Patterns Of Chemotherapy Use Research Articles

Evaluation of variables that may impact chemotherapy (CT) administration after determination of Oncotype DX (ODX) recurrence score (RS).

571 Background: Cardinal Health Specialty Solutions (CHSS) partners with payers to manage clinical care pathways in oncology and rheumatology. Observations from one such pathway with CareFirst BlueCross Blue Shield revealed lower than expected use of CT in patients (pts) with estrogen receptor-positive early-stage breast cancer (ESBC) at high-risk for recurrence by ODX RS. To better understand physician behavior, CHSS examined patterns of care in a large private practice oncology group with a robust EMR, Georgia Cancer Specialists (GCS). Pt characteristics and physician-prescribing patterns were analyzed to determine variables that most impacted the physician’s decision to treat high-risk pts with CT. Methods: Using the GCS EMR from 2009 to 2011, we retrospectively identified pts with ESBC (stage I-II, node-negative, estrogen receptor-positive, HER2-negative) who underwent ODX testing. We determined the number of pts with a RS value in the low- (RS <18), intermediate- (RS 18-30), and high-risk (RS ≥31) groups along with the number of pts who subsequently received CT in each category. The use of CT in high-risk pts was analyzed by pt age, tumor size, tumor grade, and physician prescribing patterns. Results: Of the 1908 pts identified with ESBC, 788 were eligible for ODX testing and 288 (37%) underwent testing. Fifty percent of pts were in the low-, 34% in intermediate-, and 16% in the high-risk groups. Six percent of low-, 41% of intermediate-, and 83% of high-risk pts received CT. In high-risk pts analyzed by age, CT was used in 100% of pts ≤ 45 years (y), 86% in pts 46-55 y, 86% in pts 56-65 y, and 25% in pts >66 y. CT use in high-risk pts was 82% and 86% in pts with tumor sizes <2 cm and 2-5 cm, respectively; and, 100%, 60%, and 91% in pts with grade 1, 2, or 3 tumors, respectively. Of the 41 physicians who were evaluated, 10 (24%) used ODX <15% of the time, 13 (32%) used ODX 15-40%, 10 used (24%) used ODX 41-60%, and 8 (20%) used ODX > 60% of the time. There were no significant differences in patterns of CT use. Conclusions: The less than expected use of CT in high-risk patients appears to be related to physician preference and pt age. Tumor size and grade did not appear to influence choice of therapy.

A Population-Based Study on the Implementation of Treatment Recommendations for Chemotherapy in Early Breast Cancer

BackgroundThere is considerable heterogeneity in the use of chemotherapy for patients with early breast cancer (BC), despite international recommendations issued from the National Comprehensive Cancer Network (NCCN), National Institutes of Health (NIH), and the St. Gallen biannual conference. This population-based study assessed the patterns of chemotherapy use in early BC. Patients and MethodsThe study included all or representative samples of patients with stage I-III BC from 7 Swiss cancer registries between 2003 and 2005. Factors modifying chemotherapy use were determined by logistic regression, considering patients receiving chemotherapy as cases (n = 1535) and the others as controls (n = 2004). ResultsNodal involvement was by far the strongest predictor for the use of chemotherapy (adjusted odds ratio [OR], 9.7; 95% confidence interval [CI], 7.2-13.0). Tumor biological characteristics such as histologic differentiation (OR, 4.4; 95% CI, 3.2-6.2), estrogen receptor (ER) status (OR, 3.8; 95% CI, 2.6-5.5), human epidermal growth factor receptor 2 (HER2) status (OR, 1.9; 95% CI, 1.3-2.7), and patient age (OR, 4.6; 95% CI, 3.5-6.2) were less important predictors for chemotherapy use. Socioeconomic and provider-related factors, such as patient education, affluence, insurance, breast surgeon's annual caseload, and case presentation at a multidisciplinary tumor conference did not predict the use of chemotherapy, with the exception of the health care provider's participation in clinical research (OR, 2.1; 95% CI, 1.6-2.8). The patient's region of residence did not predict the use of chemotherapy, but it was associated with the specific type of chemotherapy used. ConclusionNodal status, rather than surrogate markers for tumor biological features, was the predominant factor for choosing chemotherapy in patients with early BC in this large population study. Improvements should be made to increase the weight of tumor biological features in choosing chemotherapy in early BC.

Survival trends and patterns of chemotherapy use in elderly metastatic colorectal cancer (mCRC) patients.

6118 Background: Since 2002, several drugs (including bevacizumab (Bv), oxaliplatin (Ox), irinotecan (Iri)) have been approved for mCRC. The goals of this study are to examine patterns of newer chemotherapy (CTx) use and survival trends in older mCRC pts. Methods: Pts ≥ age 65 with mCRC diagnosis (dx) 2001–5 were identified from the SEER–Medicare database. Pts were excluded for Medicare HMO, lack of Medicare parts A and B, or second cancer. First–line (1L) CTx was identified within 3 mo of dx. Pts were categorized by dx year (2001–3 vs. 2004–5) and treatment (none, CTx, CTx + Bv.). A logistic regression model identified factors associated with 1L Bv use. A Cox proportional hazards regression model was used to assess association of various factors (age, comorbidity, hepatic resection (rsxn), CTx) with survival. Results: 5,725 pts (median age 77) met criteria, of whom 2,647 (46%) received 1L CTx. In 2004–5, 32% and 12% of treated pts received Ox and Iri (vs.1% and 34% in 2001–3). Following its approval in 2004, 25% of treated pts received Bv. Factors associated with 1L Bv use include age <75 (OR 1.43, p=0.02) and concurrent use of Ox (OR 10.11, p<0.001) or Iri (OR 5.82, p<0.001). In a Cox proportional hazards model, survival was greater in pts with lower comorbidity, age <75, hepatic rsxn, 1L CTx use, and dx 2004–5. Pts dx 2004–5 who used Bv had the greatest survival compared with untreated pts dx 2001–3 (HR 0.46, p<0.001, median OS 15 vs. 6 mo). Conclusions: In an elderly mCRC cohort, nearly half of pts received 1L CTx, many with regimens containing Iri, Ox, or Bv. Survival was greatest in pts dx 2004–5 who used Bv. Increased Ox use may also have improved survival in this period. Future SEER–Medicare analyses may help elucidate the relative benefit of other new agents in the elderly, a population under–represented in clinical trials. Cox proportional hazards model. Factor HR 95% CI P Age < 75 0.71 0.66 – 0.75 <0.001 Comorbidity (Klabunde) ≤ 1 0.75 0.70 – 0.80 <0.001 Hepatic rsxn 0.68 0.58 – 0.79 <0.001 Dx 2001-3 + 1L CTx 0.84 0.78 – 0.91 <0.001 Dx 2004-5 no 1L CTz 0.88 0.81 – 0.95 0.002 Dx 2004-5 + 1L CTx 0.63 0.57 – 0.69 <0.001 Dx 2004-5 + 1L CTx and Bv 0.46 0.39 – 0.55 <0.001 Reference: Age ≥ 75. Comorbidity >1, No hepatic rsxn, Dx 2001-3 no 1L CTx

Race and Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma

Blacks are twice as likely to develop and die from multiple myeloma (MM), and are less likely to receive an autologous hematopoietic-cell transplant (AHCT) for MM compared to Whites. The influence of race on outcomes of AHCT for MM is not well described. We compared the probability of overall survival (OS), progression-free survival (PFS), disease progression, and nonrelapse mortality (NRM) among Black (N=303) and White (N=1892) recipients of AHCT for MM, who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2005. The Black cohort was more likely to be female, and had better Karnofsky performance scores, but lower hemoglobin and albumin levels at diagnosis. Black recipients were younger and more likely to be transplanted later in their disease course. Disease stage and treatment characteristics prior to AHCT were similar between the 2 groups. Black and White recipients had similar probabilities of 5-year OS (52% versus 47%, P=.19) and PFS (19% versus 21%, P=.64) as well as cumulative incidences of disease progression (72% versus 72%, P=.97) and NRM (9% versus 8%, P=.52). In multivariate analyses, race was not associated with any of these endpoints. Black recipients of AHCT for MM have similar outcomes compared to Whites, suggesting that the reasons underlying lower rates of AHCT in Blacks need to be studied further to ensure equal access to effective therapy.

Commentary: practice patterns and potential impact on quality measures for a practicing physician.

Commentary: practice patterns and potential impact on quality measures for a practicing physician.

Chemotherapy and survival for patients with multiple myeloma: findings from a large nationwide and population-based cohort.

To assess the patterns of chemotherapy use for patients with multiple myeloma and to determine if chemotherapy is effective in prolonging survival outside the clinical trial settings. We studied a nationwide and population-based retrospective cohort of 4902 patients > or =65 years of age with stage II or III multiple myeloma from 1992 to 1999, identified from the Surveillance, Epidemiology, and End-Results-Medicare data. Multivariate logistic regression was used to estimate the odds ratio of receiving chemotherapy and Cox proportional hazard model was used to estimate the hazard ratio of mortality associated with chemotherapy. Of 4902 patients with stage II or III multiple myeloma, 52.0% received chemotherapy during the course of the disease. The receipt of chemotherapy decreased significantly with age from 65.7% in the 65- to 69-year age group to 34.3% in those > or =80 years. Blacks (47.6%) were less likely to receive chemotherapy than whites (52.8%). Use of chemotherapy decreased significantly with comorbidity scores and increased over time. Risk of all-cause mortality was significantly reduced in patients who received chemotherapy compared with those who did not (adjusted hazard ratio = 0.65; 95% confidence interval = 0.61-0.69). A similar pattern as observed for myeloma-specific mortality (0.61; 0.56-0.67). Survival benefit increased with increasing cycles of chemotherapy (P < 0.001 for trend) and was significant across different age groups, gender, ethnic groups, and comorbidity scores. Chemotherapy was significantly associated with increased survival in patients with multiple myeloma outside the clinical trial settings. This survival benefit was significant across different groups by age, gender, race, and comorbidity. A substantial number of patients with multiple myeloma did not receive chemotherapy.

Patterns of chemotherapy use for women with ovarian cancer: a population-based study.

To evaluate adherence to published recommendations for chemotherapy for ovarian cancer patients in the general community and to identify factors associated with its use. The study population consisted of 2,150 women residing in Northern California with a first diagnosis of primary epithelial ovarian cancer between January 1994 and December 1996. Patients were identified through the California Cancer Registry and their physicians were surveyed to supplement registry treatment information. Almost 89% of women younger than 75 years with International Federation of Gynecology and Obstetrics stage III or IV tumors received chemotherapy, with levels of treatment highest for women diagnosed at stage III. Patients 75 years of age and older were significantly less likely than younger women to receive chemotherapy (58.2% v 86.1%; P =.001) regardless of stage at diagnosis. Approximately 20% of patients younger than 55 years with early-stage (stage IC and II) cancer received no chemotherapy. Treatment in an American College of Surgeons hospital and treatment by a gynecologic oncologist increased the likelihood of receiving chemotherapy. Hospitalization for comorbid illness, race/ethnicity, census-based measures of socioeconomic status, and size or teaching status of hospital were all unrelated to probability of treatment after adjustment for other factors. Reasons reported most frequently by physicians for no treatment were lack of clinical indication and patient refusal. The results of this study suggest that, despite scientific evidence and published guidelines that advocate chemotherapy for most women with ovarian cancer, some groups of women did not receive optimum treatment.

Patterns of chemotherapy use in muscle-invasive bladder cancer in a tertiary centre.

Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia. A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021. Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC. The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.