Increasing utilization and predictors of hematopoietic growth factors in patients diagnosed with colorectal cancer: findings from a large national population-based cohort in the USA, 1992–2009

Purpose Hematopoietic growth factors have played a major role in preventing infection and shortening the duration of neutropenia in patients receiving cancer chemotherapy. Little information is available on how these growth factors are used in patients with cancer outside the clinical trial setting. We performed descriptive and exploratory analyses on the patterns and correlates of the use of hematopoietic growth factors in community-dwelling elderly patients. Patients and Methods We identified 5,843 women from the Surveillance, Epidemiology, and End Results (SEER)–Medicare-linked data cohorts who were diagnosed with breast cancer at age 65 or older in 1992 to 1999 from the 11 SEER areas and received chemotherapy. Results Overall, 17.3% of the elderly women with breast cancer chemotherapy received filgrastim and 6.8% received epoetin. The use of the growth factors increased significantly over time from 1992 to 1999 (P < .001 for trend). Compared with patients diagnosed in 1992 to 1994, patients diagnosed in 1998 to 1999 were more than five times and 65 times more likely to receive filgrastim and epoetin, respectively, after controlling for other factors such as age and comorbidity. There also was substantial geographic variation in the use of hematopoietic growth factors, ranging from 10.6% in Seattle to 22.9% in Atlanta. Significant predictors of growth factors included patient age, race, tumor stage, and comorbidity. Conclusion There were substantial temporal and geographic variations in the use of hematopoietic growth factors among patients receiving chemotherapy for breast cancer. The nationwide and population-based Medicare claims provide potential for examining the effectiveness, medical costs, and cost effectiveness of hematopoietic growth factors in the community.

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Trends in chemotherapy-related treatment of late-stage colon and rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6604 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6604-6604

Author(s):

Cathy Bradley ◽

K. Robin Yabroff ◽

Joan L Warren ◽

Neetu Chawley ◽

Chris Zerutoc ◽

...

Keyword(s):

Rectal Cancer ◽

Growth Factors ◽

Median Number ◽

Population Based ◽

Hematopoietic Growth Factors ◽

Incurable Cancer ◽

Related Services ◽

Treatment Practices ◽

Colon And Rectal Cancer ◽

Patient Prognosis

6604 Background: The appropriate intensity of treatment for patients with advanced incurable cancer remains uncertain. Our study examines trends in population-based treatment following diagnosis for metastatic colon and rectal cancer in elderly adults. Methods: We used the Surveillance, Epidemiology, and End Results – Medicare database to identify persons aged 65 and older who were diagnosed with distant stage colon (N=12156) and rectal cancer (N=3071) between 2000 and 2007. We assessed treatment patterns over the year after diagnosis with a focus on chemotherapy and related services. For each year, we report the percent of patients receiving chemotherapy, hematopoietic growth factors, and antiemetics/premedication. For those patients who received chemotherapy, we estimated, by year, the median number of days from the first to the last chemotherapy claim. Results: From 2000 to 2007, the percent of patients receiving chemotherapy increased from 39.6% to 44.4% for colon patients and from 46.6% to 59.2% for rectal patients. The median duration of chemotherapy increased by more than 40 days. The type of chemotherapy used changed dramatically. Oxaliplatin and Bevacizumab were not available in 2000, but by 2007, a substantial portion of colon and rectal cancer patients received Oxaliplatin (28.4% and 37.6%) and Bevacizumab (24.4%. and 33.2%). The percent of patients receiving hematopoietic growth factors rose appreciably from 3.7% to 23.2% for colon patients and from 5.2% to 27.4% for rectal patients. From 2000-2007, use of antiemetics/premedication increased from 27.2% to 44.3% for colon patients and from 32.9% to 56.9% for rectal patients. Conclusions: The use and intensity of chemotherapy related treatment for CRC patients with advanced cancer has increased markedly from 2000 to 2007. Many of these therapies are very expensive. ASCO has encouraged realistic conversations about the potential benefits and limitations of disease-directed therapy with the hope of improving patients’ quality of life while reducing medical treatment costs. Our findings demonstrate the need for physicians to assess their treatment practices relative to health care costs and patient prognosis.

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