Hematologic Outcomes and Erythropoiesis-Stimulating Therapy Costs in Epoetin Alfa (EPO)- and Darbepoetin Alfa (DARB)-Treated Cancer Patients: Results of the Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E. Registry).

Abstract Background: National Comprehensive Cancer Network (NCCN) anemia treatment guidelines recommend maintenance of hemoglobin (Hb) levels between 11–12 g/dL. To investigate hematologic outcomes and costs of erythropoiesis-stimulating therapies (ESTs), data were analyzed from the D.O.S.E. Registry, an ongoing, prospective registry collecting data on real-world practice patterns and outcomes in cancer patients treated with ESTs. Methods: Data come from U.S. hospital and community-based outpatient practices assessed from 1/04–6/06. Adult patients with a non-myeloid malignancy and receipt of at least 2 doses of either EPO or DARB were included. Outcomes assessed included mean treatment duration; mean cumulative dose; maintenance of Hb between 11–12g/dL; mean Hb level at Weeks 4, 8, 12, and 16; and proportion of patients receiving blood transfusions. EST costs were based on May 2006 wholesale acquisition costs. Results: 861 patients (312 EPO, 549 DARB) from 45 sites were identified. Mean baseline characteristics were similar between the groups (entire cohort: age 62.4 years, 64.1% women, weight 75.9 kg, and Hb 10.4 g/dL) with the exception of a significantly higher proportion of patients receiving iron supplementation in the DARB-treated group (EPO 18%, DARB 29%, p<0.01). The most common malignancies were breast, lung and gastrointestinal. Both groups had similar mean treatment duration (approximately 8 weeks), number of Hb assessments (approximately 8) and proportion of patients requiring blood transfusion following the initial four weeks of treatment (EPO 9%, DARB 11%, p=0.32). The mean cumulative doses for EPO (373,827 Units) and DARB (1,185 mcg) were associated with EST drug costs of $4,550 for EPO and $5,267 for DARB, (p<0.001). Mean Hb level was ≥ 11 g/dL at all post-baseline time points in the EPO-treated group, however <11 g/dL in the DARB-treated group at Weeks 12 and 16. Mean Hb level was significantly higher in the EPO-treated group at Week 12 (EPO 11.3 g/dL, DARB 10.8 g/dL, p=0.03). Conclusions: In this prospective observational study, EPO-treated patients achieved and maintained NCCN target Hb levels at all timepoints. These findings also showed EST cost to be 16% higher in the DARB-treated group than in the EPO-treated group.

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Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry: Analysis of outcomes and costs of epoetin alfa (EPO) and darbepoetin alfa (DARB) treatment in cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.16009 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 16009-16009

Author(s):

A. Memisoglu ◽

C. Peake ◽

E. Buscaino ◽

R. S. McKenzie ◽

J. B. Forlenza ◽

...

Keyword(s):

Cancer Patients ◽

Drug Cost ◽

Iron Supplementation ◽

Treatment Guidelines ◽

Ferritin Level ◽

Treated Group ◽

Tumor Type ◽

Real World Data ◽

Nccn Guidelines ◽

Wholesale Acquisition Cost

16009 Background: NCCN anemia treatment guidelines recommend hemoglobin (Hb) levels be maintained between 11 and12 g/dL. To understand erythropoiesis-stimulating therapy (EST) dosing, outcomes and costs in cancer patients, data were analyzed from an ongoing prospective, observational registry (D.O.S.E. Registry) collecting real-world data on cancer patients treated for anemia in U.S. oncology clinics. Methods: Data were collected from participating hospital- and community-based outpatient oncology practices between 1/2004 and 11/2005. This analysis included adult patients who had received ≥2 doses of either EPO or DARB. Outcomes assessed included Hb values at weeks 4, 8, 12, and 16 following EST initiation. Drug cost was based on EST utilization and 2005 wholesale acquisition cost. Results: 652 patients (235 EPO, 417 DARB) from 32 sites were identified. Baseline characteristics of age, gender, Hb, tumor type and ferritin level were similar between treatment groups. The proportion of patients with iron supplementation at baseline was significantly higher in the DARB-treated group (EPO 18% v. DARB 31%, p < 0.001). EPO-treated patients were maintained between 11 and 12 g/dL throughout the therapeutic duration ( Table ). Mean cumulative administered dose of EPO was 393,047 Units and DARB 1205 mcg, corresponding to an overall drug cost of $4,783 for EPO and $5253 for DARB (p = 0.001). Conclusions: These results demonstrate that EPO-treated patients maintained target Hb levels consistent with NCCN guidelines, which was not observed in the DARB-treated patients. Drug cost was significantly higher in the DARB group compared to the EPO group without considering the costs of iron supplementation. [Table: see text] [Table: see text]

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Drug Utilization Patterns and Cost Considerations for Erythropoiesis Stimulating Agents in Cancer Chemotherapy Patients in a Managed Care Setting.

Blood ◽

10.1182/blood.v110.11.5157.5157 ◽

2007 ◽

Vol 110 (11) ◽

pp. 5157-5157

Author(s):

Alyson Mandel ◽

Richard Weininger ◽

Scott R. McKenzie ◽

Brahim K. Bookhart ◽

Catherine T. Piech

Keyword(s):

Cancer Patients ◽

Cancer Chemotherapy ◽

Drug Cost ◽

Cumulative Dose ◽

Real World ◽

Treatment Duration ◽

Treated Group ◽

Dose Ratio ◽

Utilization Patterns ◽

Chemotherapy Patients

Abstract Objective and Purpose: To understand current utilization patterns, this study examined real-world dosing and drug costs for erythropoiesis-stimulating agents (ESAs), epoetin alfa (EPO) and darbepoetin alfa (DARB) in cancer patients receiving chemotherapy. Methods: An analysis of ESA utilization in chemotherapy patients using adjudicated medical claims between 2004 and 2006 from seven health plans was conducted. Patients with ≥1 ESA claim, receiving concurrent chemotherapy identified through alphanumeric HCPCS codes, and newly initiated on EPO or DARB (no ESA administration within 90 days prior to initiation), and receiving chemotherapy were included. Those patients who received both EPO and DARB or who had myelodysplastic syndromes or end-stage renal disease were excluded. Treatment duration was defined as time from first to last ESA administration. Mean cumulative ESA dose was used to calculate drug cost (based on 1/2007 wholesale acquisition cost: EPO $12.52/1000 Units; DARB: $4.576/mcg) and dose ratio (Units EPO: mcg DARB). Results: 1,446 EPO and 2,729 DARB patients were included. Mean treatment duration was longer in the DARB-treated group by three days (EPO:49 days; DARB:52 days; p= 0.037). The EPO-treated group reported 5.8 administrations with a mean administered dose of 42,603 Units (median 40,000, interquartile range 40,000–45,714) corresponding to a mean cumulative dose of 247,097 Units. The DARB-treated group reported 5.0 administrations with mean administered dose of 262 mcg (median 250, interquartile range 200–300) corresponding to a mean cumulative dose of 1,310 mcg. Drug costs were $2,901 lower in the EPO group compared to the DARB group (EPO $3,094; DARB $5,995) and utilization reflected a dose ratio of 189:1 (Units EPO: mcg DARB). Conclusions: This observational study of over 4,100 cancer patients receiving chemotherapy found 48% lower drug cost in the EPO group compared to the DARB group. These findings provide greater understanding of current real-world ESA utilization and are consistent with other studies in the cancer chemotherapy population.

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Hematologic outcomes of epoetin-alpha-treated cancer patients based on initial intervention of Hb <10 compared to Hb 10–11 g/dL: Results from a prospective observational study

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19542 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19542-19542

Author(s):

Q. Wang ◽

E. Chen ◽

K. Larholt ◽

B. Bookhart ◽

R. McKenzie ◽

...

Keyword(s):

Observational Study ◽

Clinical Outcomes ◽

Treatment Duration ◽

Tumor Type ◽

Karnofsky Score ◽

Community Based ◽

Initial Intervention ◽

Study Completion ◽

Cancer Network ◽

Current Guidelines

19542 Background: Current guidelines recommend consideration of epoetin alfa (EPO) therapy for chemotherapy-induced anemia (CIA) when Hb <11 g/dL (National Comprehensive Cancer Network) or Hb < 10g/dL (ASCO/ASH). To evaluate clinical outcomes in EPO-treated patients initiated at Hb < 10 v. 10–11 g/dL, an analysis was conducted of clinical outcomes from practice settings. Data were analyzed from the Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry, an ongoing, prospective registry collecting data on real-world practice patterns. Methods: Data from 29 U.S. hospital and community-based outpatient practices were assessed from 1/04–10/06. Chemotherapy-treated adult patients with a non-myeloid malignancy, baseline anemia (Hb < 11 g/dL), receipt of at least two EPO doses, and study completion were included. This analysis stratified patients based on Hb level at EPO initiation. Outcomes assessed included proportion of patients requiring RBC transfusion, mean treatment duration, and proportion of patients achieving an Hb = 11 g/dL. Results: 245 patients were eligible for analysis. 97 patients were initiated at a Hb < 10 g/dL and 148 patients were initiated at Hb 10–11 g/dL Baseline characteristics (age, gender distribution, weight, platinum-based therapy, Karnofsky score, primary tumor type) were similar except baseline Hb (9.4 g/dL v. 10.5 g/dL). Treatment duration was similar in both groups at approximately nine weeks. Transfusion outcomes and time to NCCN target Hb level (Hb =11 g/dL) are described in the table . Conclusions: This ongoing observational study demonstrated over two-thirds of patients achieved NCCN target Hb = 11 g/dL. Additional benefits for the patients initiated at Hb 10–11 g/dL were a shorter time to NCCN target Hb and a lower proportion of patients requiring transfusions. These results support the use of EPO for patients with chemotherapy-induced anemia and Hb < 11 g/dL. [Table: see text] No significant financial relationships to disclose.

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Access to specialized cancer care and clinical trials for cancer patients from non-urban areas is facilitated by a Cancer Network organization

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.16006 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 16006-16006

Author(s):

J. Brunet ◽

B. Martin ◽

S. Del Barco ◽

I. Juez ◽

A. García ◽

...

Keyword(s):

Clinical Trials ◽

Cancer Patients ◽

Cancer Care ◽

Urban Areas ◽

Treatment Guidelines ◽

Medical Oncology ◽

Geographical Area ◽

Trial Participation ◽

Network Organization ◽

Cancer Network

16006 Background: In non-urban areas, there is a controversy about whether medical cancer treatments should be administered exclusively in referral cancer centers (CC) or in community hospitals (CH) (Br J Cancer 2004; 90: 1688). Limitations such as geographical distance or absence of treatment guidelines may reduce the access to specialized cancer care or clinical trials. A network organization that involves at the same time a CC and the CH from the same geographical area may provide an adequate balance between proximity, equity and quality of cancer services. Methods: We designed a cancer network in 2003 in order to consolidate all Oncology resources in an area covering a population of 700,000. A CC is placed adjacent to a general hospital in a centrally located urban area of 250,000. The remaining area is served by 6 CH. Our cancer network is based on: 1) approximately half of the Medical Oncology Dpt staff members work part-time at a CH, participating in outpatient clinic, chemotherapy treatments administration, and multidisciplinary meetings; and 2) other cancer health professionals are organized in network groups like the pharmacy group and the chemotherapy nursing group. Specialized medical cancer care included concomitant radio-chemotherapy, complex outpatient or inpatient therapies, genetic counseling and therapy for some pre-defined malignancies such as germ cell and ovarian cancers. Results: From January to December 2004, 1862 new patients were visited, 1013 (54%) at the CC (Medical Oncology Dpt.), and 849 (46%) at the CH. One-hundred ninety-three cancer patients were referred from the CH to the CC. In total, 141 of the cancer patients seen at the CC were included in clinical trials. It is remarkable that clinical trial participation was much enhanced by referrals, since 101 (72%) of patients in clinical trials came from non-urban areas. Conclusions: The establishment of a cancer network facilitates access to specialized cancer care and clinical trials for patients living in non-urban areas, therefore contributing to therapeutic equity. No significant financial relationships to disclose.

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Open to options: Lessons learned using an evidence-based treatment decision model for blood cancer patients in a community based setting

PsycEXTRA Dataset ◽

10.1037/e548132012-120 ◽

2010 ◽

Author(s):

M. F. Miller ◽

J. Belkora ◽

N. Blakeney ◽

K. Coyne ◽

B. Crawford ◽

...

Keyword(s):

Cancer Patients ◽

Decision Model ◽

Treatment Decision ◽

Lessons Learned ◽

Evidence Based ◽

Community Based ◽

Blood Cancer ◽

Evidence Based Treatment

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Female partner experiences of prostate cancer patients’ engagement with a community-based football intervention: a qualitative study

BMC Public Health ◽

10.1186/s12889-021-11448-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julie Midtgaard ◽

Tine Tjørnhøj-Thomsen ◽

Mette Rørth ◽

Malene Kronborg ◽

Eik D. Bjerre ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Exercise Adherence ◽

Negative Effects ◽

Community Based ◽

Prostate Cancer Survivors ◽

Female Partners ◽

New Beginning ◽

Group Interviews ◽

Football Programs

Abstract Background Prostate cancer is often labelled a couple’s disease wherein the partner plays an important role in the man’s illness management and related health promotion activities. The aim of this study was to explore partner experiences of prostate cancer patients’ engagement with a community-based football program. Methods Eight audio-visual recorded semi-structured focus group interviews were conducted with a total of 39 female partners of men with prostate cancer who participated in a community-based football program as part of the nationwide FC Prostate Community Trial (NCT02430792). Data was managed with the software program Nvivo 11 and analysed inductively to derive thematic findings. Results The four thematic findings were: 1) ‘Hope of a new beginning’ which included stories of hope that football would mitigate the negative effects of men’s prostate cancer treatment [s]; 2) ‘My new partner’ was characterized by attributing connections between physical activity and elevated mood as a by-product of men’s involvement in the program; 3) ‘Football first’ included assertions of the couples mutual commitment to the football program; and 4) ‘Invisible needs’ contrasted insecurity, and unforeseen challenges for partners feeling somewhat neglected. Overall, the results confirm the need for cohesion and flexibility amongst couple-dyads to ensure partners and men with prostate cancer benefit from their involvement in football programs. Conclusions This study indicates that partners of prostate cancer survivors’ engaging with community-based football align to idealized gender relations, roles and identities. In many instances, these gendered dimensions aided positive dyadic coping and long-term exercise adherence.

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