Incidence of treatment-associated toxicities in Medicare non-small cell lung cancer (NSCLC) patients
Authors: G. Ciesla, K. K. McLaurin, M. Apostolaros, I. Chico, S. Leader
Journal: Journal of Clinical Oncology (2005)

6083 Background: Radio- and chemotherapy are known to cause toxicities including nausea and vomiting, dehydration, oral complications, myelosuppression and respiratory complications. Population-based incidences of these toxicities in NSCLC patients have not been documented previously. Methods: NSCLC patients were retrospectively identified in the 1999 Surveillance, Epidemiology and End Results registry data and linked to their 1998–2001 Medicare claims (SEER-Medicare). Subjects were age or disability eligible, continuously enrolled in Parts A and B, and not enrolled in an HMO. HCPCS and ICD-9 procedure codes on Medicare claims were used to identify types of therapy: combination radio-chemotherapy (RC), chemotherapy (C) or radiotherapy (R). Treatment-associated toxicities were counted only if the diagnosis occurred on or after the first treatment date and not in the prior year. Subjects with a pre-existing toxicity diagnosis were not included in the denominator for toxicity rate calculations. Hospitalizations were counted if a diagnosis code for a toxicity was listed on the claim. A modified Charlson index was used to ascertain comorbidity and risk of death 1 year prior to cancer diagnosis. An index score of 0 represented the lowest risk. Results: 2,510 Medicare patients diagnosed with NSCLC in 1999 were treated with combination radio-chemotherapy (39%), chemotherapy (23%) or radiotherapy (38%). Patients were male (58%), Caucasian (84%) and 65+ years (95%). 69% were either Stage III or IV at diagnosis. Over 94% of all patients had a Charlson score of 0. Toxicity incidence and hospitalization rates are presented in the table below. Conclusions: The high rates of treatment-associated toxicities and hospitalizations indicate the need for interventions to minimize toxicities, improve quality of life and reduce treatment interruptions. Incidence and Hospitalization Rates of Toxicities, by Type of Therapy Toxicity Toxicity Incidence Rate1 % of Subjects Hospitalized with Toxicity2 Total Treated RC 971 (39%) C 589 (23%) R 950 (38%) RC C R Myelosuppression (anemia, neutropenia and/or thrombocytopenia) 60% (428/716) 57% (237/419) 20% (132/663) 44% 43% 52% Nausea & vomiting 40% (366/904) 35% (187/532) 9% (74/853) 8% 6% 16% Dehydration 34% (311/920) 22% (118/542) 22% (187/867) 66% 69% 74% Oral complications (dysphagia, mucositis, esophagitis, xerostomia, esophageal disorders, candidas, osteoradionecrosis and/or voice disturbances) 32% (239/750) 13% (60/446) 18% (122/676) 51% 63% 48% Respiratory complications (pneumonitis and/or pulmonary fibrosis) 8% (77/907) 3% (19/548) 6% (56/894) 52% * 39% Skin rash 3%(25/934) 2% (10/568) 2% (20/903) * * * 1 Rate Calculation: (# of subjects with toxicity diagnosis on/after first treatment date - # of subjects with toxicity diagnosis before and on/after first treatment date) / (# of treated subjects - # of subjects with toxicity diagnosis before first treatment date) X 100 2Toxicity diagnosis recorded on hospitalization claim; not necessarily reason for hospitalization. *Cell size suppressed to meet current CMS privacy guidelines. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration MedImmune Oncology, MedImmune MedImmune