Trends In Utilization Of Chemotherapy Research Articles

Abstract 6471: Trends in chemotherapy utilization in acute myeloid leukemia (AML) in last 15 years

Abstract Introduction: Chemotherapy (Chemo) can relieve symptoms and improve quality of life and survival in AML, including in many older and frail adults. However, in a prior study from the US, almost a quarter of patients (pts) with new diagnoses of AML between years (yrs) 2003 and 2011 did not receive chemo (Bhatt et al., Blood Advances, 2018). Our study examined trends in chemo utilization in the last 15 yrs to test the hypothesis that chemo use has increased in more recent yrs. We also examined any disparities in chemo use. Methods: We utilized the National Cancer Database to identify 78,864 pts diagnosed with AML between 2004 and 2019 and divided them into 2 cohorts based on date of diagnosis, 2004-2010 and 2011-2019. We used logistic regression to estimate effect of demographic and disease characteristics on odds of receiving chemo and evaluate differences in these effects between the constructed patient cohorts. Results: Seventy-seven percent of total pts received chemo. Compared to 73% in 2004, 81% of pts received chemo in 2019. The receipt of chemo declined with increasing age with higher use of chemo in all groups in 2011-2019 compared to 2004-2010: >80 (yrs)= 40 vs 33%, 71-80 yrs= 72 vs 63%, 60-70 yrs= 87 vs 84%, 41-59 yrs= 93 vs 92%, and 18-40 yrs = 95 vs 94%.The receipt of chemo was lowest in white pts overall; in black pts, receipt of chemo increased in 2011-2019 compared to 2004-2010: black= 83 vs 76%, white= 78 vs 75%, and others 83 vs 83%. The receipt of chemo was lowest in therapy-related (t)-AML in 2011-2019 and 2004-2010: t-AML 64 vs 60%, acute promyelocytic leukemia= 88 vs 87%, core binding factor AML 93 vs 88% and other 77 vs 74%. In multivariable analysis, the odds of receiving chemo increased in 2011-2019 compared to 2004-2010 in all pts, particularly in older adults. Compared to white, black pts had similar odds of receiving chemo in 2004-2010, but odds were higher in 2011-2019 (Odds ratio, 1.2, 95% confidence interval, 1.1-1.3. Pts with t-AML were less likely to receive chemo compared to all other subtypes in 2004-2010 and 2011-2019. Female sex, lower income, public insurance, higher comorbidity score, and shorter distance to treatment facility were associated with a lower likelihood of receiving chemo; however, chemo utilization did not differ over the two time periods based on these variables. Conclusion: To our knowledge, this is the largest scale analysis of chemo utilization in AML in real-world practice. Chemo receipt increased significantly over the yrs, particularly among older adults, black pts, core binding factor, and t-AML. These recent trends are encouraging and represent novel findings. Despite these results, healthcare disparity based on sex, socioeconomic, and healthcare system factors continues to persist. In addition to developing safer and more effective chemo regimens, other innovative strategies to tackle these disparities are crucial to improve outcomes. Citation Format: Prajwal Dhakal, Bradley Loeffler, Aditya Ravindra, Avantika Pyakuryal, Vijaya Raj Bhatt. Trends in chemotherapy utilization in acute myeloid leukemia (AML) in last 15 years [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6471.

Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program.

159 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncological disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, and Rutgers-CINJ and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.

Disparities in the Use of Chemotherapy in Patients with Resected Pancreatic Ductal Adenocarcinoma

BackgroundIntroduction of effective systemic therapies for pancreatic ductal adenocarcinoma (PDAC) has demonstrated survival benefit. However, chemotherapy remains underutilized in these patients. We sought to investigate the implications of disparities on the trends in utilization of chemotherapy. MethodsA retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database identified patients who underwent surgical resection for PDAC from 1998 to 2014. Clinicopathologic, demographic, racial, and geographical factors were analyzed to assess associations with receipt of chemotherapy and disease-specific survival. ResultsA total of 15,585 patients were included in the study. A majority (N = 9953, 63.9%) received chemotherapy. Factors associated with poorer odds of receiving chemotherapy included older age (p < 0.001), African-American race (p = 0.003), and living in the Southwest region of the USA (p < 0.001). Married patients were at higher odds of receiving chemotherapy (all p < 0.001). Receipt of chemotherapy was independently associated with improved disease-specific survival (p < 0.001). ConclusionsReceipt of chemotherapy results in an improved survival in patients with resected PDAC. Demographic, racial, and geographic factors influence the rate of receipt of chemotherapy. Despite prior reports, these trends have not changed over the recent decades.

Evaluating the challenges of cancer care in Botswana: Chemotherapy utilization and stock outs.

e18309 Background: As a significant percentage of cancer deaths are occurring in low- and middle-income countries, there is an unmet need in facilitating cancer care delivery in these countries. Data on stock-outs and shortages of cancer medicines in Botswana have been reported as one of the roots hindering treatment and potentially increasing mortality, with at least 40% of essential drugs being out of stock for at least 30 days in 2015. A methodologic approach was published in 2018 to forecast chemotherapy (CT) volume, however, this was based on incidence and prevalence data, using multiple estimated assumptions. To obtain objective data, we examined trends in CT utilization at Princess Marina Hospital (PMH), largest referral hospital in Botswana, over a 12-month period evaluating indications for CT, dosages, and potential issues with stock outs of essential medications. Here we present the 21 injectable essential CT utilized during this period. Methods: This is a retrospective analysis, with data collected from October 2017 to September 2018 from the log book which is used daily by the pharmacy at PMH to record CT preparations. Data was organized to reflect dosage of CT, regimen used, and its indication. Results: Over 1 year period, 21 injectable CT agents were utilized for cancer therapy, with common treated diseases being Kaposi Sarcoma, Gyn cancer, Breast cancer, and Lymphomas. The 10 most utilized agents are listed with the monthly dosage used. Conclusions: We hope to analyze trends in CT utilization based on the available stocks of drugs at PMH to help optimize plans for purchasing and storing medications, with goal of reducing stock outs. In addition, we will analyze treatment regimens used at PMH and compare to current standard of care CT in the US and Sub-Saharan Africa to optimize cancer pathway protocols used in Botswana. [Table: see text]

Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program.

e18161 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncologic disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, R-CINJ, and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer guidelines and protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.

Increased Utilization of Chemotherapy for Early Stage Oropharyngeal Squamous Cell Carcinoma Despite Evidence for Benefit

Definitive radiotherapy (RT) offers the potential for organ preservation in patients with early stage oropharyngeal squamous cell carcinoma (OPSCC). For locally advanced OPSCC, the addition of chemotherapy to RT improves overall survival (OS) at the expense of increased acute and late toxicity. However, ASTRO recently presented guidelines recommending against chemoradiotherapy (CRT) in early stage OPSCC given prospective and retrospective evidence of equivalent locoregional control with RT alone. We used the National Cancer Database (NCDB) to evaluate the trends in utilization of chemotherapy in conjunction with RT in early stage OPSCC. This study compared outcomes following definitive CRT or RT in T1N0-1 and T2N0 OPSCC patients diagnosed between 1998 and 2012. Chi squared analysis was used to compare CRT to RT for clinicopathologic factors and trends in use over time. Logistic regression (LR) was performed to determine the odds ratio (OR) for factors associated with receipt of CRT. HPV/p16 was not assessable due to limited reporting prior to 2010. Due to significant imbalances in patient characteristics, propensity-score matching was performed based on probability of receipt of CRT and quartile of patients most likely to receive CRT were evaluated with Kaplan Meier for OS. We identified 3,346 early stage OPSCC patients with median age of 61 years. Use of CRT increased significantly from 14.5% in 1998 to a peak of 57.8% in 2007 and remained elevated at 54.3% in 2012 (OR 1.16/year, 95% CI 1.147 – 1.189, p<0.01). Those patients who received CRT were younger (52.7 vs 42.1% < 60 years, p<0.01), had private insurance (58.0 vs 42.2%, p<0.01), with less tonsil primaries (35.8 vs 47.5%, p<0.01), had lower comorbidity scores (86.3 vs 82.5% Charlson/Deyo score 0, p<0.01), and more often had T2 (52.6 vs 41.4% T1, p<0.01) and N1 (43.7 vs 15.3%, p<0.01) disease. In propensity-score matching, 3-year OS for the quartile most likely to receive chemotherapy was not significantly different for CRT vs RT (91.1%, 95% CI 89.8 – 92.4; vs 87.6%, 95% CI 85.3 – 89.9, log rank p=0.37). There has been a remarkable increase in the utilization of chemotherapy for early stage OPSCC despite lack of evidence showing improvement in outcomes and at the expense of increased toxicity. Further work is needed to determine if the ASTRO consensus guidelines will impact the addition of chemotherapy to radiation in this patient population.

MP80-19 TREATMENT TRENDS AND OUTCOMES FOR LYMPH NODE POSITIVE PENILE CANCER PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease III1 Apr 2017MP80-19 TREATMENT TRENDS AND OUTCOMES FOR LYMPH NODE POSITIVE PENILE CANCER PATIENTS Shreyas Joshi, Handorf Elizabeth, Andres Correa, Michael Haifler, Benjamin Ristau, Robert Uzzo, Richard Greenberg, David Chen, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, and Daniel Geynisman Shreyas JoshiShreyas Joshi More articles by this author , Handorf ElizabethHandorf Elizabeth More articles by this author , Andres CorreaAndres Correa More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Daniel GeynismanDaniel Geynisman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate a lymph node dissection (LND) with consideration of perioperative chemotherapy (CT) for all lymph node positive (LN+) penile cancer (PC) pts. Using a large national cancer registry, we assessed temporal trends in utilization of CT for LN+M0 PC, and evaluated outcomes between those who did (LND+) and did not (LND-) receive a LND and/or chemotherapy (CT+ vs. CT-). METHODS The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with LN+ squamous cell carcinoma of the penis from 2004-2014. Temporal trends were assessed using Cochran-Armitage tests. Adjusting for patient, clinical, and tumor characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of CT. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions were used to analyze overall survival (OS). RESULTS Of 1123 pts identified, 750 (67%) underwent a LND. Receipt of chemotherapy was similar in both LND+ (40%) and LND- (42%) pts (p=0.53). From 2004-2014, the overall utilization of systemic therapy significantly increased (38% vs. 48%. p=0.0009). However, only 53% of N3 patients received CT (N1 31%, N2 40%). Following adjustment, older patients (76 + years: OR 0.34 [CI 0.19-0.59], p=0.0002) were less likely to receive CT, while N2 (OR 1.62 [CI 1.16-2.27], p=0.005) and N3 (OR 2.32 [CI 1.67-3.22], p<0.0001) pts were more likely to receive CT. High volume centers (≥ 4 cases of PC/year; 29% of all LN+ cases) delivered less CT (OR 0.69 [CI 0.48-1.00], p=0.047). OS varied from 14.9 mo in the LND-/CT- group to 42.6 mo in the LND+/CT+ group. On multivariable analysis, receipt of CT was not associated with OS (HR 0.95 [CI 0.77-1.19], p=0.67). CONCLUSIONS In hospitals reporting to the NCDB, only 67% of LN+ PC pts receive a LND. While CT utilization has increased since 2004, rates remain low, even for N3 pts for whom the NCCN clearly recommends systemic therapy. Surprisingly, high volume centers were less likely to deliver CT for LN+ patients. Receipt of CT does not appear to affect OS, which likely reflects the aggressive natural history of PC. Nonetheless, these data highlight opportunities to improve adherence to guideline-recommended care. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1088 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shreyas Joshi More articles by this author Handorf Elizabeth More articles by this author Andres Correa More articles by this author Michael Haifler More articles by this author Benjamin Ristau More articles by this author Robert Uzzo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Daniel Geynisman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Trends in utilization of chemotherapy and radiation for resectable pancreatic head adenocarcinoma: an NCDB analysis

Trends in utilization of chemotherapy and radiation for resectable pancreatic head adenocarcinoma: an NCDB analysis

Trends in utilization of chemotherapy and radiation for resectable gastric adenocarcinoma: An NCDB analysis.

163 Background: Locally advanced gastric adenocarcinoma (GACa) is optimally treated with a combination of surgery, chemotherapy (CHEMO) and radiation (RT). Utilization of therapies can vary with institutional practices. Methods: The NCDB was queried for pts with GACa who had RO resection (2006-2012). Pts with metastatic disease, incomplete pathologic staging, and incomplete CHEMO or RT sequencing data were excluded. Pts were divided into groups by treatment regimen: G1: perioperative CHEMO; G2: adjuvant CHEMO±RT; G3: neoadjuvant CHEMORT; G4: other adjunctive regimens; G5: surgery only. Pts who received neoadjuvant therapy were staged using clinical TNM; those who did not or had incomplete clinical staging were staged using pathologic TNM. 3 subsets were created: LOCAL: T0-2N0, LOCALLY ADV: T3-4N0, REGIONAL: N+. Chi-square, univariate, multivariable with stepwise selection, and Cochran-Armitage time trend analyses were performed. Results: N = 12946: G1 = 1099, G2 = 4771, G3 = 180, G4 = 244 and G5 = 6652. The percentage of pts receiving adjunctive therapy was determined for each subset: LOCAL = 17.2%, LOCALLY ADV = 59.8%, and REGIONAL = 66.0%. Use of adjunctive therapy increased from 2006: 44% to 2012: 53% (p &lt; 0.01). Use of perioperative CHEMO increased from 2006: 4% to 2012: 18% (p &lt; 0.01). Factors affecting use of adjunctive therapy on multivariable analysis are: age (p &lt; 0.01), race (p &lt; 0.01), income (p &lt; 0.01), insurance (p &lt; 0.01), comorbidity score (p &lt; 0.01), and facility volume (p = 0.01). Conclusions: Though utilization of adjunctive therapy is increasing, a large proportion of pts with resectable GACa do not receive recommended adjunctive therapy. This study highlights disparities in utilization of optimal multimodality care. National efforts to expand access to care are necessary to improve outcomes in resectable GACa. [Table: see text]

Trends in Chemotherapy Utilization for Colorectal Cancer

Background Since 1990, significant advances have occurred in the adjuvant and metastatic treatment of colorectal cancer (CRC). Not all patients may be eligible for chemotherapy (CT), and the proportions and characteristics of patients who receive treatment are not well defined. In this study, treatment patterns of patients referred to the British Columbia Cancer Agency (BCCA) with early-stage colon cancer and metastatic CRC between 1990 and 2004 are described. Patients and Methods This study included patients with stage II or III colon cancer or stage IV CRC at presentation referred to the BCCA during a 1-year period for 3 time cohorts: 1990, 2000, and 2004. Patients were considered treated with CT if they received ≥ 1 cycle of any CT for indication of the initial referral diagnosis. Results A total of 1421 patients were included: stage II/III, n = 915; stage IV, n = 506. Chemotherapy utilization increased significantly from 1990 to 2004 for adjuvant CT (1990: 29%; 2000: 45%; 2004: 52%; P < .001) and for palliative CT (1990: 35%; 2000: 51%; 2004: 63%; P < .001). The proportion of patients with stage II disease treated with adjuvant CT dramatically increased (1990: 4%; 2000: 26%; 2004: 30%; P < .001). The use of palliative CT was significantly associated with male sex ( P = .025). Among older patients, only 25% received adjuvant CT, and 31% received palliative CT. Conclusion In this population-based study, adjuvant and palliative CT utilization increased significantly between 1990 and 2004. The majority of patients aged > 70 years did not receive CT, and women appeared less likely to receive palliative CT. Such disparities in CT utilization require further investigation.