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]

Real-world treatment patterns, survival, and cost among elderly patients with small-cell lung cancer (SCLC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20647-e20647
Author(s):  
Changxia Shao ◽  
Jinghua He ◽  
Sumesh Kachroo ◽  
Fan Jin
Keyword(s):  
Real World ◽  
Stage Iv ◽  
Small Cell Lung ◽  
First Line ◽  
Duration Of Treatment ◽  
Medicare Data ◽  
Kaplan Meier ◽  
Medical Need ◽  
Systemic Therapies

e20647 Background: Given a dearth of literature, this study aimed to investigate real-world use of systemic therapies, survival, and costs among elderly SCLC patients (pts) in U.S. Methods: Pts (65+ years old) with an initial diagnosis of SCLC during 2007-2013 were identified using the SEER-Medicare data. Overall survival (OS), duration of treatment (DOT) and time to next treatment (TTNT) were estimated based on the Kaplan-Meier method. Costs (2016 US dollars) were derived from Medicare claims. Results: A total of 11 812 pts were identified with 7 797 (66%) being stage IV at diagnosis. During an average of 10 months (m) follow-up post diagnosis, 6 509 (55%), 2 238 (19%) and 679 (6%) received first line (1L), 2L and 3L therapy, respectively. The median OS was 9 m from 1L start and 6 m from 2L or 3L start, suggesting existing treatment providing limited survival benefit. Majority pts (93%) received platinum-based therapy for 1L with Car + etoposide (Eto, 59%) being the most commonly used regimen, followed by Cis + Eto (18%) and Car monotherapy (8%). Car + Eto, Top and Pac were the top 3 regimens used in 2L and 3L. Median DOTs were 4-6 m, yet TTNT ranged from 7 to 18 m across lines of therapy. The average per person per month (PPPM) costs were $9.4k for 1L, $8.9k for 2L, and $8.8k for 3L. Conclusions: Advanced SCLC remains an aggressive malignancy with poor prognosis, lack of ideal therapy and high medical cost, which highlighted high unmet medical need of SCLC among elderly pts. [Table: see text]

Special Focus on Stage IV Cervical Cancer Patients: A Decade Experience

Oncology ◽  
2019 ◽  
Vol 97 (3) ◽  
pp. 125-134
Author(s):  
Sophie Espenel ◽  
Max Adrien Garcia ◽  
Julien Langrand-Escure ◽  
Alexis Vallard ◽  
Jane Chloé Trone ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
Special Focus

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.

Determinants of spending for metastatic breast, lung, and colorectal cancer in SEER-Medicare.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6621-6621
Author(s):  
Michael J. Hassett ◽  
Matthew P. Banegas ◽  
Hajime Uno ◽  
Shicheng Weng ◽  
Angel M. Cronin ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Recurrent Disease ◽  
Metastatic Cancer ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Cancer Type ◽  
Recurrent Cancer ◽  
Medicare Data ◽  
Episode Of Care ◽  
Spending Patterns

6621 Background: A substantial proportion of cancer spending is directed towards patients with metastatic disease. Past efforts to characterize spending for metastatic cancer have been limited, because they have not included patients with recurrent disease or analyzed spending across the entire episode of care. Spending for stage IV and recurrent metastatic cancer patients may differ. Methods: Using SEER-Medicare data from 2008-13, we identified breast (BC), colorectal (CRC), and lung (LC) cancer patients who were continuously enrolled in parts A, B and D, and had either stage IV or recurrent disease (i.e., return of cancer after resection of stage I-III disease). Mean total Medicare spending/patient per month and per year (2012$US) were estimated from 12 months prior to 12 months after diagnosis, and described for relevant patient sub-groups. Results: In a cohort of 27,847 patients, total spending for stage IV vs. recurrent cancer was 61-73% lower in the year before diagnosis ($11,339 vs. $28,796 for BC; $13,359 and $49,804 for CRC; $15,118 and $49,555 for LC), and 28-88% higher in the year after diagnosis ($68,787 and $42,091 for BC; $111,304 and $58,657 for CRC; $92,181 and $72,354 for LC). When considering the 2 year-period spanning the diagnosis, spending was similar (≤14%) between groups. The primary drivers of spending differences between patients with stage IV and recurrent disease were cancer type and time from diagnosis (Table). Younger age, higher comorbidity, and SEER region were also drivers of higher spending, especially after diagnosis. Conclusions: Spending patterns differ for patients with stage IV vs. recurrent cancer, suggesting different patterns of care that warrant further investigation. Spending differences after diagnosis were driven largely by part B spending, which was due in part to differential chemotherapy use. [Table: see text]

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