Platinum-doublet chemotherapy regimens have been shown to extend survival in fit patients with advanced non-small-cell lung cancer (AdvNSCLC). This study extends recent population-based analyses ...focusing on treatment and survival benefit from use of platinum-doublet therapy, and addressing the role of performance status (PS).
Patients >or= 66 years with AdvNSCLC incident from 1997 to 2002 were identified in SEER-Medicare. Multivariate models examined tumor and patient characteristics associated with receipt of any chemotherapy and receipt of platinum-doublet compared with single-agent therapy. Nonparametric models estimated treatment effects on survival. Models controlled for patient characteristics, including a novel method to use claims-based indicators to characterize PS. Propensity score analysis adjusted for confounding.
Of the 21,285 patients, 25.8% received first-line chemotherapy. Multivariate analyses indicate lower use of any chemotherapy and platinum-based doublet regimens with increasing age, comorbidity, and poor PS. Receipt of any chemotherapy was associated with reduction in the adjusted hazard of death (0.558; 95% CI, 0.547 to 0.569) and an increase in adjusted 1-year survival from 11.6% (95% CI, 11.1 to 12.0) to 27.0% (95% CI, 26.4 to 27.6). Platinum-doublet receipt increased adjusted 1-year survival over single agents, from 19.4% (95% CI, 18.3 to 20.4) to 30.1% (95% CI, 28.9 to 31.4).
Most elderly patients with AdvNSCLC do not receive chemotherapy, yet there are clear survival benefits, even with controls for age, comorbidity, and PS. The benefit of platinum-based doublet regimens is greater than single-agent chemotherapy. Claims-based proxy indicators of poor PS were independent predictors of treatment and merit further exploration.
To evaluate the value of new therapies for non-small cell lung cancer (NSCLC), it is necessary to understand overall survival (OS) rates associated with previous standard therapies and how these ...rates have evolved over time.
We retrospectively analyzed data from patients enrolled in the Surveillance, Epidemiology, and End Results (SEER) cancer registry. Adults with unresectable, stage III NSCLC treated with chemoradiotherapy were grouped by diagnosis year (2000-2002; 2003-2005; 2006-2008; 2009-2011; 2012-2013). The primary endpoint was OS (data cut-off, December 31, 2014), estimated using the Kaplan-Meier estimator. Temporal survival-trend significance was tested using a two-sided log-rank trend test.
Of 12,865 eligible patients, 59.1% were male, 59.9% had stage IIIB disease, and 62.7% had non-squamous histology. Median age at diagnosis was 67 years. Overall, 10,899 (84.7%) patients died and 1966 (15.3%) were censored/lost to follow-up. Median follow-up (95% confidence interval CI) was 80 (77-82) months; median OS (95% CI) was 15 (15-16) months; 1- and 3-year survival probabilities (95% CI) were 57.7% (56.9-58.6) and 24.1% (23.3-24.8), respectively. Stratification by diagnosis year showed consistent improvements in survival over time (p < 0.0001 for trend). Median OS was 12, 14, 15, 18, and 19 months in successive cohorts.
OS in patients diagnosed with unresectable, stage III NSCLC between 2003 and 2013 was consistent with that from clinical studies of sequential/concurrent chemoradiotherapy. Despite improvement over time, median OS was < 2 years and mortality remained high during the first year post-diagnosis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To assess the impact of sleep disturbances on work performance/ productivity. Methods: Employees (N = 4188) at four US corporations were surveyed about sleep patterns and completed the ...Work Limitations Questionnaire. Respondents were classified into four categories: insomnia, insufficient sleep syndrome, at-risk, and good sleep. Employer costs related to productivity changes were estimated through the Work Limitations Questionnaire. Performance/productivity, safety, and treatment measures were compared using a one-way analysis of variance model. Results: Compared with at-risk and good-sleep groups, insomnia and insufficient sleep syndrome groups had significantly worse productivity, performance, and safety outcomes. The insomnia group had the highest rate of sleep medication use. The other groups were more likely to use nonmedication treatments. Fatigue-related productivity losses were estimated to cost $1967/employee annually. Conclusions: Sleep disturbances contribute to decreased employee productivity at a high cost to employers.
Over the past decade, oncology therapies have trended toward orally administered regimens, and there has been growing attention on evaluation of factors that affect adherence. There has not been a ...rigorous investigation of factors associated with adherence to intravenous (i.v.) and oral anticancer drugs in the setting of metastatic colorectal cancer (mCRC).
To (a) assess potential patient-specific factors related to adherence to mCRC chemotherapy regimens and (b) compare adherence with IV versus oral dosage forms.
A retrospective analysis was performed using the Optum Oncology Management claims database. Patients aged 18 years and older diagnosed with mCRC between July 1, 2004, and December 31, 2010, who were insured by a commercial health plan were included in the study. Adherence to i.v. and oral chemotherapy regimens was assessed using the National Comprehensive Cancer Network (NCCN) guidelines as the standard for expected cycle/regimen duration. The most commonly prescribed chemotherapy regimens were assessed. Adherence was evaluated using the medication possession ratio (MPR), calculated as the number of days a patient was covered by their chemotherapy regimen, according to NCCN guidelines, divided by the number of days elapsed from the first to the last infusion of that regimen. For most analyses, the MPR was considered a continuous variable that could take on values between 0 and 1. In other analyses, a dichotomous categorical variable designated if the MPR was at least 0.8 versus less than 0.8. The Wilcoxon rank sum, Kruskal-Wallis, and Student's t-test were used to detect differences in continuous measures between patients receiving oral capecitabine therapy versus i.v. chemotherapy. The chi square test (X(2) test) or Fisher's exact test was used to assess differences in the dichotomous MPR variable. Generalized estimating equation (GEE) models were used for regimen-level analyses to account for correlated responses within individuals.
A total of 6,780 patients were included in the analysis, virtually all (98%) with commercial insurance coverage and the remaining (2%) with Medicare Advantage. Patients with mCRC received 17,095 regimens of chemotherapy, including 2,252 regimens of oral capecitabine. Of the 17,095 regimens, 6,780 (40%) were first-line regimens (i.e., the first time mCRC was treated for a given patient). The most common chemotherapy regimen, regardless of line of therapy, was FOLFOX (2,991 regimens, 17.5% of all regimens used). FOLFOX-based therapies with or without bevacizumab were the most common regimens for first- and second-line chemotherapy, while oral capecitabine treatment was the most commonly prescribed regimen for patients in third- or fourth-line therapy. Overall, medication adherence across all regimens was relatively high, with a mean MPR of 0.87 (SD = 0.17). Evaluation of the distribution of i.v. and oral capecitabine regimens revealed that 28% of all regimens were associated with an MPR of less than 0.8. The average MPR was clinically similar, but statistically higher for i.v. chemotherapy regimens (0.881) compared with oral capecitabine regimens (0.799; P < 0.0001). In the multivariable GEE model, lung or liver metastases were associated with a higher MPR, while lower Charlson Comorbidity Index and oral anticancer therapy were associated with lower MPR. Furthermore, as line of therapy increased, the difference in MPR between patients receiving oral capecitabine and i.v. chemotherapy increased.
This analysis determined that adherence with i.v. chemotherapy regimens was clinically similar, but statistically higher, compared to oral capecitabine therapy. The difference in adherence rates between the 2 routes of administration increased as the line of anticancer regimen increased. These results suggest that there should be an increased focus on improving adherence rates in patients receiving oral capecitabine.
Background The Veterans Health Administration (VHA) is the largest integrated health care system in the United States (US). Among VHA patients, the rate of use of concurrent chemoradiation therapy ...(CCRT) among those with unresectable, stage III non-small cell lung cancer (NSCLC) is unknown. The objective was to report recent CCRT treatment patterns in VHA patients and identify characteristics associated with receipt of CCRT. Methods Using Department of Veteran Affairs (VA) Cancer Registry System data linked to VA electronic medical records, we determined rates of CCRT, sequential CRT (SCRT), radiation therapy (RT) only, chemotherapy (CT) only, and neither treatment. Results Among 4054 VHA patients who met study criteria, CCRT rates slightly increased from 44 to 50% between 2013 and 2017. Factors associated with decreased odds of CCRT receipt compared to any other treatment included increasing age (adjusted odds ratio aOR per 10 years = 0.67; 95% CI: 0.60-0.76) and Charlson-Deyo comorbidity score (aOR = 0.94; 95% CI: 0.91-0.97). White race was associated with increased odds of CCRT receipt (aOR = 1.24; 95% CI: 1.004-1.53). In a chart review sample of 200 patients, less than half (n = 85) had a documented reason for not receiving CCRT. Among these, 29% declined treatment, and 71% did not receive CCRT due to "not being a candidate" for reasons related to frailty or lung nodules being too far apart for radiation therapy. Conclusions CCRT rates among VHA patients with unresectable, stage III NSCLC slightly increased from 2013 to 2017; however in 2017, only half were receiving CCRT. Older patients and those with multiple comorbidities were less likely to receive CCRT and even when controlling for these factors, non-white patients were less likely to receive CCRT. Keywords: Non-small cell lung Cancer, Concurrent and sequential Chemoradiation, Veterans health administration
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND:Metastatic colon cancer (mCC) patients often receive multiple lines of chemotherapy/biological treatment (TX), yet subsequent TX lines have not been sufficiently examined using ...SEER-Medicare data. We developed an algorithm that identifies the number and type of TX lines received by mCC patients.
METHODS:The algorithm rules for detecting TX lines were developed a priori and applied to SEER-Medicare data for 7951 elderly mCC patients, diagnosed in 2003–2007 and followed through 2009. Statistical analysis estimated the relationship between the number of treatments received and patient characteristics. Sensitivity analyses examined how results changed when different algorithm rules were used.
RESULTS:Only 41% (3266) of mCC patients received any chemotherapy/biologics treatment; 1440 (18% of all, 44% of treated) and 274 (3% of all, 8% of treated) received second-line and third-line treatment, respectively. Initial and subsequent treatment regimens varied widely. Results were robust to alterations in the algorithm.
CONCLUSIONS:The number of drugs used to treat cancer patients has increased during the past decade. Patients may have several TX lines with complex regimens. More guidance is needed with regard to identifying and studying these interventions using SEER-Medicare data. By proposing 1 approach to categorizing TX lines for mCC patients, we hope to empower the scientific community and to advance the use of SEER-Medicare data for health outcomes research.
To assess real-world management of patients diagnosed with hepatocellular carcinoma (HCC) within an integrated delivery network.
A retrospective cohort analysis of adults newly diagnosed with HCC ...from January 2014 to March 2019. Overall survival and treatment journey were assessed over the entire available follow-up period per patient.
Of the 462 patients, 85% had ≥1 treatment. The 24-month overall survival rate (95% CI) from first treatment was 77% (72–82%). Majority of Child-Pugh class A (71%) and B (60%) patients received locoregional therapy first. Half (53.6%) of the patients with liver transplantation first were Child-Pugh class C patients. Sorafenib was the predominant systemic therapy.
This integrated delivery network data analysis offers a comprehensive insight into the real-world management of HCC.
To examine the locoregional therapy (LRT) patterns and the healthcare economic burden of patients with hepatocellular carcinoma (HCC) in the USA.
Patients with newly diagnosed HCC were identified ...from the MarketScan
databases (1 July 2015–31 May 2018). The LRTs received and all-cause and HCC-related healthcare costs were measured.
Among 2101 patients with HCC, most received embolization therapy as their first LRT treatment (57.8%, n = 1215); 17.1% (n = 360) received ablative therapy and 8.7% (n = 182) radiation therapy; 16.4% (n = 344) received multiple LRTs. After patients received their first LRT treatment, total all-cause healthcare costs averaged $20,316 per patient per month; 70.7% ($14,359) were HCC related.
Among newly diagnosed HCC patients treated with LRT in the USA, the economic burden is high.
OBJECTIVE:Examine the incremental impact of absenteeism and short-term disability associated with colorectal cancer (CRC).
METHODS:Absenteeism and short-term disability data were used for a ...case–control analysis of a healthy cohort (controls) compared with CRC patients (cases). Cases were matched to controls on the basis of age, sex, and region of residence. Multivariate regression models examined the costs of absenteeism and short-term disability, controlling for patient characteristics, prior medical costs, and patient general health.
RESULTS:Compared with controls, CRC patients experience significantly higher short-term disability costs (mean, $45,716 vs $7367 P < 0.0001; median, $35,827 vs $7365 P < 0.0001), as well as significantly higher absenteeism costs (mean, $8841 vs $4596 P < 0.0001; median, $9971 vs $4795 P < 0.0001) in the 1 year after diagnosis of CRC.
CONCLUSIONS:Colorectal cancer is associated with significant work-related productivity loss costs in the first year after diagnosis.
Many pivotal trials in advanced hepatocellular carcinoma (HCC) require participants to have Child-Pugh A disease. However, many patients in real-world practice are Child-Pugh B or C. This study ...examined treatment patterns and clinical outcomes in patients with advanced HCC treated with first-line systemic therapy.
In this retrospective study, patients with HCC treated with first-line systemic therapy (2010–2017) were identified from US Oncology Network records. Outcomes included overall survival and progression-free survival, by Child-Pugh Class and prior liver-directed therapy.
Of 352 patients, 78.7% were Child-Pugh A or B, 96.6% received first-line sorafenib, and 33.8% received first-line-prior liver-directed therapy. Survival outcomes were similar for Child-Pugh A or B, and longer after first-line prior liver-directed therapy.
First-line systemic therapy is beneficial in patients with Child-Pugh A or B, and after first-line prior liver-directed therapy. These findings may help position systemic therapy in the community setting.
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