A comparison of chemotherapy use in stage IV pancreatic cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 257-257
Author(s):  
Naomi Whittaker ◽  
Kristin Hueftle ◽  
Mary Warlaumont ◽  
Lauren Brin ◽  
David C. Olson ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Native American ◽  
Cancer Patients ◽  
Private Insurance ◽  
Stage Iv ◽  
Standard Of Care ◽  
Uninsured Patients ◽  
Asian Pacific Islander ◽  
Asian Pacific ◽  
To Receive

257 Background: Palliative chemotherapy is the standard of care for stage IV pancreatic cancer patients (SFPC). Methods: This study compares the amount of chemotherapy given for SFPC across insurance types using the National Cancer Database (NCDB), which contains 70% of U.S. cancer cases. Results: The NCDB reported 115,512 patients diagnosed with SFPC from 2000 to 2009. Overall, 38.3% of SFPC patients received chemotherapy. The VAH (28.3%) and Medicare (29.7%) provided significantly less chemotherapy to SFPC patients as compared to Managed Care (48.2%), Private Insurance (46.7%), Tricare/Military (42.8%), Medicaid (37.8%), Medicare Plus Supplement (35.5%), and Uninsured (34.4%). From 2000 to 2009, the rate of chemotherapy for SFPC increased for both VAH (22.9% to 34.3%) and non-VAH (31.1% to 44.1%). At time of diagnosis, the percent of patients less than 60 at the VAH was 32%, non-VAH was 25.5% and Medicare was 7%. From age 20 to 59, the rate of chemo was stable at approximately 49%, but each successive decade demonstrated a marked reduction in use of chemotherapy (from 44% for 60 to 69 years of age to 21% for 80 to 89 and 5% for >90). The VAH PC population diagnosed with PC included 71.1% whites (W), 21.1% blacks (B), 4.8% Hispanics (H), 0.8% Asian-Pacific Islander (API), and 0.6% Native American (NA). Among all insurance types, only Medicaid (25%* B, 14%* H, 6%* API) and Uninsured (20% B, 15%* H, 4%* API) had a greater percentage of minorities. Compared to the average of all patients treated for SFPC (38.3%), blacks (34.7%*) and Hispanics (35.7%*) received less chemotherapy and whites received more (39.1%*). Conclusions: This is the largest study to analyze the use of chemotherapy in stage IV pancreatic cancer. Patients treated within the VAH were less likely to receive chemotherapy compared to all other patients except those with Medicare, who tend to be older at time of diagnosis. As age increases above 59, chemotherapy treatment for SFPC decreases. VAH patients receive less chemotherapy than Medicaid and Uninsured patients, though Medicaid and Uninsured have a greater percentage of minorities, who tend to get less chemotherapy for SFPC.

scholarly journals The Effects of Radiation Therapy (RT) and Surgical Resection on Overall Survival in Gastric Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4415-4415
Author(s):  
Henry Vuong ◽  
Gurinder Sidhu ◽  
Vaibhav Verma
Keyword(s):  
Overall Survival ◽  
Native American ◽  
Surgical Resection ◽  
Gastric Lymphoma ◽  
Stage Iv ◽  
Stage I ◽  
Stage Iii ◽  
Asian Pacific Islander ◽  
Stage Iv Disease ◽  
Asian Pacific

Abstract Introduction: Lymphoma of the stomach is an uncommon tumor. However, it is the most common extra-nodal manifestation of Non-Hodgkin lymphoma. Over the last few decades, preferred treatment for gastric lymphoma has shifted from surgical resection to non-surgical methods involving chemotherapy and RT. The current standard treatment is chemo-immunotherapy. The role of RT and surgery, if any, is unclear. Methods: We reviewed data which was obtained from the Surveillance, Epidemiology and End Results (SEER) data registry for patients with gastric lymphoma from 1973 until 2011. The data was analyzed using Microsoft Excel and statistical analysis was performed using SPSS statistical software. The SEER registry does not provide information about chemotherapy (CT) administered. Results: We analyzed 13,659 patients with the diagnosis of gastric lymphoma in the SEER database. The three most prevalent subtypes were diffuse large B-cell lymphoma (DLBCL) with 6,134 (44.9%) cases, extranodal marginal zone lymphoma (MZL) with 4,318 (31.6%) cases and chronic lymphocytic leukemia (CLL/SLL) with 352 (2.5%) cases. In the DLBCL group, the median (range) age was 71 (4 – 105) years, of which 44.7% were female and 55.3% male. Of the group, 4,992 (81%) patients were White, 447 (7%) Black, and the remainder were Asian, Pacific Islander, or Native American. The median overall survival (OS) in patients who did and did not receive RT was 63 vs. 34 months (p<0.01). Analysis by stage shows median OS with and without RT was 108 vs. 65 months in Stage I disease (p<0.01), 71 vs. 62 months (p=0.41) in Stage II disease, 59 vs. 25 months in Stage III disease (p=0.52), and 8 vs. 8 months in Stage IV disease (p=0.46). The median OS in patients who underwent surgical resection, at least partial gastrectomy, is 76 months compared to 28 months in patients who did not undergo resection (p<0.01) (Fig.1). Analyzed by stage, the median OS in patients who did and who did not undergo surgery was 114 vs. 59 months in Stage I disease (p<0.01), 70 vs. 54 months in Stage II disease (p=0.03), 50 vs. 22 months in Stage III disease (p=0.63), and 10 vs. 8 months in Stage IV disease (p=0.85). Since widespread use of rituximab started in 2001, we analyzed patients treated before and after that year. Among patients with DLBCL, 2,719 (44%) were diagnosed prior to 2001 and 3,415 (56%) were diagnosed in 2001 or afterwards. Median OS with and without RT was 43 months vs. 31 months prior to 2001 and 97 months vs. 39 months after 2001 (p<0.01). The median OS with and without surgery is 81 vs. 12 months prior to 2001 (Fig. 2) and 57 vs. 51 months after 2001 (Fig. 3) (p<0.01). In the MZL group, the median (range) age was 68 (10 – 101) years of which 50.5% were female and 49.5% male. Of the group, 3,457 (80%) patients were White, 392 (9%) Black, and the remainder were Asian, Pacific Islander, or Native American. The median OS of patients with MZL who had surgery and who did not was 146 vs. 145 months (p=0.372). Analysis by stage shows no significance difference in OS either. The median OS of patients who did not undergo RT was 132 months and was not yet reached in patients who underwent RT (p<0.01). Analysis by stage shows RT significantly benefitted patients with Stage I and II disease but not stage III and IV disease. Conclusion: Our analysis shows that patients with DLBCL who undergo RT have improved median OS. The benefit is limited to Stage I disease. Improved median OS is seen in patients with DLBCL who undergo surgical resection which is contrary to recent data. The benefit of surgical resection is seen only in Stage I and II but not in Stage III and IV. The benefit of surgery was present prior to 2001 but not seen after 2001 - after the widespread use of rituximab. In MZL, surgical resection has no impact on median OS; whereas RT improves OS, particularly in Stage I and II disease. While our analysis is limited due to the lack of data regarding chemotherapy administered, this large population based analysis supports the benefit of RT and surgery in select disease stages. Prospective clinical trials may better address the benefits of each modality independently. Fig 1. KM Curve of DLBCL gastric lymphoma, all cases, who did and did not undergo surgery (p<0.01) Fig 1. KM Curve of DLBCL gastric lymphoma, all cases, who did and did not undergo surgery (p<0.01) Fig 2. KM Curve of DLBCL gastric lymphoma of cases diagnosed before 2001 (p<0.01) Fig 2. KM Curve of DLBCL gastric lymphoma of cases diagnosed before 2001 (p<0.01) Fig 3. KM Curve of DLBCL gastric lymphoma for cases diagnosed after 2001. Fig 3. KM Curve of DLBCL gastric lymphoma for cases diagnosed after 2001. Disclosures No relevant conflicts of interest to declare.

Uptake and patterns of use of gemcitabine for stage IV pancreatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15074-e15074
Author(s):  
Paul Eliezer Oberstein ◽  
Dawn L. Hershman ◽  
John A. Chabot ◽  
Lauren Khanna ◽  
Beverly J. Insel ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Socioeconomic Status ◽  
Multivariate Analysis ◽  
Advanced Pancreatic Cancer ◽  
Stage Iv ◽  
Standard Of Care ◽  
The Elderly ◽  
Logistic Regression Models ◽  
Patterns Of Use ◽  
To Receive

e15074 Background: Gemcitabine was approved by the FDA in 1996 and subsequently became the standard of care for patients with advanced pancreatic cancer. We investigated the frequency and predictors of gemcitabine use among the elderly with stage IV pancreatic cancer. Methods: We used the SEER-Medicare database to identify subjects >65 years who were diagnosed with stage IV pancreatic cancer between 1/1/98-12/31/05, and survived for >30 days following diagnosis. After excluding patients who received non-gemcitabine chemotherapy, we used multivariate logistic regression models to analyze the association between patient and tumor characteristics and receipt of gemcitabine compared to no chemotherapy. Results: Among 3,208 patients analyzed, 1,614 (50.3%) received gemcitabine chemotherapy, 1,480 (46.1%) received no chemotherapy; 114 (3.5%) received non-gemcitabine therapy and were excluded from multivariate analysis. Among patients diagnosed early in the study period (1998-2000) the rate of gemcitabine use was 44.9%. In multivariate analysis, gemcitabine use was not associated with gender, race, tumor histology, or increasing comorbidities. Unmarried patients were less likely to receive gemcitabine (OR=0.65, 95% CI 0.55-0.76), and use decreased with increasing age (for those 75-79, OR=0.72. 95% CI 0.58-0.90, for those 80-84, OR=0.38, 95% CI 0.30-0.49, for those >84, OR=0.21 95%CI 0.15-0.30) compared to those 65-69. Patients diagnosed in 2004-2005 (OR= 1.51, 95% CI 1.23-1.84) were more likely to receive gemcitabine compared to those diagnosed in 1998-2000. Higher socioeconomic status were associated with increased utilization of gemcitabine (highest quintile OR=2.14, 95% CI 1.60-2.85, second and third quintile OR=1.45, 95%CI 1.10-1.93, compared to lowest quintile.) Conclusions: Although chemotherapy for stage IV pancreatic cancer confers a small survival benefit, uptake of gemcitabine was rapid with 55% of elderly patients receiving this therapy by 2004-2005. Future studies should explore the reasons behind the increased use in patients with higher socioeconomic status.

Use of surgery and chemoradiation in stage II and III rectal cancer: A retrospective comparison of treatment modalities in major insurance types using the NCDB.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 64-64
Author(s):  
Mary Warlaumont ◽  
Lauren Brin ◽  
Timothy Fuller ◽  
Naomi Whittaker ◽  
Peter Silberstein
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Private Insurance ◽  
Standard Of Care ◽  
Neoadjuvant Chemoradiation ◽  
Stage Ii ◽  
Treatment Modalities ◽  
Uninsured Patients ◽  
Treatment Practices ◽  
Using Data

64 Background: The standard of care (SOC) for stage II/III rectal cancer is neoadjuvant chemoradiation plus surgical resection. We aim to compare the treatment practices for patients with stage II and III rectal cancer in major insurance types. Methods: Using data from the National Cancer Database (NCDB), we analyzed the treatment patterns of 91,782 patients diagnosed with stage II/III rectal cancer from 2000 to 2009. The NCDB includes data from 70% of all U.S. cancer patients. This is the largest study of this kind to date. Results: In stage II/III rectal cancer, patients with private insurance received more SOC treatment (70.3%) than patients with VA Insurance (56.6%), Medicare (46.9%), Medicaid (66.5%), or no insurance (61.7%) (p<.0001). VA patients received less SOC treatment than Medicaid or noninsured patients (p<.0001). Medicare patients (26.9%) were treated with surgery alone more often than patients with private insurance (9.8%), Medicaid (10.4%), VAH (12.2%), or no insurance (9.4%) (p<.0001). VA (4.8%) and Medicare (4.3%) patients more often did not receive any “First Course Treatment” than patients with private insurance (1.3%) (p<.0001). Patients over 70 years old received less SOC treatment (42.2%) than patients under 70 years old (68.9%) (p<.0001) and received more surgery without chemotherapy or radiation (29.3%) than patients less than 70 years old (9.2%) (p<.0001). Conclusions: Stage II/III rectal cancer patients with private insurance received more SOC treatment than VA, Medicare, Medicaid or uninsured patients. VA patients received less SOC treatment than Medicaid or uninsured patients. [Table: see text]

scholarly journals Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482095661
Author(s):  
Bryce D. Beutler ◽  
Mark B. Ulanja ◽  
Rohee Krishan ◽  
Vijay Aluru ◽  
Munachismo L. Ndukwu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Native American ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Private Insurance ◽  
Insurance Status ◽  
The Impact ◽  
To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

Pharmaceutical assistance programs for cancer patients in the era of orally administered chemotherapeutics

2017 ◽  
Vol 24 (6) ◽  
pp. 424-432 ◽  
Author(s):  
Aaron Mitchell ◽  
Benyam Muluneh ◽  
Rachana Patel ◽  
Ethan Basch
Keyword(s):  
North Carolina ◽  
Cancer Patients ◽  
Care Delivery ◽  
Private Insurance ◽  
Standard Of Care ◽  
Drug Manufacturer ◽  
Cancer Drugs ◽  
Oral Agent ◽  
Assistance Programs ◽  
Oral Agents

Introduction The rising cost of cancer drugs may make treatment unaffordable for some patients. Patients often rely on drug manufacturer-administered Pharmaceutical Assistance Programs (PAPs) to obtain drugs and reduced or no cost. The overall usage of PAPs within cancer care delivery is unknown. Methods We included all cancer patients across an academically affiliated, integrated health system in North Carolina during 2014 ( N = 8591). We identified the subset of patients receiving PAP assistance to afford one or more cancer drugs, in order to calculate the proportion of patients receiving PAP assistance, and the retail value of the assistance. Results Among 8591 cancer patients, 215 unique patients submitted a total of 478 successful PAP requests for cancer drugs. 40% of PAP-utilizing patients were uninsured, 23% had Medicaid coverage, 20% had Medicare coverage, 2% were dual Medicare/Medicaid eligible, and 14% were commercially insured. Among all cancer patients who received medical treatment, 6.0% required PAP assistance, whereas 10.6% receiving an oral agent required PAP assistance. The proportion receiving PAP assistance varied substantially by drug, ranging from <1% of patients (e.g. carboplatin, methotrexate) to 50% of patients (e.g. ponatinib, temsirolimus). The majority of the retail value obtained was for oral agents, including $1,556,575 of imatinib and $1,449,633 of dasatinib, which were the two drugs with the highest aggregate retail value. Conclusions A substantial proportion of cancer patients receive private charitable assistance to obtain standard-of-care treatments. This includes patients with federal and private insurance, suggesting an inability of patients to meet cost-sharing requirements.

Surgery and chemoradiotherapy in stage II and III esophageal cancer: A retrospective analysis of first-course treatment across different insurances using the NCDB.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 29-29
Author(s):  
Lauren Brin ◽  
Apar Kishor Ganti ◽  
Xiang Fang ◽  
Mary Warlaumont ◽  
Timothy Fuller ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Private Insurance ◽  
Standard Of Care ◽  
Stage Ii ◽  
Similar Amount ◽  
Current Standard ◽  
Uninsured Patients ◽  
Significant Difference ◽  
The Us

29 Background: The current standard of care for stage II/III esophageal carcinoma for patients who can withstand aggressive therapy is chemotherapy, radiotherapy and surgery (tri-modality therapy). This is the largest study of its kind to date. Methods: Using the National Cancer Database (NCDB) 46,758 patients diagnosed with stage II/III esophageal carcinoma between 2000 and 2009 were identified. The NCDB database includes data from 70% of cancer patients in the US. Results: In stage II/III esophageal cancer private insurance holders received more tri-modality therapy (39%) than VA insurance (18%), Medicaid (22%), Medicare (18%), and the uninsured (19%) (p<0.0001). There was no statistically significant difference in the amount of tri-modality therapy received in patients with VA, Medicare, or no insurance. Medicaid patients received more tri-modality therapy than Medicare, uninsured, and VA patients (p<0.05). VA and uninsured patients received no treatment more frequently (13%) than those with private insurance (5%), Medicare (10%), and Medicaid (9%) (p<0.0003). Patients over 70 less frequently underwent tri-modality therapy (13%) as compared to those under 70 (34%, p<0.0001). Conclusions: Although VA, Medicare, and the uninsured patients received similar rates of tri-modality therapy (18-19%), it was much less than private insurance holders (39%). Medicaid patients received less tri-modality therapy than private insurance holders despite similar ages. Uninsured patients received a similar amount of tri-modality therapy as those with VA and Medicare. [Table: see text]

Choice of therapy and time to first treatment for patients with colon cancer: A National Cancer Database analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14642-e14642
Author(s):  
David C. Olson ◽  
Khaled Mohamed Abou El-Ezz ◽  
Peter T. Silberstein
Keyword(s):  
Colon Cancer ◽  
Stage Iv ◽  
Standard Of Care ◽  
Insurance Status ◽  
National Cancer Database ◽  
Veteran Affairs ◽  
Treatment Data ◽  
Medicare Patients ◽  
Time To First Treatment ◽  
To Receive

e14642 Background: Insurance status has been shown to affect adherence to guidelines in the treatment of colon cancer1. This study aims to investigate trends in management of colon cancer and time to first treatment in patients with various insurance types using the National Cancer Database (NCDB). Methods: Treatment data for 845,121 patients and time to first treatment data for 497,993 patients diagnosed with colon cancer between 2000 and 2010 were identified using the NCDB. Reported utilization of treatment and time to first treatment were analyzed by insurance status. Results: Among all stages of colon cancer, no treatment was received more often by Veteran Affairs (10.5%) and Medicare (10.9%) patients than uninsured (8.8%), managed care (4.5%), private insurance (4.7%), Medicaid (8.4%) or Medicare with supplement (7.7%). Among stage I colon cancer, surgery was received less often by uninsured (90.9%) than other insurance types. Stage III colon cancer patients enrolled in Medicare with/without supplement received chemotherapy less often than other insurance types (49.9% and 46%). Stage IV Medicare patients with/without supplement also received chemotherapy less than other insurance types (59.5% and 52.9%). Surgery as monotherapy was the most common treatment received among all insurance types and stages. More uninsured patients received treatment within 3 days than any other insurance types (61%). A delay of at least 17days occurred more in Veteran Affairs patients than other insurance types (40.6%). Conclusions: This is the largest study to date to have examined treatment trends and time to first treatment. Among all insurance types, Medicare without supplement and Veteran Affairs patients were most likely to receive no treatment. Uninsured were less likely to receive the standard of care treatment with stage I cancers. Medicare patients were less likely to receive the standard of care for stage III and stage IV cancers than other insurance types. Veteran Affairs patients had treatment delayed significantly more than other insurance types. Future studies are needed to assess factors leading to receipt of substandard care.

scholarly journals Intralesional injection of Rose Bengal augments the efficacy of gemcitabine chemotherapy against pancreatic tumors

2021 ◽  
Author(s):  
Patrick Innamarato ◽  
Jennifer Morse ◽  
Amy Mackay ◽  
Sarah Asby ◽  
Matthew Beatty ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Rose Bengal ◽  
Pancreatic Tumor ◽  
Advanced Pancreatic Cancer ◽  
Standard Of Care ◽  
Pancreatic Tumors ◽  
Intralesional Injection

Abstract Background Chemotherapy regimens that include the utilization of gemcitabine are the standard of care in pancreatic cancer patients. However, most patients with advanced pancreatic cancer die within the first 2 years after diagnosis, even if treated with standard of care chemotherapy. This study aims to explore combination therapies that boost the efficacy of standard of care regimens in pancreatic cancer patients. Methods In this study, we used PV-10, a 10% solution of rose bengal, to induce the death of human pancreatic tumor cells in vitro. Murine in vivo studies were carried out to examine the effectiveness of the direct injection of PV-10 into syngeneic pancreatic tumor cells in causing lesion-specific ablation. Intralesional PV-10 treatment was combined with systemic gemcitabine treatment in tumor-bearing mice to investigate the control of growth among treated tumors and distal untreated tumors. The involvement of the immune-mediated clearance of tumors was examined in immunogenic tumor models that express ovalbumin (OVA). Results In this study, we demonstrate that the injection of PV-10 into mouse pancreatic tumors caused lesion-specific ablation. We show that the combination of intralesional PV-10 with the systemic administration of gemcitabine caused lesion-specific ablation and delayed the growth of untreated distal tumors. We observed that this treatment strategy was markedly more successful in immunogenic tumors that express the neoantigen, OVA, suggesting that the combination therapy enhanced the immune clearance of tumors. Moreover, the regression of tumors in mice that received PV-10 in combination with gemcitabine was associated with the depletion of splenic CD11b+Gr-1+ cells and increases in damage associated molecular patterns HMGB1, S100A8, and IL-1α. Conclusions These results demonstrate that intralesional therapy with PV-10 can enhance the efficacy gemcitabine against pancreatic tumors.

Multi-agent and single-agent chemotherapy in stage IV pancreatic cancer: An NCDB analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 231-231
Author(s):  
Aabra Ahmed ◽  
Ryan W Walters ◽  
Timothy Dean Malouff ◽  
Lakshmi Manogna Chintalacheruvu ◽  
Peter T. Silberstein
Keyword(s):  
Pancreatic Cancer ◽  
Statistical Significance ◽  
Private Insurance ◽  
Single Agent ◽  
Advanced Pancreatic Cancer ◽  
Stage Iv ◽  
Median Income ◽  
Multi Agent ◽  
Survival Differences ◽  
Single Agent Chemotherapy

231 Background: Cartright et al (2014) examined 2,422 patients in the iKnowMed database and found that patients with advanced pancreatic cancer lived longer with multi-agent chemotherapy compared to single-agent chemotherapy (11.2 months vs 7.2 months). Our goal was to compare survival of patients with stage IV pancreatic cancer receiving multi-agent, single-agent, or no chemotherapy using a significantly larger sample of patients identified in the National Cancer Database (NCDB). Methods: We identified 86,048 patients with stage IV pancreatic cancer. Between-chemotherapy survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Patients receivingmulti-agent chemotherapy were more likely to have private insurance than single-agent and no chemotherapy patients (49.9% vs. 33.0% vs. 22.9%, respectively), live in an area with a median income of $63,000+ (36.9% vs. 30.2% vs. 28.4%, respectively), receive treatment at an academic center (43.3% vs. 34.5% vs. 32.8%, respectively), and have no comorbidities (72.9% vs. 66.9% vs. 61.1%, respectively). Statistically significant survival differences were indicated between all chemotherapy groups (all adjusted p < 0.05), such that patients receiving multi-agent chemotherapy had the longest survival followed by patients receiving single-agent chemotherapy and patients receiving no chemotherapy (median survival = 7.4, 4.9, and 1.4 months, respectively). A larger proportion of patients receiving multi-agent chemotherapy were alive at 6, 12, and 24 months relative to patients receiving single-agent or no chemotherapy. Conclusions: Our study is the largest to show the benefit of multi-agent chemotherapy over single-agent chemotherapy for stage IV pancreatic cancer, as well as analyze the demographics of patients receiving differing chemotherapy treatments. [Table: see text]

Real-world treatment patterns, survival, and cost among elderly cervical cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18226-e18226
Author(s):  
Changxia Shao ◽  
Jinghua He ◽  
Chizoba Nwankwo ◽  
Karen Stein ◽  
Stephen Michael Keefe
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Real World ◽  
Median Overall Survival ◽  
Stage Iv ◽  
Standard Of Care ◽  
Emergency Room Visits ◽  
Duration Of Treatment ◽  
Medicare Data ◽  
Systemic Therapies

e18226 Background: Limited chemotherapy data is available for elderly cervical cancer patients (pts). This study aimed to investigate real-world use of systemic therapies, survival, and costs among elderly pts in U.S. Methods: Pts who aged 65+ years and initially diagnosed with cervical cancer between 2007 and 2013 were identified using the SEER-Medicare data. Regimens were classified into 3 mutually-exclusive categories, i.e. cisplatin (Cis), carboplatin (Car), and Other based therapies. Chemotherapy within 90 days of surgery or radiation therapy were not considered as first line (1L) systemic therapy. All costs were converted to 2016 US dollars. Results: A total of 1 651 eligible pts were identified with 430 (26%) being stage IV at diagnosis. Among pts received systemic therapies, the median overall survival (OS) was 14 m from 1L initiation and 10 m from 2L initiation. Among 225 pts who received 1L, 58% pts received Cis-based therapy, and 17% pts received Car-based therapy. Car + paclitaxel was the most commonly used regimen (44%). Among 73 pts who received 2L, 34% and 15% pts received Cis- and Car-based therapy, respectively. Pts with 2L therapy received a variety of regimens with the top 3 being Car + paclitaxel (19%), gemcitabine (11%), and topotecan (9.6%). Median duration of treatment (DOT) was 4-6 m across line of therapies (LOTs), yet median time to next treatment (TTNT) ranged 10-32 m for 1L, and 9-11 m for 2L. The average per person per month (PPPM) costs were 7.1k for 1L and 8.8k for 2L with primary drivers of spending being outpatient and emergency room visits. Conclusions: Elderly pts with advanced cervical cancer requiring chemotherapy had poor prognosis and had no standard of care for 2L therapy. Per-patient economic burden is substantial for both 1L and 2L therapy, exceeding 7k dollars per month. [Table: see text]

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