRTNer): Baseline financial toxicity and attitudes toward costs from a pilot study.
Authors: Chino Fumiko , Brizel David M. , Mowery Yvonne Marie 
Published: September 2021

56 Background: Cancer patients face considerable financial burden, but few studies have explored associations between radiation therapy (RT) and financial toxicity. This study assessed financial toxicity, patient-reported outcomes, and attitudes/perspectives on the role of cost in treatment decisions. Methods: In a prospective, survey-based, longitudinal study (NCT3506451), eligible patients were adults with newly diagnosed non-metastatic head and neck cancer (HNC) undergoing RT as part of their definitive cancer treatment. Surveys collected demographics, cancer details, the COmprehensive Score for financial Toxicity (COST) score to measure financial toxicity, and patient attitudes regarding cost conversations. Results: 60 patients were enrolled (2019-2021), and 58 completed the baseline survey prior to the start of RT. Most were white (75.9%) and non-Hispanic (98.1%). Median age was 61 (range 42-86). Most were married or in long term partnerships (67.0%), had completed at least some college (70.7%), and had employer sponsored private insurance (55.2%). Half were working at least part time, and most earned > $60,000/yr (55.4%). Oropharynx (48.3%) was the most common disease site; almost half (48.1%) received concurrent chemotherapy. Median baseline COST score was 25 (range 0-44), indicating borderline financial toxicity. 37.7% had reduced spending on leisure items, and 30.9% had reduced spending on basics like food or clothing to pay for cancer care. 10.5% had skipped doses of medications to make them last longer, and 21.1% had not filled a prescription because it was too expensive. 19.6% had borrowed money, and 36.4% had used either all or part of their savings (or had no savings at all) to pay for care. Of those employed at diagnosis, 38.9% took extended leave or reduced hours to part time. 25.9% felt their treatment costs/financial situation should be a factor in treatment decisions. 50.8% wanted the less costly treatment, assuming equal effectiveness. 46.6% felt they should receive cost information from their doctor, and 63.8% wanted a financial assistance counselor or social worker to provide cost information. 46.6% felt that discussing their costs would make them feel more involved in their care. While 43.1% felt that talking about cancer-related costs would reduce their anxiety, 36.2% felt it would increase their anxiety. The majority (63.8%) had little or no understanding about the costs of their cancer care, and 69.0% felt that educational materials about costs would be helpful. Conclusions: Despite borderline baseline financial toxicity scores, some HNC patients had already made significant sacrifices in order to afford care before RT had even started. There was little baseline knowledge of cancer costs and overall mixed attitudes toward cost conversation. Most patients felt that cost education would be helpful. Clinical trial information: NCT03506451.
Trends in pegfilgrastim average sales price and cost-effectiveness of primary prophylaxis for patients at intermediate risk for febrile neutropenia.
Authors: Li Edward C. , Campbell Kimberley J. , Schroader Bridgette Kanz , Campbell David , Chaplin Stephen , Lyman Gary H. 
Published: September 2021

58 Background: The introduction of biosimilar colony-stimulating factors has led to the reduction in prices for these historically expensive therapies. To understand the impact of recent pricing trends on delivering efficient care, the cost-effectiveness of primary prophylaxis (PP) versus secondary prophylaxis (SP) using pegfilgrastim was assessed in patients with breast cancer, non–small-cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL) receiving potentially curative chemotherapy at intermediate risk for febrile neutropenia per NCCN guidelines. Methods: A Markov decision analytic model was constructed from the US payer perspective over a lifetime horizon to evaluate pegfilgrastim PP versus SP in patients with breast cancer, NSCLC, and NHL receiving curative chemotherapy at intermediate risk of FN. Modeled chemotherapy regimens were adjuvant docetaxel (breast cancer), adjuvant carboplatin/paclitaxel (NSCLC), and R-CHOP (NHL) representing baseline FN risk of 16%, 18%, and 18%, respectively. Historical average sales prices (ASP) according to the Centers for Medicare and Medicaid Services of all pegfilgrastim products were obtained from January 2017 to April 2021. When more than one pegfilgrastim product was available, the average ASP was used as the cost input for the model. Cost-effectiveness for the base case scenario of each cancer type was evaluated over the range of years for cost per quality-adjusted life year (QALY) gained. Results: Pegfilgrastim as PP vs. SP provided an additional 0.069, 0.112, and 0.166 QALYs for breast cancer, NSCLC, and NHL, respectively. The peak ASP for pegfilgrastim was $4,554 per 6 mg during July 2018. Afterwards, a linear regression observed a declining ASP of approximately $134 dollars every 3 months to $3,024 per 6 mg during April 2021. At peak ASP, the incremental cost-effectiveness ratios (ICERs) for pegfilgrastim PP in patients with breast cancer, NSCLC, and NHL were $200,320, $113,942, and $103,495 per QALY, respectively. For April 2021, the ICERs were $124,845, $67,294, and $57,269 per QALY, respectively (Table). Conclusions: The trend of decreasing pegfilgrastim ASP improved the cost-effectiveness of PP vs. SP across intermediate risk breast cancer, NHL, and NSCLC indications between July 2018 to April 2021. For the most recent ASP, PP was cost-effective at a willingness-to-pay threshold of $100,000/QALY for NSCLC and NHL, and $150,000/QALY for breast cancer. This analysis provides support to expand the use of growth factor PP to intermediate risk patients. [Table: see text]
A comparative analysis of attribution methods for newly diagnosed cancer patients to hospitals in oncology care.
Authors: Chaudhuri Anamika 
Published: September 2021

60 Background: Attribution is the term that describes how payers and employers determine which provider is responsible for a member’s care, when prospective patient selection is not available. Several claims-based attribution models exist for primary care. The challenges of attribution become salient in oncology because cancer care is often multidisciplinary—involving medical oncologists, surgeons, and radiation oncologists—rendering it difficult to discern which practice should be held accountable. Given the uniqueness of the population the generic primary care attribution model does not fit well. Methods: The objective of this study was to propose and compare methods that attribute patients to hospitals using administrative databases. The models were defined as pre-specified rules that determine the specific patients, types of health care services, and the duration of care for which providers are responsible. Both National Medicare database and Statewide All Payers Claims Database (2014-2015) were used for the purpose to analyze Medicare and commercial population. Two different methods with 6 and 12-months episodes were compared. Method 1 defined episode trigger as first diagnosis of cancer and Method 2 as first treatment of cancer, both with no prior 12 months of cancer diagnosis. Patients were attributed to a hospital based on plurality of claims (including both outpatient and inpatient) with a minimum threshold of 2 claims from the same hospital. Ties were broken with the most recent visit, if not, the highest cost. Success measure was defined as highest attribution rate vs. lowest feasible unassigned rate. Results: A total of 1.7 million patients were included in the Medicare cohort and 98,005 from All Payers Claims database (APCD). Results suggested for a 6 months episode, Method 1 vs. Method 2 attributed 94% vs. 98% to a hospital. For a 12-months episode, Method 1 vs. Method 2 attributed 96% vs. 98% to a hospital. Similar results were evident from APCD. It was evident attribution of patients were higher towards their first diagnosed hospital. Also, longer the duration of care, better the attribution. The outcome of the study was a tool in tableau. Conclusions: Attribution is not a problem to be solved and left alone; it requires ongoing work, enhancements. This study results in a framework for attribution that can be used as a mechanism to link indicators of patient-level health care quality and spending to specific providers for the purpose of profiling and accountability. Better systems will seek to identify specific care for a condition based on the types of doctors a patient is seeing (chemotherapy), and identify who is delivering most of that care vs. who is delivering different types of care (surgery, radiation, primary care).