Value assessment in oncology drugs: funding of drugs for metastatic breast cancer in Canada

Background Life expectancy for women with metastatic breast cancer has improved since the early 2000s, in part because of the introduction of novel therapies, including chemotherapy, hormonal therapy, and targeted agents. However, those treatments can come at a cost for the patient (short- and long-term toxicities from treatment) and at a financial cost for the health care system. Given the increase in the number of costly anticancer agents being introduced into the clinical setting, the American Society of Clinical Oncology (asco) and the European Society for Medical Oncology (esmo) have developed a system to quantify the value of new cancer treatments in terms of benefit, toxicities, and costs.MethodsIn our value-assessment analysis, we included drugs that were funded in Canada between 2012 and 2017 for metastatic breast cancer. We reviewed the clinical benefit of those agents (survival, progression, quality of life), their costs, their value according to the asco and esmo value frameworks, and their assessments from the pan- Canadian Oncology Drug Review [pcodr (in Canada, except Quebec)] and the Institut national d’excellence en santé et en services sociaux [iness (in Quebec)].Results Drugs funded in Canada showed variation in their asco net health benefit scores and esmo magnitude of clinical benefit scores, but all had a cost-effectiveness ratio greater than $100,000 per quality-adjusted life–year. The strength and magnitude of the clinical benefit (for example, overall survival benefit vs. progression-free survival benefit) was not necessarily associated with a higher value score.Conclusions Although great progress has been made in developing value frameworks, use of those frameworks has to be refined to help patients and health care providers make informed decisions about the benefit of novel cancer therapies and to help policymakers make decisions about the societal benefit of funding those therapies.

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Assessment of Clinical and Psychological Needs of Patients With Metastatic Breast Cancer: Challenges and Gaps in Meeting Their Needs in Uganda

Journal of Global Oncology ◽

10.1200/jgo.18.10120 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 11s-11s

Author(s):

Henry Ddungu ◽

Edward Kumaketch ◽

Eva Namisango

Keyword(s):

Breast Cancer ◽

Health Care ◽

Metastatic Breast Cancer ◽

Supportive Care ◽

Family Caregivers ◽

Metastatic Breast ◽

Psychological Needs ◽

Cost Of Care ◽

Care Providers ◽

Care Services

Purpose Uganda has one of the highest age-standardized incidence rates for breast cancer (38.3/100,000) occurring among women age 35 to 45 years. The disease is associated with increased biomedical and psychological demands on affected women and their families. Clinical and supportive care services are offered to patients with metastatic breast cancer (MBC) to meet their needs and improve survival and quality of life. However, the existence of challenges and barriers to health care access affect the satisfaction of the needs of patients with MBC and imply that available services cannot meet every clinical and psychological need these patients. No previous assessment has been done in Uganda of the clinical and psychological needs of patients with MBC. The aim of the current study was to generate data that can be used to increase awareness of the unmet clinical and psychological needs of patients with MBC and their families to inform advocacy strategies for supportive care services in Uganda. Methods We conducted interviews, in-depth interviews, focus group discussions, and document review. Results Patients with MBC (n = 67), survivors (n = 185), clinical providers (n = 24), family (n = 134), and VHT (n = 12) participated in this work. The patient’s most important needs include physical and daily living needs (relieving pain, 85.69%; nutrition and diet, 83.69%; wound management, 80.69%; help when tired, 74.6%; help with house cores, 73.19%); health system, information, and patient support (treatment with dignity, 86.6%; pleasant environment, 83.6%; sensitivity to feelings, 80.6%; counseling, 79.1%; choice of cancer specialists, 77.6%; treatment plan, 76.1%; respect for a patient’s opinion, 74.6%); and psychological (close family concerns, 79.1%; advice on faith, 79.6%; comforting when sad, 74.6%; positive outlook, 73.3%; how to disclose, 71.6%). Long waiting times, out-of-stock medicines, inadequate hospital amenities, family exclusion during patient review conversations, caregiver burnout, cost of care, limited funding, and spiritual, legal, and human resource shortages were needs and challenges identified by survivors, family caregivers, clinical providers, and policymakers. Polices on supportive care for patients with MBC are also unclear. Conclusion There exists a mismatch between patients with MBC, survivors, and health care providers with regard to knowledge of some of the needs of patients with MBC, particularly clinical-related information needs. Dialogue between patients with MBC, survivors, family caregivers, clinical providers, and VHTs is recommended to harmonize knowledge and perceptions of the needs of patients with MBC. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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Experiences of Patients Diagnosed and Living With Metastatic Breast Cancer in Kumasi, Ghana: A Lesion to Learn From Low-Middle Income Country

Journal of Global Oncology ◽

10.1200/jgo.18.40600 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 8s-8s

Author(s):

C. Asoogo ◽

M. Hoyte-Williams ◽

B. Dwobeng ◽

D. Sam ◽

E. Amankwa-Frimpong

Keyword(s):

Breast Cancer ◽

Health Care ◽

Metastatic Breast Cancer ◽

Cancer Patients ◽

Support Groups ◽

Metastatic Breast ◽

Care Providers ◽

Breast Cancer Patients ◽

Financial Changes ◽

Fear And Anxiety

Background: Breast cancer is a leading cause of death among women in Ghana. About 50% of cases seen at the oncology directorate are breast cancer-related, and 85% of these cases present in advanced stage with very poor prognosis and high mortality. Objectives: To explore and describe the experiences of patients diagnosed and living with metastatic breast cancer. Methods: A cross sectional descriptive study design was used to involved breast cancer patients at Komfo Anokye Teaching Hospital who comes from various social and ethnic groups as well as geographically distinct areas from the vast territory of the Ashanti region and the Northern part of Ghana. Convenient sampling was used to select 120 participants for the study using semistructured questionnaire. Data of their social and demographic background and experiences living with metastatic breast cancer were obtained after seeking informed consent. Results: The study revealed that 12% of participants diagnosed and living with metastatic breast cancer experience loneliness and devastated, 22% experience fear and anxiety, while 35% experience stigma from both family and the society. Moreover, feeling of anger and hopelessness also account for 15%, 11% experience financial changes, while 5% of participants experience both physical and emotional pain with their diagnosis and treatment. Recommendations were made for policy makers, health care professionals, and other researchers. These include the need for intensified metastatic breast cancer awareness campaigns, educating health care providers on the need for professional counseling on metastatic breast cancer and the need to organized support groups, so that patients could contact each other. Emphasis should be placed on training of nurses to deal with issues relating to metastatic breast cancer. Conclusion: Generally, fear and anxiety, stigma, feeling of loneliness, devastated, anger and hopelessness, emotional and physical pain and financial changes are the variables that explain the experiences of women diagnosed and living with metastatic breast cancer. Some support groups has shown an improvement, therefore efforts to raise public awareness of metastatic breast cancer should be continued. The current study became imperative to fill this identified gap and improve health interventions and health outcomes for metastatic breast cancer patients in future.

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Patient and provider education on HER2-positive metastatic breast cancer: Defining gaps in clinician practice, patient behaviors, patient-provider alignment, and clinical knowledge.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e23007 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e23007-e23007

Author(s):

Wendy Turell ◽

Tariqa Ackbarali

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Clinical Practice ◽

Health Care Providers ◽

Metastatic Breast ◽

Lessons Learned ◽

Care Providers ◽

Provider Education ◽

Her2 Positive ◽

Cancer Management

e23007 Background: Current breast cancer management is driven by inherent heterogeneity of disease. Therapeutic options for later lines of HER2 therapy have expanded, shifting practice patterns to incorporate the latest evidence and guidelines. Health care providers (HCPs) require education to synthesize new evidence in the context of clinical practice including three approved HER2-directed therapies between December 2019 and April 2020. Concurrent patient and caregiver education is imperative to improve collaborative treatment decisions for HER2+ metastatic breast cancer (MBC). Methods: Two, 1-hour online video-based programs were hosted in June, 2020 for HCPs and patients/caregivers, respectively. Practice and knowledge gaps among HCPs, and knowledge, communication and self-efficacy behaviors among patients were assessed. Each activity was interactive, consisting of slides, polling and live questions, and both remain on-demand (and on social media for patients/caregivers) for 12 months. Assessments were administered at 3 time points (pre-, immediate post-, and 2 mos. post-activity). Data from these questions, responses to live polling questions, and learner-submitted questions during live Q&A were analyzed to determine engagement, lessons learned, and continuing education gaps. Results: As of February 2021, 525 HCPs and 9,582 patients (9,449 Facebook Video; 133 CancerCoachLive.com) participated in the ongoing activities. Post education, HCP learners anticipated the education would positively impact practice behavior (77%) and patient clinical outcomes (73%). HCP improvements in pre/post knowledge and competence questions were realized in 3/4 of the questions. Of patients/caregivers, 34% more learners reported confidence in managing their condition post vs. pre-education. They listed “affording therapy” and “understanding treatment options” as their greatest challenges, and reported “self-care strategies” as their most sought information during the COVID-19 pandemic. At 2-mos. follow-up, 83% of patients reported improvements in communication with their HCPs, and 77% of HCPs reported improvements in their clinical practice. Updated data will be shared, including aligned HCP and patient questions pertaining to care challenges and communication goals. Conclusions: CME and patient education can yield gains in clinical practice behaviors, patient healthcare communication and confidence, and treatment knowledge of HER2-postive breast cancer. Together, aligned education directed to HCPs and patients can improve the ability to provide evidence-based treatment for patients.

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What Do We Mean When We Ask for More Metastatic Breast Cancer Research?

Archives of Breast Cancer ◽

10.32768/abc.202183243-246 ◽

2021 ◽

pp. 243-246

Author(s):

Kimberly Badovinac ◽

Heather Douglas ◽

Catherine Hays

Keyword(s):

Breast Cancer ◽

Cancer Research ◽

Metastatic Breast Cancer ◽

Health Care Providers ◽

Metastatic Breast ◽

Breast Cancer Research ◽

Research Progress ◽

Care Providers ◽

Optimal Sequence ◽

Research Investment

Background: Almost all deaths from breast cancer are due to metastasis. People living with metastatic breast cancer (MBC) and their loved ones have been concerned about the lack of research progress. The purposes of this paper were to analyze breast cancer research spending in Canada, and to evaluate whether MBC research was aligned with patient priorities. The results from the MBC Priority Setting Partnership (MBC PSP) were used as an approximation of patient priorities. Methods: The data source was the Canadian Cancer Research Survey. MBC projects were identified and mapped to the patient priorities.Results: This analysis found that 18% of breast cancer research investment was directed to MBC, with a large proportion of this research investment focused on the biology of metastasis. Four of the top 10 MBC PSP priorities had not been addressed: optimal sequence of therapy, role of continuous versus intermittent treatment, benefits of early palliative care, and best methods for patient education. Conclusion: These figures provide a baseline from which any increases in MBC research and improved alignment to patient priorities can be measured. A cooperative effort by funders, researchers, patients, caregivers, and health care providers is needed to address research gaps.

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Single arm, phase two study of low-dose metronomic eribulin in metastatic breast cancer

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06175-x ◽

2021 ◽

Author(s):

Pavani Chalasani ◽

Kiah Farr ◽

Vicky Wu ◽

Isaac Jenkins ◽

Alex Liu ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Metastatic Breast Cancer ◽

Peripheral Neuropathy ◽

Clinical Benefit ◽

Low Dose ◽

Response Rate ◽

Metastatic Breast ◽

Progression Free Survival ◽

Free Survival

Abstract Background Treatment options for metastatic breast cancer (MBC) refractory to anthracyclines and taxanes are limited. In a phase III trial, eribulin demonstrated a significant improvement in overall survival compared to treatment of physician’s choice, but had limited tolerability because of neutropenia and peripheral neuropathy. Based on prior studies of alternative treatment schedules with other therapies, we hypothesized that a low-dose metronomic schedule of eribulin would permit patients to remain on treatment more consistently without treatment delays, resulting in longer time to progression, and improved toxicity profile. Methods We conducted a multi-site single arm, phase II trial patients with MBC. All patients were treated with metronomic eribulin (0.9 mg/m2 administered intravenously on days 1, 8, and 15 of a 28-day cycle.) Treatment was continued until the patient developed disease progression, unacceptable toxicity, or chose to stop the study. Patients must have had prior taxane exposure. The primary endpoint was progression-free survival. Secondary end points were overall survival, response rate, and clinical benefit rate. Exploratory biomarkers were performed to analyze change in levels of circulating endothelial cells (CECs), circulating endothelial precursors, and carbonic anhydrase IX (CAIX) with response to therapy. Findings We consented 86 patients and 59 were evaluable for final analysis. Median age was 59 years; 78% had HER2 negative tumors. The median progression-free survival (PFS) was 3.5 months with overall survival (OS) of 14.3 months. Objective response rate was 15% with clinical benefit rate of 48%. Reported grade 3 neutropenia and peripheral neuropathy were 18% and 5%, respectively. Treatment discontinuation due to toxicity was seen in 3% of patients. Interpretation Metronomic weekly low-dose eribulin is an active and tolerable regimen with significantly less myelosuppression, alopecia, and peripheral neuropathy than is seen with the approved dose and schedule, allowing longer duration of use and disease control, with similar outcomes compared to the standard dose regimen.

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