Analysis Of SEER-Medicare Data Research Articles

Treatment Patterns, Clinical Outcomes, Health Care Resource Utilization and Costs in Older Patients With Metastatic Castration-Resistant Prostate Cancer in the United States: An Analysis of SEER-Medicare Data.

Prostate cancer (PC) is more likely to develop in men ≥65 years old than in those <65 years old. This study aimed to generate real-world evidence on treatment patterns, clinical outcomes, health care resource utilization (HCRU), and costs among older patients with metastatic castration-resistant PC (mCRPC). A claims algorithm based on treatments expected for mCRPC was used to identify men ≥65 years old with mCRPC in the SEER-Medicare data between 2007 and 2019. The index date was defined as the date of the start of first-line therapy (1L). Treatment patterns and all-cause and PC-specific HCRU and costs were measured in the 12 months preindex period and the postindex follow-up period. Time to next treatment or death (TNTD) and overall survival (OS) were assessed in the follow-up period. A total of 4758 patients met the eligibility criteria and received 1L treatment. Among these 1L patients, 57.4% subsequently received second-line (2L) treatment; among patients receiving 2L treatment, 49.3% subsequently received third-line (3L) treatment. Abiraterone, enzalutamide, and docetaxel were most common regimens in 1L (41.9%, 22.0%, 22.0%, respectively), 2L (33.3%, 32.7%, 13.6%, respectively), and 3L (17.9%, 25.1%, 22.3%, respectively). On average, patients had 1.2 inpatient admissions, 1.1 emergency room visits, and 27.6 outpatient visits per year during follow-up. The mean total all-cause and PC-related costs during the follow-up period were $111,060 and $99,540 per-patient-per-year, respectively. Median TNTD was 9.3, 6.5, and 5.7 months for 1L, 2L, and 3L, respectively. Median OS from the start of 1L treatment for mCRPC was 21.5 months. Among older patients with mCRPC, high attrition from 1L to subsequent lines of therapy was observed. Median TNTD was <1 year and median OS was <2 years. These results highlight a need to introduce more effective mCRPC therapies in 1L to improve clinical outcomes for older patients.

Partial Nephrectomy Drives the Association Between High-volume Centers and Decreased Mortality: A Surveillance, Epidemiology, and End Results-Medicare Analysis

To better understand the association between high-volume surgical kidney cancer centers and decreased mortality. To identify quality metrics that mediate this association. We designed a cohort of 14,044 patients who were diagnosed with kidney cancer between 2004 and 2013 and underwent a partial or radical nephrectomy using SEER-Medicare data. Hospitals were divided into quartiles based on their total nephrectomy volume for the study period. We investigated 6 quality metrics as potential mediators of the association between hospital volume and mortality using a mediation model. At the highest volume centers, survival was higher at 1-, 3-, 5-, and 10-year time intervals, respectively (91% vs 89%, 80% vs 76%, 70% vs 66%, 45% vs 38%, P<.001) compared to the lowest quartile nephrectomy centers. Receipt of partial nephrectomy for stage ≤T1a tumors explains 52.3% of the total association between hospital nephrectomy volume and mortality. Additionally, patients at the highest-volume centers were more likely to be younger (20% vs 26% 80≤ years old, P<.001), white (82% vs 78%, P<.001), reside in more densely populated counties (≥1 million residents, 62% vs 42%, P>.001), have a shorter mean length of stay (5.03 vs 5.88days, P<.001) when compared to those in the lowest-volume quartile. This analysis of SEER-Medicare data is the first to suggest that partial nephrectomy in the setting of T1a tumors mediates the association between hospital volume and mortality. Quality metrics that reduce mortality should be harnessed to develop more efficient and higher-quality health systems.

Disease-free survival (DFS) as a surrogate endpoint (SE) for overall survival (OS) in early-stage resected esophageal/gastroesophageal junction cancer (EC/GEJC): An analysis of SEER-Medicare data.

321 Background: OS is the gold standard efficacy measure in oncology; however, its need for prolonged follow-up motivates the establishment of SEs for earlier assessments of emerging treatments. We assessed DFS as a candidate SE for OS in early-stage EC/GEJC using data from Medicare beneficiaries with cancer in the SEER registry. Methods: Patients aged &gt; 65 years in the US with resective surgery after a primary diagnosis of stage 2 or 3 EC/GEJC between 2009-2017 were analyzed (N=925; median follow-up 26.2 months). Surrogacy was assessed via both individual-level association of DFS to OS, and via the association between the treatment effects on DFS and OS. Strength of individual-level association was measured via Spearman’s rank correlation (ρ) non-parametrically and Kendall’s τ using copula functions. The strength of correlation between the treatment effects on DFS and OS—measured by the coefficient of determination (R2) and the surrogate threshold effect (STE), which is the minimum DFS benefit that would translate into statistically significant OS benefit—was derived from a regression model predicting OS hazard ratio (HR) from DFS HR. Patients were classified in clusters based on treatments they received and baseline characteristics (age, sex, index year, staging, and race/ethnicity). Propensity score matching addressed imbalances in baseline characteristics between the treatment and control groups in the constructed clusters. Predictive accuracy of the surrogacy equation was assessed internally via leave-one-out cross-validation and externally via predictions made for 26 RCTs of early-stage EC/GEJC. Results: Patients were mostly male (84%), non-Hispanic white (89.3%), with median age of 71.8 years and almost evenly distributed between cancer stages 2 (50.4%) and 3 (49.6%). Among patients receiving adjuvant (23.6%) or neoadjuvant (82.8%) treatment, most (81.7% of adjuvant and 92.0% of neoadjuvant therapies) received multi-agent chemotherapy. Spearman’s ρ was estimated to be 0.76 (95% CI: 0.70, 0.89) whereas estimates for Kendall’s τ ranged between 0.62 and 0.79. Estimated R2 for the correlation between treatment effects was 0.92 (95% CI: 0.56, 1.00) and estimated from the surrogacy equation log(HROS) = 0.02 + 1.09 × log(HRDFS) with a corresponding STE of 0.86. The 95% prediction intervals generated from this equation contained the raw OS HRs for 91% of the clusters in the internal validation, and 89% of the RCTs in the external validation. Conclusions: Correlations between DFS and OS, and between the treatment effects on these endpoints, were both moderate. The highly accurate surrogacy equation between the treatment effects can enable earlier assessments of OS benefit from the DFS benefit for early-stage EC/GEJC treatments in the real-world setting.

EPR22-111: Outcomes and Utilization of Adjuvant Chemotherapy With and Without an Anthracycline in Node-Positive, Triple-Negative Breast Cancer: Analysis of SEER-Medicare Data

"EPR22-111: Outcomes and Utilization of Adjuvant Chemotherapy With and Without an Anthracycline in Node-Positive, Triple-Negative Breast Cancer: Analysis of SEER-Medicare Data" published on 31 Mar 2022 by National Comprehensive Cancer Network.

Opportunities for personalizing colorectal cancer care: an analysis of SEER-medicare data.

United States clinical practice guidelines for metastatic colorectal cancer recommend use of medications impacted by genetic variants but do not recommend testing. We analyzed real-world treatment using a cancer registry and claims dataset to explore pharmacogenomic (PGx) medication treatment patterns and characterize exposure. In a cohort of 6 957 patients, most (86.9%) were exposed to at least one chemotherapy medication with PGx guidelines. In a cohort of 2 223 patients with retail pharmacy claims available, most (79.2%) were treated with at least one non-chemotherapy (79.2%) medication with PGx guidelines. PGx-associated chemotherapy exposure was associated with age, race/ethnicity, educational attainment, and rurality. PGx-associated non-chemotherapy exposure was associated with medication use and comorbidities. The potential impact of PGx testing is large and policies aimed at increasing PGx testing at diagnosis may impact treatment decisions for patients with metastatic colorectal cancer as most patients are exposed to medications with pharmacogenomics implications during treatment.

Use of Bevacizumab for Elderly Patients With Stage IV Colon Cancer: Analysis of SEER-Medicare Data

BackgroundBevacizumab is used for the treatment of metastatic colon cancer in conjunction with first-line chemotherapy. In this study, we examined receipt of first-line bevacizumab and predictors of its use among older patients with stage IV colon cancer. Materials and MethodsWe used data from the Surveillance, Epidemiology, and End Results-Medicare dataset to identify patients with stage IV colon cancer diagnosed from 2005 to 2013 who received FOLFOX (5-fluorouracil/leucovorin/oxaliplatin) or FOLFIRI (5-fluorouracil/leucovorin/irinotecan) as first-line therapy. We used multivariable regression analysis to determine demographic and clinical factors associated with use of concomitant bevacizumab. ResultsWe identified 3785 patients with stage IV colon cancer who met our eligibility criteria. Of these, 2352 (62.1%) received bevacizumab. Bevacizumab use has decreased over time from 68.2% in 2005 to 57.6% in 2013 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91-0.97). Patients were less likely to receive bevacizumab if they were older (compared with 65-69 years, ≥ 80 years: OR, 0.64; 95% CI, 0.52-0.80), or had multiple comorbidities (compared with comorbidity score of 0, score of 1: OR, 0.73; 95% CI, 0.60-0.89). ConclusionOver one-half of elderly patients received bevacizumab as part of their first-line therapy for stage IV colon cancer. Bevacizumab use has been slowly decreasing since 2005. Newer anti-epidermal growth factor receptor treatments have not been supplanting bevacizumab, as first-line biologic use in general has also decreased during this time period.

FOLFOX and FOLFIRI Use in Stage IV Colon Cancer: Analysis of SEER-Medicare Data

BackgroundShortly after the year 2000, randomized trials demonstrated that patients with metastatic colon cancer treated with infusional 5-fluorouracil (5-FU)/leucovorin with either oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) had a comparable progression-free survival benefit, superior to patients who received 5-FU/leucovorin alone. Factors associated with the initial receipt of the FOLFOX or FOLFIRI regimen are unknown. Our goal was to investigate the patterns and predictors of use for first-line FOLFOX and FOLFIRI. Patients and MethodsWe used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data set to identify patients with newly diagnosed stage IV colon cancer between the years 2005 and 2013 who received either first-line FOLFOX or FOLFIRI. We used logistic regression to assess demographic and clinical predictors for FOLFOX versus FOLFIRI. Survival was compared by Kaplan-Meier models. ResultsOverall, 3000 patients (79.3%) received FOLFOX and 785 (20.7%) FOLFIRI. FOLFOX was associated with later year of diagnosis (odds ratio [OR] = 0.66, 95% confidence interval [CI], 0.54 to 0.82 for 2011-2013 vs. 2005-2007), being female (OR = 0.82; 95% CI 0.69 to 0.98), and living in the southern region of the United States. FOLFIRI was associated with having a higher comorbidity index (OR = 1.33; 95% CI, 1.07 to 1.67 for >1 comorbidity score vs. 0). There was no survival difference observed between the two treatments. ConclusionThe majority of SEER-Medicare patients received FOLFOX and not FOLFIRI as a first-line treatment for stage IV colon cancer. Several demographic and clinical factors were associated with the use of each specific regimen. No survival difference was detected for the 2 groups.

Incidence, patterns of treatment, and survival among men newly diagnosed with advanced prostate cancer: An analysis of SEER-Medicare data.

265 Background: About 5% of men are newly-diagnosed with advanced stage prostate cancer (PCa) and experience far poorer survival compared to men diagnosed with local or regionally-advanced disease. PCa mortality is higher in African Americans (AA) compared to non-Hispanic whites (NHW), with a marginally higher proportion of AA men first diagnosed with advanced disease. Thus, we sought to describe recent trends in incidence, survival and patterns of treatment among men diagnosed with de novo AJCC stage IV PCa. Methods: SEER*Stat software was used to calculate age-adjusted rates and annual percent changes for PCa stratified by AJCC stage and race/ethnicity for men age 66 or older diagnosed 2004-2014. We then used the Surveillance, Epidemiology and End Results database linked to Medicare Claims files to identify men diagnosed with advanced PCa during same time period. We examined patterns of treatment among all eligible patients and by race/ethnicity. Results: Rates for AJCC stage I-III PCa among elderly men have significantly declined in recent years for both NHW and AA men (-5.8% APC, p&lt;0.001 for both), while rates for AJCC stage IV increased for NHW men (+1.5% APC, p=0.011) and decreased for NHB men (-1.8% APC, p=0.008). Of the 8,828 eligible patients identified from the SEER-Medicare database, 13% were AA, with a median survival of 32 months among all patients and survival significantly poorer among AA (p &lt; 0.0001). AA patients were also more likely to go without treatment (p &lt; 0.0001) compared to NHW patients, even after accounting for early mortality and TNM stage. The frequency of nearly all forms of treatment was lower among AA patients with the exception of orchiectomy, which was significantly higher (10.1% vs. 6.1%), and among Medicare Part D enrollees, the progesterone Megace (24.6% vs. 15.0%). Conclusions: Results from this study of Medicare patients diagnosed with advanced stage PCa suggest less aggressive treatment may contribute to the poorer survival observed in AA men. Understanding drivers of treatment-related decisions are critical in reducing racial disparities in survival among men with advanced PCa.

Anti-dementia and anti-hyperlipidemic medication use at end of life in elderly lung cancer patients: Analysis of SEER-Medicare data.

10027 Background: Despite risk for polypharmacy, elderly cancer patients may receive drugs whose time to benefit likely exceeds life expectancy. This study aims to describe use of drugs considered potentially unnecessary, namely anti-hyperlipidemics and anti-dementia drugs, and to identify factors associated with their use in Stage 3 or 4 non-small cell lung cancer (NSCLC) patients approaching end of life. Methods: We identified all patients older than 65 diagnosed with primary Stage 3 or 4 NSCLC between 2006 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Information on drug prescriptions was extracted from Medicare Part D files. First-time hospice enrollment or death date was used as the final endpoint in analysis. The primary outcome was use of drugs of interest at 4 months before NSCLC diagnosis, 6 months and 3 months before death or hospice. Associations with demographic or other factors were tested using the Pearson χ2 test. Results: Of all 7983 patients, 45.1% were taking statins before diagnosis, while 40.7% and 30.9% were still taking statins at 6 and 3 months before death or hospice. Use of bile acid sequestrants, fibric acid derivatives, and cholesterol absorption inhibitors were found to decrease toward death or hospice. In contrast, anti-dementia drug use did not decrease, with 3.4% before diagnosis and 4.2% and 3.5% at 6 and 3 months before death or hospice. Approximately 30% of anti-dementia medications were newly prescribed at 6 and 3 months before study endpoint. Having a higher number of prescriptions at 3 months before death or hospice was associated with higher rates of drug use both before and after cancer diagnosis. Having a higher Charlson comorbidity index correlated with greater anti-dementia drug use before diagnosis. Demographic, socioeconomic, and treatment factors were not found to be correlated with drug use. Conclusions: A high prevalence of statin use persists while a notable proportion of anti-dementia drugs are newly prescribed toward death or hospice. Our findings suggest an opportunity for clinicians to re-evaluate risks and benefits of potentially unnecessary medications in elderly patients nearing end of life.

Linking Costs and Survival in the Treatment of Older Adults With Chronic Myeloid Leukemia: An Analysis of SEER-Medicare Data From 1995 to 2007.

The high prices of chronic myeloid leukemia (CML) therapy are well recognized, but less discussion has focused on the value of health care spending on the disease. This study examined whether the added costs have been "worth" the benefits among older adults with CML. We analyzed trends in health care costs and survival over time of 2164 CML patients over age 65 using the Surveillance, Epidemiology and End Results-Medicare-linked database. We estimated life expectancy over a 15-year duration after diagnosis using a Weibull survival model and projected the corresponding costs using a 2-part model, adjusting for patient characteristics. We estimated population-level survival, total health care costs, and incremental cost-effectiveness ratios (expressed as cost per life year gained) over the period of 1995-2007. We found that therapeutic improvements in the treatment of CML have been associated with survival gains among older adults. Mean life expectancy was 2.2 years in 1995 and increased to 4.2 years in 2007. During the same timeframe, CML care costs have increased, from $127,000 in 1995 to $278,000 in 2007 (2010 dollars), mostly due to increasing tyrosine kinase inhibitor costs. The aggregated incremental cost-effectiveness ratio was $74,000/life year gained. Our findings showed that, despite high costs, CML care may provide reasonable value for money among older patients between 1995-2007. Our study sheds light on the value of health care spending on CML by considering both the costs and the benefits. Future research should investigate strategies to improve treatment adherence to maximize the value of CML care.

Octreotide LAR (OCT-L) among elderly patients with stage IV neuroendocrine tumors (NETs): A survival analysis of SEER-Medicare data.

4112 Background: OCT-L is approved in the US for the management of secretory syndromes among patients with NETs. Two placebo-controlled studies have recently demonstrated that somatostatin analogue...

PCN56 - Excess Health Care Costs Among Elderly Breast Cancer Patients, by Receipt of Human Epidermal Growth Factor Receptor 2-Targeted Therapy: An Analysis of Seer-Medicare Data

PCN56 - Excess Health Care Costs Among Elderly Breast Cancer Patients, by Receipt of Human Epidermal Growth Factor Receptor 2-Targeted Therapy: An Analysis of Seer-Medicare Data

Do we know (or just believe) that partial nephrectomy leads to better survival than radical nephrectomy for renal cancer?

Partial nephrectomy (PN) has become the gold standard for treating small renal masses amenable to such an approach. Surprisingly, the single randomized controlled trial of PN versus radical nephrectomy (RN) indicated an overall survival benefit for RN over PN. Recent studies have shed light on this discordance, and this review will attempt to discern what is known at present. Multiple retrospective observational studies have demonstrated superior outcomes with PN compared with RN. Whether the observed survival benefit with PN is the result of renal functional advantages or the result of selection bias and other unmeasured variables is up for discussion. A meta-analysis of 21 studies including the EORTC 30904 found a 19 % reduction in all-cause mortality (p = 0.0001) and 29 % reduction in cancer-specific mortality (p = 0.0002) with PN versus RN. Recent analysis of SEER-Medicare data revealed that patients undergoing RN had similar survival when compared with non-cancer controls, further supporting concerns about selection biases in prior observational series. Although PN is clearly of benefit for those likely to experience end-stage renal disease with RN, a survival benefit with PN in the elective setting is not proven at present. While experts may still believe PN to improve survival for these patients, the only level I evidence in the field would suggest otherwise, and selection bias is undoubtedly responsible for a significant part of the improved survival observed in retrospective studies. Given recent evidence, any further push to limit the role of RN should be tempered until we know PN is indeed superior.

Adjuvant Chemotherapy for Stage II Right-Sided and Left-Sided Colon Cancer: Analysis of SEER-Medicare Data

Survival benefit from adjuvant chemotherapy is established for stage III colon cancer; however, uncertainty exists for stage II patients. Tumor heterogeneity, specifically microsatellite instability (MSI), which is more common in right-sided cancers, may be the reason for this observation. We examined the relationship between adjuvant chemotherapy and overall 5-year mortality for stage II colon cancer by location (right- vs left-side) as a surrogate for MSI. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified Medicare beneficiaries from 1992 to 2005 with AJCC stage II (n=23,578) and III (n=17,148) primary adenocarcinoma of the colon who underwent surgery for curative intent. Overall 5-year mortality was examined with Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. It was found that 18% of stage II patients (n=2941) with right-sided cancer and 22% (n=1693) with left-sided cancer received adjuvant chemotherapy. After adjustment, overall 5-year survival benefit from chemotherapy was observed only for stage III patients (right-sided: hazard ratio [HR], 0.64; 95% CI, 0.59-0.68; p<.001 and left-sided: HR, 0.61; 95% CI, 0.56-0.68; p<.001). No survival benefit was observed for stage II patients with either right-sided (HR, 0.97; 95% CI, 0.87-1.09; p=.64) or left-sided cancer (HR, 0.97; 95% CI, 0.84-1.12; p=.68). Among Medicare patients with stage II colon cancer, a substantial number receive adjuvant chemotherapy. Adjuvant chemotherapy did not improve overall 5-year survival for either right- or left-sided colon cancers. Our results reinforce existing guidelines and should be considered in treatment algorithms for older adults with stage II colon cancer.

Capsule Commentary on Shahinian et al.: Patterns of Bone Mineral Density Testing in Men Receiving Androgen Deprivation for Prostate Cancer

This analysis of SEER-Medicare data by Shahinian and Kuo compared bone mineral density (BMD) testing in prostate cancer survivors on androgen deprivation therapy (ADT) to prostate cancer survivors who were not receiving ADT.1 BMD testing in the men on ADT increased from less than 1% in 1996 to 11.5% in 2008. While BMD testing increased in the prostate cancer survivors not on ADT, it occurred at a much lower rate, increasing from less than 1% to 4.4%. This increase in BMD testing is not surprising and is clinically appropriate given that ADT use is associated with an increased risk of osteoporosis and fractures. The authors also show that patients who were cared for by a urologist alone were significantly less likely to undergo BMD testing than those cared for by both a urologist and a primary care physician (PCP). Given what we know about the bony side effects of ADT, why isn’t BMD testing more common? I believe that the answer lies not in the specialty of the treating physician but in the clinical uncertainty of what to do with the results of BMD testing when ordered. Obviously, if the test finds that the patient is osteoporotic, some type of treatment should be initiated, but should this be an oral alendronate, intravenous zoledronic acid or subcutaneous denosumab, all of which have been shown to be effective in preventing further bone loss?2–4 Furthermore, if BMD testing shows osteopenia or is normal, should one of these agents be used for prevention? The National Comprehensive Cancer Network (NCCN) guidelines on the treatment of prostate cancer suggest initiating treatment in patients at certain increased levels of fracture risk, based upon the FRAX nomogram from the World Health Organization.5 The guidelines, however, do not provide guidance on the frequency of BMD testing and are based primarily on expert opinion. Acknowledging these limitations, these guidelines still provide useful information for clinicians, and, as such, urologists and PCPs need to be more aware of bone health in prostate cancer survivors on ADT and perform BMD testing more often.

Longitudinal trends in costs for palliative radiation for metastatic prostate cancer.

6554 Background: Prostate cancer is a leading contributor to cancer health care costs, with end of life care composing a substantial portion of overall costs. In recent years, palliative treatment of metastases has been characterized by the use of more complex radiation planning and delivery systems. However, little is known about how costs of palliative radiation treatment in patients with metastatic prostate cancer have changed over this period. Methods: Retrospective analysis of SEER-Medicare data of men aged 66 and older who died from metastatic prostate cancer between 2000 and 2007. Inclusion criteria included all fee-for-service beneficiaries treated with radiation therapy for bony metastases in the last year of life. Direct costs were obtained by summing Medicare carrier and outpatient facility payments for all radiation treatment claims following an initial radiation treatment claim for bony metastases and adjusted to 2008 dollars using Consumer Price Indexes for medical care. Results: A total of 1,705 men met study inclusion criteria. Median age at diagnosis was 74, median time from diagnosis to death was 47 months, and 37% of men had distant metastatic disease at the time of diagnosis. Total Medicare payments for radiation therapy for bony metastases increased from an average of $2,763 to $3,989 for men who died from prostate cancer in 2000 vs. 2007. Outpatient facility claims for radiation therapy increased relative to carrier claims, composing 48% ($1,316) and 57% ($2,276) of all radiation treatment Medicare payments in 2000 vs. 2007 (All P &lt; 0.001). Conclusions: Between 2000 and 2007, average Medicare payments for palliative radiation therapy for bony prostate cancer metastases increased by roughly a third. The majority of increased costs were observed within outpatient facility claims, suggesting a shift in the administration of palliative radiation therapy from free-standing clinics to hospital-based outpatient facilities. Changes in end of life palliative radiation therapy for men with prostate cancer may impact future increases in Medicare health care expenditures.

Mo1132 Adjuvant Chemotherapy for Stage II Right- and Left-Sided Colon Cancer: Analysis of SEER-Medicare Data

Mo1132 Adjuvant Chemotherapy for Stage II Right- and Left-Sided Colon Cancer: Analysis of SEER-Medicare Data

Mortality Differs by Stage for Right- vs Left-Sided Colon Cancer: Analysis of SEER-Medicare Data

G A A b st ra ct s (95% CI: 15.3-16.5) in 1993-1997 to 18.3 (95%CI: 17.8-18.9) in 2003-2007. On the other hand, a 32% decrease was observed in ages >50 from 120.0 (95% CI: 119.1-121.8) in 1993-1997 to 90.6 (95% CI: 89.6-91.7) in 2003-2007. Hispanic men had 27% higher CRC rates than Hispanic women, but the age and time trends were similar for men and women. The overall stage distribution was 33% localized, 42% regional, and 25% distant in ages 50. Over time, the proportion of cases with regional and distant disease increased by 37% and 18% in ages 50. The Poisson regression model confirmed the increasing CRC incidence in younger Hispanics during 1993-2007. The 1-year observed and relative survival “improved” in all ages from approximately 86% to 90%, however no significant improvement in 5-year observed or relative survival was observed in patients <50 years. CONCLUSION: The incidence of CRC in Hispanics <50 years is rapidly increasing in the United States. This increase has affected both men and women, many of which are diagnosed with regional or distant disease. Unlike older patients, long-term survival has not improved in younger age groups. This finding may have implications on CRC screening guidelines.

Visit and treatment patterns over time among elderly patients (pts) with M1 prostate cancer (PC): An analysis using SEER-Medicare

5170 Background: Treatment options for the management of pts diagnosed with M1 PC have evolved over time. It is unknown whether visits to medical oncologists/hematologist oncologists (MOH) and treatment patterns are also changing over time. The objective of this study is to examine changes in visit and treatment patterns over time. Methods: A retrospective analysis of SEER Medicare data included pts diagnosed with M1 PC from 1994–2002 (age &gt; 65 years) and residing in SEER registries that were present for the entire period. The study included pts with a post-diagnosis visit to a urologist; pts who saw a MOH prior to the urologist visit were excluded. Pts were grouped as 1) no MOH visit, 2) MOH visit w/in 3 mos of a urologist visit, 3) MOH visit =&gt; 3 mos after a urologist visit. Treatment with hormone therapy or chemotherapy was defined as 1) none received; 2) timely (i.e. within 6 mos of diagnosis); and 3) delayed, i.e. =&gt; 6 mos following the diagnosis. Time periods were defined as early (1994–1996), middle (1997–1999) and late (2000–2002). Results: 3,269 pts (mean age 77, 81% white) were available for analysis. Ninety-three percent of pts received treatment. Thirty-eight percent of pts saw a MOH during the study period; over the study period (early; middle; late) 13% (10%; 13%; 17%) of pts had a timely visit to the MOH and 25% (24%; 28%; 25%) had a delayed visit to the MOH. The proportion of patients seeing a MOH increased (34%; 41%; 42%, p &lt; 0.001) and the proportion of treated pts increased (93%; 93%; 95%, p = 0.03) over the early, middle, and late periods. Conclusions: Approximately one-third of patients with M1 disease and a post-diagnosis urologist visit also see a medical oncologist. The vast majority of these patients receive treatment. Over time, a larger proportion of patients are seeing medical oncologists. [Table: see text]

Total societal costs attributable to the prevention of recurrent HER2+ breast cancer.

Abstract Abstract #6101 Introduction: Adjuvant therapies are available to prevent breast cancer recurrence that may reduce morbidity and mortality. However, the associated savings to society have not been quantified, particularly for HER2+ patients. Methods: We reviewed the literature (PubMed) to estimate the costs attributable to breast cancer recurrence including direct (medical and non-medical) and indirect (loss income, productivity, informal care) costs. The following sources were used to estimate the recurrence cost. The 10-year average direct medical costs of recurrence were obtained from an analysis of SEER-Medicare data (Stokes 2008). This study compared women with recurrence to similar women without recurrence and accounts for differential costs associated with survival (ie, it did not estimate only the cost of treating recurrent cancer). In the initial year after cancer diagnosis, women required an additional 66 hours of personal time to obtain medical services (Yabroff 2007). After recurrence, an excess of 9% of patients would leave the work force if they were aged 50-64 (Lidgren 2007). Women were found to take an additional 8.5 months away from work during the 3 years following a recurrence compared with those without recurrence (Drolet 2005). The intensity of informal care was similar (0.8 hour/week) in the first year after recurrence as it was for women without recurrence (Lidgren 2007). The valuation of utilization was conducted from a societal perspective and costs reported as 2008 US dollars. Because certain costs were relevant to specific ages, we estimated costs in 3 age cohorts (30-49, 50-69, and ≥70). Lost income from early retirement was calculated as the number of years retired from work before the age 65 times the annual average income derived using the national average wage and benefit data. Patient time required for receiving care, time absent from work, and caregiver time were also valued in the same way. We combined this information into a simulation used to estimate the number of HER2+ women diagnosed in one calendar year in the United States, and whose recurrence could be prevented with trastuzumab. The model accounted for variability of clinical and economic inputs by sampling from distributions using 5,000 replications. The mean costs per person and the middle 95% of the distribution were reported. Results: For ages 50-69, early retirement costs were $39,600. Costs due to work absences were $41,600 (age 30-49) and were $31,200 (age 50-69). The total societal costs attributable to a single recurrence were $60,400 ($32,000 to $129,000) for ages 30-49, $89,600 ($45,000 to $203,000) for ages 50-69, and $18,900 ($13,000 to $25,000) for ages ≥70. Overall, the savings from preventing recurrence with trastuzumab were estimated at over $167 million ($70 million to $385 million) per year of diagnosed cases of HER2+ tumors. Conclusion: Therapies that can prevent breast cancer recurrence can lead to substantial savings to society and represent a considerable opportunity cost. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6101.