Best Supportive Care or Chemotherapy for Stage IV Non-Small Cell Lung Cancer

1999 ◽  
pp. 199-207 ◽  
Author(s):  
J. P. Sculier ◽  
T. Berghmans ◽  
C. Castaigne ◽  
Y. Lalami ◽  
S. Luce ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Supportive Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stage Iv ◽  
Best Supportive Care ◽  
Small Cell ◽  
Small Cell Lung

scholarly journals Chemotherapy versus best supportive care in stage IV non-small cell lung cancer, non metastatic to the brain

2001 ◽  
Vol 56 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Agnaldo Anelli ◽  
Candice A. A. Lima ◽  
Riad N. Younes ◽  
Jefferson L. Gross ◽  
Ricardo Fogarolli
Keyword(s):  
Lung Cancer ◽  
Supportive Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Systemic Chemotherapy ◽  
Stage Iv ◽  
Best Supportive Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
The Brain

Stage IV non-small cell lung cancer is a fatal disease, with a median survival of 14 months. Systemic chemotherapy is the most common approach. However the impact in overall survival and quality of life still a controversy. OBJECTIVES: To determine differences in overall survival and quality of life among patients with stage IV non-small cell lung cancer non-metastatic to the brain treated with best supportive care versus systemic chemotherapy. PATIENTS: From February 1990 through December 1995, 78 eligible patients were admitted with the diagnosis of stage IV non-small cell lung cancer . Patients were divided in 2 groups: Group A (n=31 -- treated with best supportive care ), and Group B (n=47 -- treated with systemic chemotherapy). RESULTS: The median survival time was 23 weeks (range 5 -- 153 weeks) in Group A and 55 weeks (range 7.4 -- 213 weeks) in Group B (p=0.0018). In both groups, the incidence of admission for IV antibiotics and need of blood transfusions were similar. Patients receiving systemic chemotherapy were also stratified into those receiving mytomycin, vinblastin, and cisplatinum, n=25 and those receiving other combination regimens (platinum derivatives associated with other drugs, n=22). Patients receiving mytomycin, vinblastin, and cisplatinum, n=25 had a higher incidence of febrile neutropenia and had their cycles delayed for longer periods of time than the other group. These patients also had a shorter median survival time (51 versus 66 weeks, p=0.005). CONCLUSION: In patients with stage IV non-small cell lung cancer, non-metastatic to the brain, chemotherapy significantly increases survival compared with best supportive care.

Economic Analysis of the TAX 317 Trial: Docetaxel Versus Best Supportive Care as Second-Line Therapy of Advanced Non–Small-Cell Lung Cancer

2002 ◽  
Vol 20 (5) ◽  
pp. 1344-1352 ◽  
Author(s):  
Natasha B. Leighl ◽  
Frances A. Shepherd ◽  
Rita Kwong ◽  
Ronald L. Burkes ◽  
Ronald Feld ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Supportive Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Best Supportive Care ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
The Cost

PURPOSE: To determine the cost-effectiveness (CE) of second-line docetaxel compared with best supportive care (BSC) in the TAX 317 trial, a randomized clinical trial of second-line chemotherapy in non–small-cell lung cancer. METHODS: A retrospective CE analysis of the TAX 317 trial was undertaken, evaluating direct medical costs of therapy from the viewpoint of Canada’s public health care system. Costs were derived in 1999 Canadian dollars, and resource use was determined through prospective trial data. RESULTS: The incremental survival benefit in the docetaxel arm over BSC was 2 months (P = .047). The CE of docetaxel was $57,749 per year of life gained. For patients treated with docetaxel 75 mg/m2, the CE was $31,776 per year of life gained. In univariate sensitivity analyses, CE estimates were most sensitive to changes in survival, ranging from $18,374 to $117,434 with 20% variation in survival at the recommended dose. The largest cost center in both arms was hospitalization, followed by the cost of drugs, investigations, radiotherapy, and community care. BSC patients had fewer hospitalizations than patients in the chemotherapy arm and were more often palliated at home. CONCLUSION: Although the decision to treat should not be based on economic considerations alone, our CE estimate of $31,776 per year of life gained (at the currently recommended dose of docetaxel) is within an acceptable range of health care expenditures, and the total costs of therapy are similar to those of second-line palliative chemotherapy for other solid tumors.

Resource utilization and provider variation in the care of patients with stage IV non-small cell lung cancer six months before death.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 216-216
Author(s):  
Erin Aakhus ◽  
Abigail T. Berman ◽  
Neil Crimins ◽  
Peter Edward Gabriel ◽  
Jennifer Braun ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Supportive Care ◽  
Small Cell Lung Cancer ◽  
Resource Utilization ◽  
Cell Lung Cancer ◽  
Stage Iv ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Contact

216 Background: Cost of care of cancer patients near the end of life is a focus for payers and others. The breakdown of costs during this period for patients with Stage IV non-small cell lung cancer (NSCLC) are shifting as therapeutic choices change. We measured and reported variation in utilization, by oncologist, aiming to improve standardization and reduce utilization while maintaining or increasing the quality of care. Methods: Within the University of Pennsylvania Health System (UPHS), we identified all deceased patients with Stage IV NSCLC with first contact of 1/3/2011 to date of death of 4/10/2016, at least 1 chemotherapy visit, and 6 months between first contact and death (N=175). We captured all inpatient and outpatient charges within 6 months of patient death. Results: The median gross total charge per patient was $209,637 (interquartile range, $121,517-$371,196), which consisted of 39% outpatient infusions, 23% radiation therapy, 18% inpatient medical admissions, 11% outpatient radiology, 4.5% professional charges, and <1% ED visits. Infusions of pemetrexed and bevacizumab accounted for 7.3% and 6.1% of the gross total charges, respectively. Only 13/175 (7.4%) of patients received infusions within 14 days of death. Primary oncologist was not found to be a significant driver of variation in total, outpatient, or inpatient gross charges per patient (p=0.097, 0.208, 0.297). However, we showed that professional charges and use of outpatient radiology differed by oncologist (p=0.039, 0.003). We also identified oncologist-driven differences in use of supportive care drugs pegfilgrastim, darbepoietin, and denosumab (p=0.002, <0.001, <0.001). We detected no differences in use of pemetrexed or bevacizumab (p=0.835, 0.521). The differences in number of infusion visits approached significance (p=0.058). Conclusions: Outpatient infusions and radiation therapy were the largest contributors to healthcare resource utilization in the care of Stage IV NSCLC patients in the last 6 months of life. Variation in utilization by primary oncologist was detected in professional charges, outpatient radiology, and the use of supportive care (but not chemotherapeutic) agents.

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