Patterns Of Cancer Care Research Articles

In the patient’s shoes: The impact of hospital proximity and volume on stage I endometrial cancer care patterns and outcomes

ObjectiveTo compare the impact of travel burden and hospital volume on care patterns and outcomes in stage I endometrial cancer. MethodsThis retrospective cohort study identified patients from the National Cancer Database with stage I epithelial endometrial carcinoma who underwent hysterectomy between 2012 and 2020. Patients were categorized into: lowest quartiles of travel distance and hospital surgical volume for endometrial cancer (Local) and highest quartiles of distance and volume (Travel). Primary outcome was overall survival. Secondary outcomes were surgery route, lymph node (LN) assessment method, length of stay (LOS), 30-day readmission, and 30- and 90-day mortality. Results were stratified by tumor recurrence risk. Outcomes were compared using propensity-score matching. Propensity-adjusted survival was evaluated using Kaplan-Meier curves and compared using log-rank tests. Cox models estimated hazard ratios for death. Sensitivity analysis using modified Poisson regressions was performed. ResultsAmong 36,514 patients, 51.4% were Local and 48.6% Travel. The two cohorts differed significantly in demographics and clinicopathologic characteristics. Upon propensity-score matching (p < 0.05 for all), more Travel patients underwent minimally invasive surgery (88.1%vs79.1%) with fewer conversions to laparotomy (2.0%vs2.6%), more sentinel (20.5%vs11.3%) and fewer traditional LN assessments (58.1vs61.7%) versus Local. Travel patients had longer intervals to surgery (≥30 days:56.7%vs50.1%) but shorter LOS (<2 days:76.9%vs59.8%), fewer readmissions (1.9%vs2.7%%), and comparable 30- and 90-day mortality. OS and HR for death remained comparable between the matched groups. ConclusionsCompared to surgery in nearby low-volume hospitals, patients with stage I epithelial endometrial cancer who travelled longer distances to high-volume centers experienced more favorable short-term outcomes and care patterns with comparable long-term survival.

Urban-Rural Differences in Receipt of Cancer Surgery at High-Volume Hospitals and Sensitivity to Hospital Volume Thresholds.

Methods for identifying high-volume hospitals affect conclusions about rural cancer care access.

Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.

To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. We used data from the New Jersey State Cancer Registry from 2012 to 2014. We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care. We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61). Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.

Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data.

Although strengthening coverage has improved cancer care, there are concerns related to medical distortion. Previous studies have only examined whether patients visit a specific hospital, and not the continuum of patients with cancer, resulting in a lack of evidence in South Korea. This study aimed to investigate the patterns in hospital type for cancer care and analyze their association with outcomes. The data for this study were obtained from the National Health Insurance Services Sampled Cohort database. This study included patients with four types of cancer (top four cancer incidence in 2020): gastric (3353), colorectal (2915), lung (1351), and thyroid (5158) cancer. The latent class mixed model was used to investigate cancer care patterns, and multiple regression or survival analysis was performed to examine medical cost, length of stay (LOS), and mortality. The patterns in each cancer type were classified into two to four classes, namely, mainly visited clinics or hospitals, mainly visited general hospitals, mainly visited tertiary hospitals (MT), and tertiary to general hospitals through trajectory modeling based on the utilization of cancer care. Compared to the MT pattern, other patterns were generally associated with higher cost, LOS, and mortality. The patterns found in this study may be a more realistic way of defining patients with cancer in South Korea compared to previous studies, and its association-related outcomes may be used as a basis to address problems in the healthcare system and prepare alternatives for patients with cancer. Future studies should review cancer care patterns related to other factors such as regional distribution.

Abstract PR004: Urban/rural differences in receiving cancer surgery at high-volume hospitals and sensitivity to hospital volume thresholds

Abstract Research Objective: There is strong evidence that hospital volume is associated with improved outcomes for patients undergoing surgery for cancer across a number of common cancers, yet there is no consensus on how to classify hospitals as high-volume. Further, lack of access to high-volume hospitals (HVHs) may contribute to rural-urban disparities in cancer outcomes. This study examines urban/rural differences in receipt of cancer surgery at HVHs and sensitivity to volume thresholds used. Study Design: We used logistic regression models to examine the association between cancer surgery at a HVH and individual and area factors using different volume thresholds that are commonly used in the literature: top 10%, 20%, 25%, and 30%. Population Studied: Using 2017-2020 statewide Pennsylvania Health Care Cost Containment Council (PHC4) inpatient data, we identified patients ages 18+ with a diagnosis of 10 cancers (lung, pancreas, breast, brain, rectum, bladder, colon, esophagus, prostate, stomach) who underwent a cancer-related surgery. Principal Findings: We found variability in the number of hospitals classified as high-volume as well as the percentage of surgeries performed at HVH. Across the 10 cancers examined, the relationship between rural residence and treatment in a HVH varied by cancer type, and for some cancers, varied depending on the volume threshold used. There was a consistent negative relationship between rural residence and surgery at a high-volume hospital for breast and lung cancer; for colon and prostate cancers the association was generally negative but only significant using certain high-volume thresholds. For esophageal and pancreatic cancer, there was a positive relationship between rural residence and surgery at a HVH and therefore, compared to urban counties, patients with esophageal and pancreatic cancer in rural counties were more likely to be treated at a HVH. Among less prevalent cancers (bladder, stomach, rectum and brain) there was less consistency in the relationship between rural residence and treatment at a HVH across different thresholds. Conclusions: For many cancers, rural patients are less likely to receive care at HVHs, though the relationship differs across cancers and depending on volume threshold examined. Findings highlight the complexity of examining patterns of cancer care at HVHs, and the importance of protocols outlining minimum procedural volume thresholds. Positive relationships between rural residence and treatment at a HVH may result from selection effects if rural patients are less likely to receive surgery overall. Implications for Policy or Practice: There has been interest in using treatment at HVHs as a quality metric for determining reimbursement, including for breast cancer in the New York Medicaid program in recent years. Our findings highlight the complexity of developing such programs for other cancers. This study informs protocols focusing on high-volume thresholds and have implications for surgical education and training. Citation Format: Haleh Ramian, Lindsay Sabik, Zhaojun Sun, Jonathan Yabes, Bruce Jacobs. Urban/rural differences in receiving cancer surgery at high-volume hospitals and sensitivity to hospital volume thresholds [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR004.

Expenditure and Utilization Patterns of Cancer Care in Kuwait

#Introduction Cancer is among the leading causes of morbidity and mortality worldwide. However. The trends in utilization of cancer services and related expenditures in Kuwait are poorly known. We aim to investigate the expenditure and utilization patterns of cancer care in Kuwait. Methods A three-year retrospective analysis study of expenditure and utilization pattern in KCCC was performed from 2015 to 2017 in MOH in Kuwait. Results We report a considerable variation of utilizations and expenditure levels over the three-year period. After adjusting the data, there was significant increase in utilization rates and expenditure in 2015-16 followed by significant decrease in year 2016-17. The expenditure was observed to increase by 1.1% in 2016 before it declined by 1.9% in 2017. Conclusions This study is the first of its kind in Kuwait. We report adequate utilization and expenditure of cancer care in Kuwait. However, we recommend heavy investments in precision medicine technology and patient outcomes research to improve overall financial and operational performance pertaining to cancer care in MOH in Kuwait.

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Are older patients with non-small cell lung cancer receiving optimal care? A population-based study

Background Results from studies addressing age-related patterns of cancer care have found evidence of unjustified differences in management between younger and older patients. Methods We examined associations between age and clinical presentation, management and mortality in patients diagnosed with non-small cell lung cancer (NSCLC) between 2002 and 2016. Analyses were adjusted for comorbidity and other factors that may have affected management decisions and outcomes. Results The study population encompassed 40,026 patients with NSCLC. Stage at diagnosis did not differ between age groups ≤ 84. The diagnostic intensity was similar in age groups <80 years. In patients with stage IA–IIB disease and PS 0–2, surgery was more common in the youngest age groups and decreased with increasing age, and was rarely performed in those ≥ 85 years. The use of stereotactic body radiotherapy (SBRT) increased with age (≤69 years 5.4%; ≥85 years 35.8%). In patients with stage IIIA disease and PS 0–2, concurrent chemoradiotherapy was more common in younger patients (≤69 years 55.3%; ≥85 years 2.2%). In stage IA–IIIA disease, no major differences in treatment-related mortality was observed. In stage IIIB–IV and PS 0–2, chemotherapy was more common in patients <80 years. However, 58.1% of patients 80–84 years and 30.3% ≥ 85 years received treatment. In stage IA–IIIA, overall and cause-specific survival decreased with increasing age. No age-differences in survival were observed in patients with stage IIIB-IV NSCLC. Conclusion Treatments were readily given to older patients with metastatic disease, but to a lesser degree to those with early stage disease. Significant differences in cause specific survival were observed in early, but not late stage disease. Our findings underscore the importance of individualized assessment of health status and life expectancy. Our results indicate that older patients with early stage lung cancer to a higher extent should be considered for curative treatment.

Patterns of Cancer Care and Association with Survival among Younger Adolescents and Young Adults: A Population-Based Retrospective Cohort Study.

Younger adolescents and young adults (AYA) may receive care from either adult or pediatric oncologists. We explored patterns of care in this population and whether survival is associated with provider type. Utilizing the California Cancer Registry, we examined a cohort of 9,993 AYAs diagnosed with cancer aged 15 to 24 years from 1999 to 2008. Provider type (adult/pediatric) was determined by individual physician identifiers. For provider type, multivariable logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, diagnosis, and stage. For observed survival, Cox proportional hazard models were additionally adjusted for provider type. ORs and HR with 95% confidence intervals (95% CI) were determined. Most patients saw adult providers (87.3% overall; 72.7% aged 15-19 years). Patients with acute leukemia, sarcoma, and central nervous system (CNS) malignancies more often saw pediatric providers [OR (95% CI) adult versus pediatric 0.48 (0.39-0.59), 0.74 (0.60-0.92), 0.76 (0.60-0.96), respectively]; those with germ cell tumors and other cancers, including carcinomas, more often saw adult providers [2.26 (1.72-2.98), 1.79 (1.41-2.27), respectively]. In aggregate and for most cancers individually, there was no survival difference by provider type [overall HR (95% CI) 1.00 (0.86-1.18)]. Higher survival was associated with pediatric providers for CNS malignancies [1.63 (1.12-2.37)] and rhabdomyosarcoma [2.22 (1.03-4.76)], and with adult providers for non-Hodgkin lymphoma [0.61 (0.39-0.96)]. Most AYAs 15 to 24 years old are treated by medical oncologists. In general, survival was not associated with provider type. Current patterns of care for this population support increased collaboration between medical and pediatric oncology, including joint clinical trials.

Breast Cancer in West Java: Where Do We Stand and Go?

Background: Breast cancer is the most common cancer in Indonesia, a low-middle income country in Southeast Asia. We provide a regional hospital-based cancer registry of the central hospital in West Java, Indonesia. This study aims to characterize the presentation, diagnosis, evaluation, and management of breast cancer; to develop a regional breast cancer registry in West Java to monitor cancer care patterns; to evaluate cancer treatment outcomes.Methods: The data were collected from the medical records deposited in the Hasan Sadikin General Hospital Information System. The team has been contracted to operate the registry &amp; organize an advisory board to standardize definitions of coding terminology of the registry’s reporting system and to monitor the cancer care pattern. Data validation was conducted by a team in the cancer registry, consisting of health officers, pathologists, and registrars. Data management and analysis were conducted by the cancer registry team.Results: A total of 913 women diagnosed with breast cancer, from January 2014 until December 2018, were studied. The median age was 49.5 years old. The initial diagnosis was at the age of 42.4 years old on average. About 64.5% were diagnosed with stage-3 and -4 cancers, and 75.1% had undergone a mastectomy, of which 47.3% of the intent was palliative. Of those who have hormonal receptors, only 26.9% were positive, and 36.5% were not assessed for immunohistochemistry evaluation. Inappropriate surgical management of breast cancer was common at the community level, which included indiscriminate diagnostic lumpectomy (21.9%), incomplete mastectomy and omission, or suboptimal lymph node axillary clearance (47.4%). Only 3.0% of patients received breast-conserving surgery and were treated with mastectomy and reconstruction. Conclusions: Breast cancer in West Java is often recognized at the late stage. Treatment was suboptimal, leading to poor survival. A more aggressive approach to early detection and treatment needs to be developed to improve the outcomes of this potentially curable disease.

Patterns of cancer care in Sri Lanka: Assessing care provision and unmet needs through an electronic database

Sri Lanka Cancer Registry (SLCR) maintained by the National Cancer Control Programme contains socio-demographic, histologic and some staging data on cancers. Currently there is no systematic process to gather outcome data of any cancer in Sri Lanka. The National Cancer Institute, Sri Lanka (NCISL) is the only dedicated cancer hospital in the country. This provides a unique opportunity to create an inception cohort that can be studied and followed up over an extended period.Our objective is to create an inception cohort of patients to study the patterns of cancer care at the NCISL. Detailed information on patient demographics, cancer diagnosis, treatment delivery, outcomes, comorbidities and health seeking behaviour are captured using an electronic database. This database was developed based on District Hospital Information System (DHIS 2) software platform.Approximately 4400 patients with breast cancer and 1200 patients with colorectal cancer have been collected both prospectively (February 1st 2018 to date) and retrospectively (January 1 st, 2016 to January 31 st, 2018) with ongoing prospective follow-up for all patients at 6-month intervals. Future of the data repository include coverage of cancers beyond breast and colorectal, expansion to include data from other public cancer treatment centres and linkage to the SLCR.This cancer care registry has the potential to form the cornerstone of cancer plans in Sri Lanka and to inform delivery of care and health policy decision-making enriching the SLCR. This registry is a crucial first step to build capacity in health systems research in Sri Lanka.

Lung Cancer Surgical Regionalization Disproportionately Worsens Travel Distance for Rural Patients.

Major cancer surgeries have regionalized to fewer and higher-volume hospitals, with the goal of improving the quality of surgical care. However, regionalization may have negative effects on geographic access to care. We hypothesize that lung cancer patients have been traveling further for surgery over time as regionalization has occurred, and this increased travel has primarily impacted rural patients. A North Carolina all-payer state discharge database was used to capture discharges from 2005 to 2015 for patients undergoing lung cancer resection. Changes in patterns of care over time in high-volume centers (HVC) were examined. Adjusted patient straight-line travel distance was estimated over time and stratified by rural-urban location. The number of hospitals performing lung cancer resections decreased from 49 to 31 over the study period (P = .0006), and the proportion of patients receiving care at HVC increased from 23% to 44% (P < .0001). Rural patient travel distance increased over time by 8.5miles (95% CI: 0.56-17.10, P = .048), from45.1 to53.6miles. There was no change in urban patient travel distance. The difference in adjusted travel distance between rural and urban patients nearly doubled from 2005 to 2015 (9.6 to 17.9 miles,P < .0001). In North Carolina, lung cancer surgical regionalization occurred over the study period and was accompanied by increases in travel distance for rural patients only. Further work is needed to determine the effects of greater travel distance on patterns of cancer care for rural patients.

Attendance at National Cancer Institute and Children's Oncology Group Facilities for Children, Adolescents, and Young Adults with Cancer in Pennsylvania: A Population-Based Study.

Purpose: Adolescents and young adults (AYAs) with cancer are a vulnerable population with decreased attendance at National Cancer Institute (NCI) comprehensive cancer centers and Children's Oncology Group (COG) facilities. Decreased attendance at NCI/COG facilities has been associated with poor cancer outcomes. The objective of this study was to evaluate cancer care patterns of AYAs compared with children, within Pennsylvania, and factors associated with attending an NCI/COG facility. Methods: Data from the Pennsylvania Cancer Registry between 2010 and 2015 for patients aged 0-39 years at cancer diagnosis were used. Primary analyses focused on age at diagnosis, insurance status, race, ethnicity, gender, cancer type, stage, diagnosis year, and distance to the NCI/COG facility. The primary outcome was receipt of care at an NCI/COG facility. Odds ratios (ORs) were calculated using multivariable logistic regression models. Sensitivity analyses were conducted to test and estimate robustness. Results: A sample of 15,002 patients, ages 0-39, was obtained, including 8857 patients (59%) who attended an NCI/COG facility. Patients were significantly less likely to attend an NCI/COG facility if they were aged 31-39 years (OR 0.054, 95% confidence interval [CI] 0.04-0.07), non-White (OR 0.890, 95% CI 0.80-0.99), Hispanic (OR 0.701, 95% CI 0.59-0.83), female (OR 0.915, 95% CI 0.84-1.00), had Medicaid insurance (OR 0.836, 95% CI 0.75-0.93), and lived further from an NCI/COG facility. Sensitivity analyses largely corroborated the performed estimates. Conclusions: AYAs with cancer in Pennsylvania have disproportionate attendance at specialized NCI/COG facilities across a variety of demographic domains. Enhancing the attendance of AYAs with cancer at these specialized centers is crucial to improve cancer outcomes.

Pattern of care for cancer of the oesophagus in a western population.

Most oesophageal outcome research focuses on surgical treatment, despite most patients not undergoing surgery as they are unfit or have metastatic disease. Few studies have evaluated the patterns of care for all patients presenting with oesophageal cancer. All patients with oesophageal cancer, and high-grade dysplasia (HGD), presented at the South Australian state-wide upper gastrointestinal cancer multidisciplinary team from 2012 to 2015 were reviewed to determine the patterns of presentation and treatment. A total of 375 patients were included. Diagnosis was adenocarcinoma in 69.6%, squamous cell carcinoma in 24.8% and HGD in 5.6%. The majority of patients presented with stages II and III disease (56.8%). A total of 51.5% were treated with curative intent, with 28.8% undergoing surgery and/or neoadjuvant therapy. Treatment was palliative in 48.5%, with chemoradiotherapy utilized in 20.8%. Disease stage and age impacted treatment intent. All patients with HGD received curative treatment versus 89.7%/63.8%/1% of patients with stage I/II and III/IV disease, respectively. A total of 56.9% of patients <80 years received curative treatment versus 25% of those >80 years old. Whilst approximately half of patients underwent treatment with curative intent, only a minority underwent surgery. Future efforts to improve survival outcomes for oesophageal cancer should address patients who are unfit for surgery and those presenting with metastatic disease.

Abstract P6-16-04: Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study

Abstract Background Randomised clinical trials (RCT) are considered a gold standard generating efficacy and safety data supporting drug approval. However, real world data (RWD) reflecting health care delivery is becoming increasingly important. RWD on patient profiles and patterns of care in MBC are scarce in developing countries. As an example, observational studies suggest that despite guideline recommendations clearly indicating ET for hormone receptor positive MBC, a considerable proportion of patients in clinical practice begin chemotherapy in early lines of therapy. This pragmatic information addresses the uptake and applicability of the RCT results and should be able to help informing health care planning complementing RCT generated data. The objective of this study is to describe patient characteristics and evaluate actual physician-reported treatments for MBC in Brazil. Methods This analysis addresses the first 362 patients included in LACOG-0312, a retrospective study planning to recruit over 700 patients (cut-off date April 30th 2016) with recurrent locally advanced or MBC diagnosed in 2012 in 18 institutions across Brazil. Patient characteristics, type of health insurance coverage, treatment and survival outcome were analysed. Results Median age at BC diagnosis was 53 years and 37% were premenopausal. Regarding the educational level, 63.2% had completed elementary (primary) schooling, 75.7% were covered by the public health system while 24.3% had some form of private coverage. 70% of patients had hormone receptor positive (HR+) and 18% had HER2 positive tumors. Median disease free survival time from surgery was 29 months. Interestingly, 30% of patients underwent a biopsy of a metastatic site. Of the 362 patients, 349 (96.9%) received some form of palliative systemic therapy. Median time from diagnosis of metastatic disease to first-line therapy initiation was 46 days but a significant difference was noted between patients with public versus private health insurance (50 vs. 33 days p=0.012). Half of the patients received at least 3 lines of therapy (chemo or endocrine) to a maximum of 9 lines. In patients with HR+ tumors, endocrine therapy was administered in 47% in first, 65% in second and 61% in third-line, respectively. Median overall survival (OS) from diagnosis of metastatic disease was 34 months (CI 95%: 25.7-44.3) and no differences in OS were observed between patients with public or private coverage (34 months vs. 35 months p=0.808). Causes of death were cancer in 85.2% of patients and treatment toxicity in 3.6%. Conclusion Our study included a population with predominantly low educational level and mostly public health insurance. This likely corresponds to the majority of cases and reflects cancer care patterns in Brazil and many developing countries. A considerable proportion of patients were premenopausal at MBC diagnosis. More than half of HR+ patients received at least 3 lines of endocrine therapy although 54% of them had chemotherapy as the first systemic treatment. Patients from the public health system experienced a delay in starting first-line therapy but this didn't seem to jeopardize cancer outcomes in this setting. Citation Format: Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-04.

Prevalence and characteristics of cancer patients receiving care from single vs. multiple institutions

IntroductionPatients may receive cancer care from multiple institutions. However, at the population level, such patterns of cancer care are poorly described, complicating clinical research. To determine the population-based prevalence and characteristics of patients seen by multiple institutions, we used operations data from a state-mandated cancer registry. Methods and materials59,672 invasive cancers diagnosed in 1/1/2010-12/31/2011 in the Greater Bay Area of northern California were categorized as having been reported to the cancer registry within 365days of diagnosis by: 1) ≥1 institution within an integrated health system (IHS); 2) IHS institution(s) and ≥1 non-IHS institution (e.g., private hospital); 3) 1 non-IHS institution; or 4) ≥2 non-IHS institutions. Multivariable logistic regression was used to characterize patients reported by multiple vs. single institutions. ResultsOverall in this region, 17% of cancers were reported by multiple institutions. Of the 33% reported by an IHS, 8% were also reported by a non-IHS. Of non-IHS patients, 21% were reported by multiple institutions, with 28% for breast and 27% for pancreatic cancer, but 19%% for lung and 18% for prostate cancer. Generally, patients more likely to be seen by multiple institutions were younger or had more severe disease at diagnosis. ConclusionsPopulation-based data show that one in six newly diagnosed cancer patients received care from multiple institutions, and differed from patients seen only at a single institution. Cancer care data from single institutions may be incomplete and possibly biased.

Patterns of cancer screening, incidence and treatment disparities in China: protocol for a population-based study

IntroductionCancer has become the leading cause of death in China. Several knowledge gaps exist with respect to the patterns of cancer care and disparities in China. Chinese healthcare researchers do...

Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment.

The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment. We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics. Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00). Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care.

Evolution of RAS testing in colorectal cancer in France, Germany, Italy, Spain and UK (EU5).

e14679 Background: EGFR monoclonal antibodies, cetuximab (cetux) and panitumumab (pani) are treatment choices for colorectal cancer (CRC) patients with KRAS wild type (WT) disease. Despite this, a number of KRAS WT patients fail to respond to these therapies. There has been discussion to expand CRC testing to include NRAS. This study evaluates the trends in RAS testing across the EU5, as identifying the right patients for treatment is paramount in ensuring optimal treatment outcomes. Methods: IMS Oncology Analyzer, an anonymised patient database ( > 57,000 patients annually) collected through a quarterly physician panel survey, from 2009 to 2014, provides data on patterns of cancer care in the European Union across a range of different cancers. Inclusion criteria were metastatic patients diagnosed with CRC who are currently receiving chemotherapy. RAS testing uptake was analyzed from time 0 (Q1 2009 for KRAS and Q4 2013 for NRAS) until 2014. Results: In Q2 2009, 43% (278/646) of patients were tested for KRAS status in EU5. While France, Germany, Italy and Spain had established testing rates between 48-58%, the UK testing rate was 5% (6/116). Over the following years KRAS testing continued to increase at a rate of 3%, these rates differed slightly by market – FR 1.5%, DE 3.0%, IT, 2.2%, ES 2.0%, UK 11.5%. Current testing rates across the EU5 are at 84%. In Q3 2014, 47% (183/386) of KRAS tested patients in EU5 were KRAS mutant (MT). Following the regulatory requirement for NRAS testing for cetuximab, total RAS testing increased from 14% (268/1980) to 44% (228/513) in Q3 2014 at a rate of 37%. As with KRAS, the slowest uptake for total RAS testing was observed in the UK (25% in Q3 2014). In Q3 2014 K/NRAS dual testing identified 11% of KRAS WT patients as NRAS MT. Conclusions: Testing for KRAS mutations is now commonplace across EU5, with over 80% of patients being tested. NRAS testing however is a fairly recent requirement set out by the EMA in Nov 2013. A clear uptake of NRAS testing is observed following this time period and can be expected to become more routine within clinical practice as physicians strive to better personalize cancer treatment management.

Dose variation in metastatic breast cancer: Are European Medicines Agency summary of product characteristics (SmPC) being followed?

e11581 Background: Breast cancer represents the highest cancer burden in the EU and is a high profile treatment area. We identify variation in treatment length and dosing of bevacizumab (BV) and capecitabine (CP) in France, Germany, Italy, Spain and UK (EU5) compared to European Medicines Agency (EMA) SmPC dosing recommendations for metastatic breast cancer (mBC). Methods: This study used IMS Oncology Analyzer, an anonymised patient database collected through quarterly physician panel survey, which provides information on patterns of cancer care. Inclusion criteria of mBC patients currently receiving BV or CP collected within the last 3 years (October 2011 – September 2014). Correct dosing defined as (+/- 10%): BP – 10 mg/kg over 2 weeks or 15 mg/kg over 3 weeks; CP – 1,250 mg/m2 over 2 weeks with 1 week rest. Results: 84% (513/612) of BV patients received correct cycle length, with 77% of these patients (397) dosed correctly. 97 patients (19%) were under dosed with less than half over 60 years old and 70% presenting with an ECOG score of 1-2. While the remaining 16% of BV patients did not receive the recommended cycle length, 82% (81/99) did receive either 10 or 15 mg/kg EMA recommended doses. Although 90% of CP treated patients (619/686) received the correct cycle length, only 23% of those patients were dosed at the recommended 1,250 mg/m2. 60% (372/619) were under dosed; of which 70% are over 60 years old and 83% presented with an ECOG status of 1-2, with 244 patients receiving 1,000 mg/m2. While this dosage is commonly prescribed in combination in colorectal and gastric cancer, panel physicians were of the opinion that lower doses in mBC have similar efficacy and reported reducing doses to increase tolerability, as supported by the proportion of over 60 year olds being under dosed in the data. Conclusions: This study has identified variation in dosing and cycle duration of both BV and CV from those recommended by the EMA. It therefore appears that physicians are actively tailoring dosage and cycle length to patients’ fitness as opposed to strictly following EMA SmPC.