P4-16-09: Health Resource Utilization (HRU) Associated with Skeletal-Related Events (SREs) in Advanced Breast Cancer Patients with Bone Metastases: Results from a Prospective Multinational Observational Study.
Authors: Lüftner D , Lorusso V , Duran I , Hechmati G , Garzon-Rodriguez C , Ashcroft J , Bahl A , Ghelani P , Wei R , Thomas E , Hoefeler H 
Published: June 2012

Abstract
Background Patients with advanced breast cancer and bone metastases suffer from skeletal complications (SREs, defined as spinal cord compression [SCC], surgery to bone [SB], pathologic fracture [PF] or radiation to bone [RB]). Planning future resource requirements and estimating the value of new treatment options requires prospective data on the health resource burden. However, there is a lack of these data in the literature.
Materials and Methods Patients had bone metastases secondary to advanced breast cancer and were eligible to be included in the study if they had: at least one SRE within 90 days prior to enrolment; life expectancy &gt;6 months; ECOG≤2. HRU (number and length of inpatient hospitalizations, outpatient visits, emergency room visits, number of procedures, etc) associated with SREs was collected retrospectively for 90 days prior to enrolment and prospectively for up to 18–21 months. Attribution of HRU to each SRE was determined independently by the investigators. This pooled European analysis includes data for breast cancer patients from centers in Germany, Italy, Spain and UK.
Results A total of 223 eligible patients with breast cancer and bone metastases were enrolled from the four countries. A total of 118 of 457 SREs (25.8%) were associated with inpatient stays with a mean duration of 18.2 (SD=15.7) days per inpatient stay (for the total 125 stays; a single SRE could contribute multiple hospitalizations). The length of inpatient stays varied by facility (i.e., oncology, radiation, surgical) and SRE type. The most common SRE requiring hospitalization was SB (42 of 54 events [77.8%]) with 45 inpatient stays requiring an average length of stay of 15.1 (SD=16.8) days. The least common SRE requiring hospitalization, RB (27 of 279 events [9.7%]), was still associated with 23 inpatient stays with an average of 16.7 (SD=12.4) days per inpatient stay. A total of 342 SREs (74.8%) required an outpatient visit and 159 (34.8%) required &gt;5 visits. As expected, RB was associated with the highest number of outpatient visits (239 of 279 [85.7%] SREs). SB and PF were associated with fewer outpatient visits with 23 of 54 (42.6%) of 54 SREs and 66 of 105 (62.9%) SREs requiring a visit, respectively. 22 of 457 (4.8%) SREs were associated with an emergency room visit.
Discussion SREs can lead to lengthy hospitalizations and numerous outpatient visits. Neither pain requiring opioid use nor changes in cancer therapy to treat bone pain were reported as SREs, although they may have led to additional inpatient and outpatient visits. Thus, HRU estimated in this study likely underestimates overall HRU associated with SREs in advanced breast cancer patients. Relatively low utilization of emergency room visits reported here may be due to emergency care provided directly by the specialist oncology unit or the patient visiting a different institution. Preventing SREs in advanced breast cancer patients may help to reduce the financial burden to the European healthcare systems.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-16-09.