The Impacts of Thromboembolic Events in Breast and Prostate Cancer Patients: Incidence, Hospitalization Duration and Costs

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4828-4828
Author(s):  
Isabelle Borget ◽  
Guy Meyer ◽  
Alexandre Vainchtock ◽  
Nicolas Martelli ◽  
Florian Scotté ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Research Funding ◽  
Public Hospitals ◽  
Extra Cost ◽  
Recurrent Event ◽  
Thromboembolic Events

Abstract Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). We intended to determine the incidence and recurrence rate of VTE in breast cancer (BC) and prostate cancer (PC) French patients, to evaluate their impacts on the number and the duration of hospitalizations and to calculate their additional cost for hospitals. Methods: The French national hospital database (PMSI) was used to identify BC and PC patients diagnosed in 2010 who were hospitalized for a VTE during the following two years. The number of stays induced by a VTE, the number of patients hospitalized or re-hospitalized and the time before recurrent event were determined using the disease-specific ICD-10 codes, among all VTEs classified as primary or related diagnosis (PD / RD) and significant associated diagnosis (SAD). Subsequently, we evaluated the extra cost and extra length of stay when a VTE ocurred during a hospitalization: respectively 275 stays for breast cancer and 292 stays for prostate cancer during which a VTE occurred and prolonged the stay (cancer was classified as PD/PR and the VTE as SAD) were matched and compared to similar stays without VTE. We calculated the hospital costs using the French official tariffs, from the perspective of the third-party payer. Results: We identified 62,365 new patients with BC and 45,551 new patients with PC. During the two-year follow-up period, 1,271 with BC (2.0%) and 997 with PC (2.2%) were hospitalized for a VTE or experienced a VTE during a hospital stay. In total, 1,604 and 1,210 stays related to first VTE or recurrent VTE were analyzed for BC patients and PC patients, respectively. We found that 202 BC patients and 144 PC patients were re-hospitalized at least once for a recurrent VTE, representing 546 admissions (19.4% of total admissions). In those patients with VTE recurrence, median time before recurrent event was 23 days in BC patients and 25 days in PC patients. The comparison between stays during which a VTE occurred and stays without VTE showed that the duration of hospital stay was longer in patients with VTE: in public hospitals, median stay duration for BC patients with VTE raised by 133% to 7 days (vs. 3 days for BC patients without VTE), and by 67% to 10 days for PC patients (vs. 6 days for patients without VTE). VTE consequently induced a significant extra cost related to hospitalizations over the two years of follow-up: the median expenditure per stay showed an increase of 37.3% in BC, up to 5,518 Euros (vs. 4,018 Euros per stay without VTE) and of 21.7% in PC up to 6,200 Euros (vs. 5,094 Euros per stay without VTE). Conclusion: VTE appeared to make cancer management much heavier as patients faced increased hospital stays number and duration whereas healthcare system faced important additional costs. This burden may be reduced by decreasing the occurrence of thromboembolic complications and their recurrence in cancer patients, with better prevention and follow-up measures. Table. Hospital stay duration in patients with breast or prostate cancer as PD / RD and VTE as significant associated diagnosis compared to patients without VTE (in public hospitals) Median stay duration (days) Mean stay duration (days) Breast cancer Patients with VTE 7 11.32 Patients without VTE 3 4.56 Prostate cancer Patients with VTE 10 13.52 Patients without VTE 6 6.98 Disclosures Borget: LEO Pharma: Honoraria. Meyer:LEO Pharma: Research Funding. Vainchtock:HEVA: Research Funding. Martelli:LEO Pharma: Honoraria. Scotté:LEO Pharma: Honoraria.

scholarly journals Thrombosis in Cancer Patients during Hospitalization: Impact on Stays and Costs

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4487-4487
Author(s):  
Isabelle Borget ◽  
Florian Scotte ◽  
Nicolas Martelli ◽  
Alexandre Vainchtock ◽  
Ismail Elalamy
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Lung Cancer ◽  
Colon Cancer ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Public Hospitals ◽  
Recurrent Event ◽  
Additional Costs

Abstract Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Following a previous study on two localizations, we intended to determine the incidence and recurrence rate of VTE in breast cancer (BC), colon cancer (CC), lung cancer (LC) and prostate cancer (PC), four of the most frequent cancers in France. We evaluate their impact on the number and the duration of hospitalizations and calculate the additional costs for hospitals compared to cancer patients without VTE. Methods: The French national hospital database (PMSI) was used to identify BC, CC, LC and PC patients diagnosed in 2010 who were hospitalized for a VTE during the following two years. The number of stays induced by a VTE, the number of patients hospitalized or re-hospitalized and the time before recurrent event were determined using the disease-specific ICD-10 codes, among all VTEs classified as primary or related diagnosis (PD / RD) and significant associated diagnosis (SAD). Subsequently, we evaluated the extra cost and extra duration of stay when a VTE is managed during a hospitalization. Therefore, we selected stays during witch a VTE is managed but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays without VTE. Costs were estimated from the healthcare system perspective, using the French official tariffs. Results: Among 194,964 patients newly diagnosed in 2010 with BC, CC, LC and PC in 2010, 1,271 (2.0%) BC patients, 2,866 (6.0%) CC patients, 3,775 (9,6%) LC patients and 997 (2.2%) PC patients, were hospitalized for a VTE or experienced a VTE during a hospital stay, over two years. In total, 12,880 stays related to VTE were identified. We found that 2.053 cancer patients (23.0% of all VTE patients) were re-hospitalized at least once with a recurrent VTE, representing 3,969 admissions (30.8% of total admissions). In those patients with VTE recurrence, median time between first and recurrent event was 23 days in BC patients, 22 days in CC patients, 19 days in LC patients 25 days in PC patients. In the second part of our study, the comparison between stays for cancer during which a VTE occurred and stays for cancer without VTE showed that the duration of hospital stay was longer in patients with VTE: in public hospitals, median stay duration raised from 4 to 7 days for BC, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC. VTE consequently induced a significant extra cost related to hospitalizations over the two years of follow-up: in public hospitals, the median expenditure per stay increased by 37% in BC, (up to Û 5,518), by 61% in CC (up to Û9,878), by 202% in LC (up to Û7,308) and by 22% in PC (up to Û6,200). Conclusion: VTE appeared to make cancer management much heavier as patients faced increased hospital stays duration whereas healthcare system faced important additional costs. Better prevention and follow-up guidelines could reduce this burden, and benefit both patients and hospitals. Table. Median hospital stay duration and cost in cancer patients with and without VTE as SAD Breast cancer Colon cancer Lung cancer Prostate cancer Duration (days) Cost Duration (days) Cost Duration (days) Cost Duration (days) Cost With VTE 7 Û 5,518 16 Û9,878 9 Û7,308 10 Û 6,200 Without VTE 4 Û 4,018 8 Û6,171 2 Û2,422 6 Û 5,094 Disclosures No relevant conflicts of interest to declare.

Thromboembolic events in hospitalized cancer patients: Impact on stay duration and cost for four major cancer localizations.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 186-186
Author(s):  
Florian Scotte ◽  
Alexandre Vainchtock ◽  
Nicolas Martelli ◽  
Isabelle Borget
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Lung Cancer ◽  
Colon Cancer ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Thromboembolic Events ◽  
Cancer Management ◽  
Venous Thromboembolic Events ◽  
The Impact

186 Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Our study aimed to evaluate the impact of VTE on the length and cost of hospital stay in French patients hospitalized for breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC). Methods: The French national hospital database (PMSI) and the disease-specific ICD-10 codes were used to identify BC, CC, LC or PC patients diagnosed in 2010 who were hospitalized with a VTE during the following two years. We selected stays during which a VTE occurred but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays (same cancer and same reason for hospitalization) without VTE. Costs were calculated using the French official tariffs, from the perspective of the third-party payer. Results: We identified 214 stays for breast cancer during which a VTE occurred and was classified as significant associated diagnosis, 843 stays for colon cancer, 1301 for lung cancer, and 126 for prostate cancer. The comparison between those stays and similar stays without VTE showed significant increase of hospital stay duration in patients experiencing VTE. Median duration rose from 4 to 7 days in BC patients, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC. Consequently, the median expenditure per stay increased by 37% in BC patients with VTE (up to € 5,518), by 61% in CC (up to € 9,878), by 202% in LC (up to € 7,308) and by 22% in PC (up to € 6,200). Conclusions: When occurring during hospitalization, VTE made cancer management much heavier: patients faced prolonged hospital stays whereas healthcare system faced significant additional cost. Better prevention and follow-up measures could reduce this burden, and benefit both patients and hospitals. [Table: see text]

Secondary Myeloid Neoplasms in Older Women with Breast Cancer after Radiotherapy: A Population-Based Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1676-1676
Author(s):  
Amer M. Zeidan ◽  
Jessica B. Long ◽  
Rong Wang ◽  
James B. Yu ◽  
Jane Hall ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Research Funding ◽  
Breast Cancer Diagnosis ◽  
Breast Cancer Patients ◽  
Treatment Delivery ◽  
Post Surgery ◽  
Single Modality

Abstract BACKGROUND: Chemotherapy and combined chemo-radiotherapy are well-documented risk factors for myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML), collectively referred to in this setting as therapy-related myeloid neoplasms (t-MN). While single-modality radiotherapy post-lumpectomy has been shown to reduce local recurrence among breast cancer patients, data regarding the impact on development of t-MN are limited and inconsistent. METHODS: We conducted a retrospective cohort study of elderly female breast cancer patients (aged 67-94 years at diagnosis) who were diagnosed with in situ or stage 1-3 breast cancer between 1/1/2004 and 12/31/2011 using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. Eligibility criteria included 1) enrollment in Medicare Parts A and B continuously through death or end of study (12/31/2013); 2) underwent surgery for breast cancer within 9 months of diagnosis; and 3) were not diagnosed with other neoplasms prior to breast cancer diagnosis. Delivery of radiation therapy was ascertained using the Healthcare Common Procedural Coding System codes. In order to be considered a recipient of radiotherapy, the patient had to receive radiotherapy within 9 months of diagnosis and had any treatment delivery code for brachytherapy or ≥ 4 treatment delivery codes for external bream radiotherapy. Competing-risk analysis was used to assess the risk of developing t-MN in radiotherapy-treated patients compared to those treated with surgery alone. Patients were censored at the time of receiving chemotherapy or at development of another malignancy (aside of t-MN) during follow-up. Competing-risk analysis was used to assess the risk of developing secondary MN women who received radiation therapy compared to those who did not. These models included adjustment for breast cancer diagnosis age and year, number of comorbidities, anemia, functional status prior to breast cancer diagnosis and breast cancer stage. RESULTS: A total of 63,543 patients were included in the study. Median follow-up for all participants was 48 months. A total of 32,809 patients (51.6%) received radiotherapy post-surgery while 30,734 patients (48.4%) were not treated with radiotherapy post-surgery. Patients who received radiotherapy had significantly better overall survival than those who did not (median overall survival [OS] 107 vs. 89 months, p<0.001). During follow-up, a total of 167 patients were diagnosed with MDS or AML (89 cases among those who received radiotherapy and 78 among those who did not receive radiotherapy). The median time to develop MDS/AML was 24 months. In the unadjusted model, there was no significantly increased risk of subsequent AML/MDS among breast cancer patients who received single-modality radiotherapy compared to those who underwent surgery alone (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 0.82-1.51, p=0.49). Similarly, no significant difference in subsequent MDS/AML according to receipt of radiotherapy was observed in the adjusted analysis (HR = 1.16, 95% CI: 0.84-1.59, p=0.36). CONCLUSIONS: Older patients with early breast cancer who were treated with single-modality radiotherapy post-surgery did not have a higher risk of subsequent MDS/AML compared to patients who did not receive radiotherapy, and the overall rate of MN was low.While additional studies with a longer duration of follow-up are warranted, these results suggest that the single-modality radiotherapy administered in the contemporary management of early breast cancer is not a risk factor for t-MN in this population. Disclosures Yu: 21st-Century Oncology LLC: Research Funding. Gore:Celgene: Consultancy, Honoraria, Research Funding. Gross:Johnson and Johnson: Research Funding; Medtronic: Research Funding; 21st-Century Oncology LLC: Research Funding. Ma:Celgene Corp: Consultancy; Incyte Corp: Consultancy. Davidoff:Celgene: Consultancy, Research Funding.

scholarly journals Myelodysplastic Syndromes and Acute Myeloid Leukemia in Prostate Cancer Patients after Radiotherapy, a Population-Based Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3295-3295
Author(s):  
Rong Wang ◽  
Amer M. Zeidan ◽  
Pamela R Soulos ◽  
James B. Yu ◽  
Amy J. Davidoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Prostate Cancer Diagnosis ◽  
Myeloid Malignancies ◽  
Increased Risk ◽  
The Impact

Abstract Background: Radiation is a known risk factor for myeloid malignancies. Approximately 1.4% of prostate cancer patients who undergo radiotherapy and survive >10 years will develop a secondary cancer. However, the impact of radiotherapy on the development of second myeloid malignancies among prostate cancer patients is unclear. Methods: We performed a retrospective cohort study of elderly prostate cancer patients (diagnosed with clinical stages T1-T3 at the age of 66-99 years during 1999-2009) using the linked Surveillance, Epidemiology and End Results (SEER) - Medicare database. Patients who received chemotherapy after prostate cancer diagnosis or had radiotherapy for prostate cancer recurrence were excluded. We searched Medicare claims and SEER records to identify incident myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) diagnoses after prostate cancer diagnosis. Patients were followed from the diagnosis of prostate cancer through the diagnosis of a second malignancy, death or end of study (12/31/2010 for prostate cancer patients diagnosed in 1999-2003, and 12/31/2012 for those diagnosed in 2004-2011), whichever came first. Competing risk analysis was conducted to assess the impact of radiotherapy on the development of second MDS/AML, compared with surgery. Death and developing a second malignancy other than MDS/AML were considered competing events. Competing risks regression models were performed using the Fine and Gray method to provide estimates of hazard ratios (HRs). Age at prostate diagnosis, race, Elixhauser comorbidity score excluding anemia, history of anemia, disability function score (in quartiles), stage of prostate cancer, and year of prostate cancer diagnosis were adjusted for in the multivariate model. Results: A total of 32,212 prostate cancer patients were included, with a median follow-up of 4.91 years. Patients who received surgery (n = 17,503) were younger than those who underwent radiotherapy (n = 14,709). Intensity-modulated radiotherapy (IMRT) was the most common type of radiotherapy received (n = 8,813, 59.9%; median follow-up: 3.91 years), followed by brachytherapy (n = 3,201, 21.8%; median follow-up: 5.67 years) and external beam radiotherapy (EBRT, n = 2,695, 18.3%; median follow-up: 7.84 years). We observed 158 incident cases of MDS/AML (123 MDS cases and 35 AML cases) after the diagnosis of prostate cancer. The median time to develop MDS/AML was 3.30 (range: 0.20-9.77) years. In the multivariate model, compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing second MDS/AML (HR = 1.54, 95% confidence interval [CI]: 1.09-2.11). When the analysis was stratified by specific radiation modality, increased risk of second MDS/AML was observed in each group, but the increase only reached statistical significance in the IMRT group (HR = 1.66, 95% CI: 1.09-2.52) (Table). We also conducted a separate analysis of the 123 patients who developed MDS. In the unadjusted model, compared with prostate cancer patients who received surgery only, patients who underwent any type of radiotherapy, EBRT, or IMRT had significantly increased risk of MDS. However, after adjusting for other factors, the magnitude of the effect diminished, and the effect was no longer statistically significant (Table). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by radiation modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. Table 1. Risk of Second MDS/AML after Radiotherapy among Prostate Cancer Patients Second cancerof interest Unadjusted Adjusted n (%) HR (95% CI) p HR (95% CI) p MDS/AML (n=158) Surgery 60 (0.34) 1.00 1.00 Radiotherapy 98 (0.67) 1.94 (1.41-2.68) <.01 1.54 (1.09-2.17) 0.01 Brachytherapy 19 (0.59) 1.58 (0.94-2.64) 0.08 1.35 (0.80-2.27) 0.26 EBRT 29 (1.08) 2.13 (1.36-3.34) <.01 1.51 (0.91-2.50) 0.11 IMRT 50 (0.57) 2.02 (1.39-2.93) <.01 1.66 (1.09-2.52) 0.02 MDS (n=123) Surgery 49 (0.28) 1.00 1.00 Radiotherapy 74 (0.50) 1.80 (1.25-2.58) <.01 1.43 (0.97-2.12) 0.07 Brachytherapy 15 (0.47) 1.53 (0.86-2.73) 0.20 1.32 (0.74-2.35) 0.35 EBRT 24 (0.89) 2.17 (1.33-3.54) <.01 1.53 (0.87-2.70) 0.14 IMRT 35 (0.40) 1.72 (1.11-2.65) 0.01 1.43 (0.88-2.33) 0.15 Disclosures Yu: 21st-Century Oncology LLC: Research Funding. Davidoff:Celgene: Consultancy, Research Funding. Gore:Celgene: Consultancy, Research Funding. Gross:21st-Century Oncology LLC: Research Funding; Medtronic: Research Funding; Johnson and Johnson: Research Funding. Ma:Incyte Corp: Consultancy; Celgene Corp: Consultancy.

Solid Tumors in Patients with Chronic Lymphocytic Leukemia Who Received Frontline Lenalidomide Therapy: Distribution and Clinical Outcomes

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5573-5573
Author(s):  
Ahmad Alhuraiji ◽  
Lorenzo Falchi ◽  
Michael Keating ◽  
Zeev Estrov ◽  
Paolo Strati ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Clinical Trials ◽  
Radiation Therapy ◽  
Research Funding ◽  
Lymphocytic Leukemia ◽  
Prior History ◽  
Skin Cancers ◽  
History Of

Abstract Introduction: Patients (pts) with Chronic Lymphocytic Leukemia (CLL) are known to have an increased risk of other cancers. Treatment with lenalidomide has been associated with an increased rate of solid tumors (ST) in pts with multiple myeloma (MM). However, the occurrence of ST in patients with CLL receiving therapy with lenalidomide remains unknown. Methods: We evaluated the development of ST in pts with CLL that received front-line treatment with lenalidomide as monotherapy or in combination with rituximab in clinical trials conducted at our institution. We report the characteristics and timing of ST, as well as patient outcome. All pts enrolled had indication for therapy according to the International Workshop on CLL guidelines and no history of malignancy for three years, with the exception of treated malignancy with indolent behavior such as prostate cancer that was treated with surgery or radiation therapy. Results: One-hundred twenty-one pts were enrolled in two consecutive phase II clinical trials of frontline therapy with lenalidomide (N = 61, 51%) or combination of lenalidomide and rituximab (N = 60, 49%). Baseline pts characteristics are shown in Table 1, median age was 66 yrs and 24% of patients were age 70 or older. At a median follow up after lenalidomide therapy of 41 months (range 1-102+), 7 (6%) pts developed a ST: renal cell carcinoma (RCC, 3 pts), localized breast cancer (LCIS and DCIS, 2 pts), pancreatic adenocarcinoma (1 pt) and colon adenocarcinoma (1 pt) (details are shown in Table 2). The median time interval between receiving lenalidomide-based therapy and the development of ST was 1.5 years (range 0-8.5). At the time of this report, 5 out of 7 pts with ST are alive and cancer-free. Two pts died: 12 months and 18 months after developing ST from progression of pancreatic adenocarcinoma and heart failure, respectively. Since pts with CLL have a high rate of non-melanoma skin neoplasms (NMSC), we also monitored patients for new diagnoses of skin cancers. Seven (6%) additional pts developed NMSC, 4 of these pts had prior history of NMSC. All cases of NMSC were superficial and did not require systemic therapy. Additionally, because of the high median age of this population, we reviewed prior history of malignancies. Eleven (9%) pts had history of ST [prostate cancer (N = 9), bladder cancer (N = 1), RCC (N = 1)]. Twenty-two pts (18%) had skin cancers (NMSC, (N = 21) and 1 pt had history of melanoma. None of them had received chemotherapy, two had radiation therapy [prostate cancer = 1, NMSC (basal cell carcinoma of the nose (1 pt)]. All ST were in remission before starting therapy with lenalidomide for more than 3 years as per the inclusion criteria. Conclusions: Seven cases of ST were observed in our population of 121 pts with CLL that received initial therapy with lenalidomide, after a median follow-up of 3.5 years. The most common neoplasm was RCC followed by in-situ breast cancer. In our limited experience the timing, number and type of malignancies do not appear to mirror what was seen in patients with MM. However, this comparison may be limited by the size of our patient population and length of follow-up. Our group reported the incidence of ST in patients treated with FCR. After a similar follow-up the incidence of second malignancies was similar (5.9%), but the type of malignancies was different, although NMSC remained the most common ST in both experiences. Reporting the incidence of other malignancies in patients with CLL enrolled in large studies, including those of novel targeted agents, will help understanding the expected incidence of ST and how novel treatments modulate such risk. Disclosures Jain: Pharmacyclics: Consultancy, Honoraria, Research Funding; ADC Therapeutics: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Celgene: Research Funding; Seattle Genetics: Research Funding; Infinity: Research Funding; Abbvie: Research Funding; Genentech: Research Funding; Incyte: Research Funding; Servier: Consultancy, Honoraria; Novimmune: Consultancy, Honoraria; BMS: Research Funding; Novartis: Consultancy, Honoraria. Thompson:Pharmacyclics: Consultancy, Honoraria.

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