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Evaluation of Hospitalization Trends in Lung Cancer Patients With Hyponatremia
S62
International Journal of Radiation Oncology Biology Physics
savings were partly offset by $4908 higher postprogression costs as a result of extended survival. At a willingness-to-pay threshold of $100,000 per (QALY) gained, nab-PC was found to be cost-effective in 99% of all simulations. Conclusions: In this cross-trial comparison based on available data, nab-PC was found to extend survival and reduce total medical care costs compared with B+sb-PC in pts 70 years with advanced NSCLC. Author Disclosure: V. Hirsh: E. Research Grant; Celgene. F. Honoraria; Celgene. G. Consultant; Celgene. K. Advisory Board; Celgene. A. Berger: D. Employment Other; Was an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder). G. Binder: A. Employee; Celgene. M. Stock; Celgene. C. Langer: E. Research Grant; Celgene. K. Advisory Board; Celgene. T.J. Ong: A. Employee; Celgene. M. Stock; Celgene. M. Renschler: A. Employee; Celgene. M. Stock; Celgene. R. Bornheimer: D. Employment Other; I am an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder). S. Whiting: A. Employee; Celgene. M. Stock; Celgene. G. Oster: D. Employment Other; I am an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder).
Author Disclosure: A. Chiappori: None. S. Antonia: None. J. Peabody: S. Leadership; President, QURE Healthcare, LLC. T. Kubal: None. D. Letson: None.
239 Clinical Pathway Adherence Improvement: A Quality Engagement Initiative for Lung Cancer Outcomes/Health Services Research A. Chiappori,1 S. Antonia,1 J. Peabody,2 T. Kubal,1 and D. Letson1; 1H. Lee Moffitt Cancer Center, Tampa, FL, 2QURE Healthcare, San Rafael, CA Purpose/Objective(s): Despite the expanded use of evidence based guidelines and clinical pathways in oncology care, promoting adherence to these pathways remains a challenge for providers and a concern for patients and payors. Our institution has developed and recently begun implementing clinical pathways across their service lines, most recently lung cancer. To increase pathway use and adherence, we utilized Clinical Performance and Value (CPV) vignettes to both measure physician performance against evidence-based institution pathways and provide feedback based on those same pathways Materials/Methods: In consultation with institution physician leadership and using CPV vignettes, an in silico simulation measurement tool, we created 12 cases, to reflect a variety of lung cancer presentations ranging from evaluation of high risk individuals to evaluation and treatment of patients with stage IV metastatic disease. Thirty-four multidisciplinary providers, actively caring for patients with lung cancer are serially evaluated for pathway adherence every 4 months. Data from rounds 1 and 2 are presented here. In all, 136 simulations were analyzed (2 per provider per round) and overall CPV scores are calculated. Score are reported as the percentage of the time that the physician completed necessary clinical pathway items. After completing the case, physicians were benchmarked to their peers and sent individualized feedback to assist with maintaining on pathway care. Results: At baseline, there was wide variance with regards to pathway adherence across the physician cohort. In round 2, the mean overall CPV score increased from 54% (round 1) to 66% (round 2). Adherence to pathway care in specific dimensions improved in palliative care (increased from 18% to 55%), chemotherapy (increased from 29% to 33%), radiation therapy (increased from 34% to 75%), and workup for metastasis (increased from 46% to 54%). Adherence to surgery pathways was high in round 1 (94%) and was unchanged in round 2 (94%). Conclusions: Lung cancer, with its large and complex patient population, is a key focal area to assess and improve adherence to pathways. We find that clinical practice patterns can be standardized over time with a measurement and feedback tool. Consistent feedback at the individual and group level will serve to align providers around pathway based care.
240 Evaluation of Hospitalization Trends in Lung Cancer Patients With Hyponatremia Outcomes/Health Services Research H.A. Kazi, M. Behera, C. Steuer, R.N. Pillai, T.K. Owonikoko, F.R. Khuri, and S.S. Ramalingam; Emory University School of Medicine, Atlanta, GA Purpose/Objective(s): Hyponatremia is a common inpatient diagnosis and prognostic factor in lung cancer. We evaluated hospitalization data by age categories in lung cancer patients with hyponatremia. Materials/Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, we reviewed patients with any concurrent diagnosis of lung cancer and hyponatremia from years 2006 to 2010. The total number of patients was subcategorized by age to compare less than 70 years old, between ages 70 and 80 and greater than 80 years (eldest group). Demographics extracted include length of stay (LOS), cost of hospitalization, mortality, sex, race, household income quartiles, severity of illness, teaching and urban hospital status, and number of concomitant comorbidities. Comorbidities were compared to LOS and cost of hospitalization in each age category. Results: Out of 570,304 hospitalizations related to lung cancer, hyponatremia was observed in approximately 8%. Of these, 51% (24,222) were less than age 70 (median age 61), 34% (15,798) between ages 70 and 80 (median age 75), and 15% (7151) greater than age 80 years (median age 84). Mortality rate was 12.1% (2932), 11.1% (1752) and 10.5% (752) with increasing age by categories as mentioned. The percentage of female patients, 44.2% (10,703), 50.3% (7947) and 55.8% (3990) increased with older age groups. Median LOS was 6 days in all groups. Median hospitalization charges were $30,790 for age <70, $30,216 for 70-80 years and $27,223.50 for >80 years. Severity of illness in each category was comparable. The <70 age group had the greatest percentage (29.5%) in the bottom median household income quartile and the age >80 group had the greatest percentage (26.2%) in the top median household income quartile. As the number of comorbidities in each age category increased, there were higher hospitalization costs and longer LOS. Conclusions: Hyponatremia contributes to hospitalizations in a significant subset of lung cancer patients and is associated with a mortality of nearly 12%. There was a higher cost and longer LOS with an increasing number of comorbid conditions. Author Disclosure: H.A. Kazi: None. M. Behera: None. C. Steuer: None. R.N. Pillai: None. T.K. Owonikoko: None. F.R. Khuri: None. S.S. Ramalingam: None.
241 Quantification of ALK From Non-Small Cell Lung Cancer (NSCLC) FFPE Tissue by Targeted Mass Spectrometry Outcomes/Health Services Research T. Hembrough,1 W. Liao,1 C.P. Hartley,2 S. Thyparambil,1 E. An,1 J. Burrows,1 and L.J. Tafe2,3; 1OncoPlex Diagnostics, Rockville, MD, 2 Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Geisel School of Medicine at Dartmouth, Hanover, NH Purpose/Objective(s): Crizotinib has significant antitumor activity in ALK-rearranged (AR) NSCLC. The current diagnostic test for AR, breakapart FISH, is a low throughput assay and not ideal for the detection of low-frequency oncogenic drivers. We sought to develop a quantitative ALK mass spectrometric (MS) assay and correlate the findings with ALK FISH, IHC results, and clinical outcomes. Materials/Methods: We used trypsin digestion mapping of recombinant ALK to identify optimal peptides. Labeled peptides were synthesized as internal standards, and the assay was predclinically validated in the
International Journal of Radiation Oncology Biology Physics
savings were partly offset by $4908 higher postprogression costs as a result of extended survival. At a willingness-to-pay threshold of $100,000 per (QALY) gained, nab-PC was found to be cost-effective in 99% of all simulations. Conclusions: In this cross-trial comparison based on available data, nab-PC was found to extend survival and reduce total medical care costs compared with B+sb-PC in pts 70 years with advanced NSCLC. Author Disclosure: V. Hirsh: E. Research Grant; Celgene. F. Honoraria; Celgene. G. Consultant; Celgene. K. Advisory Board; Celgene. A. Berger: D. Employment Other; Was an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder). G. Binder: A. Employee; Celgene. M. Stock; Celgene. C. Langer: E. Research Grant; Celgene. K. Advisory Board; Celgene. T.J. Ong: A. Employee; Celgene. M. Stock; Celgene. M. Renschler: A. Employee; Celgene. M. Stock; Celgene. R. Bornheimer: D. Employment Other; I am an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder). S. Whiting: A. Employee; Celgene. M. Stock; Celgene. G. Oster: D. Employment Other; I am an employee of Policy Analysis Inc., Brookline, MA, which received research funding from Celgene for this project. (I am not a shareholder).
Author Disclosure: A. Chiappori: None. S. Antonia: None. J. Peabody: S. Leadership; President, QURE Healthcare, LLC. T. Kubal: None. D. Letson: None.
239 Clinical Pathway Adherence Improvement: A Quality Engagement Initiative for Lung Cancer Outcomes/Health Services Research A. Chiappori,1 S. Antonia,1 J. Peabody,2 T. Kubal,1 and D. Letson1; 1H. Lee Moffitt Cancer Center, Tampa, FL, 2QURE Healthcare, San Rafael, CA Purpose/Objective(s): Despite the expanded use of evidence based guidelines and clinical pathways in oncology care, promoting adherence to these pathways remains a challenge for providers and a concern for patients and payors. Our institution has developed and recently begun implementing clinical pathways across their service lines, most recently lung cancer. To increase pathway use and adherence, we utilized Clinical Performance and Value (CPV) vignettes to both measure physician performance against evidence-based institution pathways and provide feedback based on those same pathways Materials/Methods: In consultation with institution physician leadership and using CPV vignettes, an in silico simulation measurement tool, we created 12 cases, to reflect a variety of lung cancer presentations ranging from evaluation of high risk individuals to evaluation and treatment of patients with stage IV metastatic disease. Thirty-four multidisciplinary providers, actively caring for patients with lung cancer are serially evaluated for pathway adherence every 4 months. Data from rounds 1 and 2 are presented here. In all, 136 simulations were analyzed (2 per provider per round) and overall CPV scores are calculated. Score are reported as the percentage of the time that the physician completed necessary clinical pathway items. After completing the case, physicians were benchmarked to their peers and sent individualized feedback to assist with maintaining on pathway care. Results: At baseline, there was wide variance with regards to pathway adherence across the physician cohort. In round 2, the mean overall CPV score increased from 54% (round 1) to 66% (round 2). Adherence to pathway care in specific dimensions improved in palliative care (increased from 18% to 55%), chemotherapy (increased from 29% to 33%), radiation therapy (increased from 34% to 75%), and workup for metastasis (increased from 46% to 54%). Adherence to surgery pathways was high in round 1 (94%) and was unchanged in round 2 (94%). Conclusions: Lung cancer, with its large and complex patient population, is a key focal area to assess and improve adherence to pathways. We find that clinical practice patterns can be standardized over time with a measurement and feedback tool. Consistent feedback at the individual and group level will serve to align providers around pathway based care.
240 Evaluation of Hospitalization Trends in Lung Cancer Patients With Hyponatremia Outcomes/Health Services Research H.A. Kazi, M. Behera, C. Steuer, R.N. Pillai, T.K. Owonikoko, F.R. Khuri, and S.S. Ramalingam; Emory University School of Medicine, Atlanta, GA Purpose/Objective(s): Hyponatremia is a common inpatient diagnosis and prognostic factor in lung cancer. We evaluated hospitalization data by age categories in lung cancer patients with hyponatremia. Materials/Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, we reviewed patients with any concurrent diagnosis of lung cancer and hyponatremia from years 2006 to 2010. The total number of patients was subcategorized by age to compare less than 70 years old, between ages 70 and 80 and greater than 80 years (eldest group). Demographics extracted include length of stay (LOS), cost of hospitalization, mortality, sex, race, household income quartiles, severity of illness, teaching and urban hospital status, and number of concomitant comorbidities. Comorbidities were compared to LOS and cost of hospitalization in each age category. Results: Out of 570,304 hospitalizations related to lung cancer, hyponatremia was observed in approximately 8%. Of these, 51% (24,222) were less than age 70 (median age 61), 34% (15,798) between ages 70 and 80 (median age 75), and 15% (7151) greater than age 80 years (median age 84). Mortality rate was 12.1% (2932), 11.1% (1752) and 10.5% (752) with increasing age by categories as mentioned. The percentage of female patients, 44.2% (10,703), 50.3% (7947) and 55.8% (3990) increased with older age groups. Median LOS was 6 days in all groups. Median hospitalization charges were $30,790 for age <70, $30,216 for 70-80 years and $27,223.50 for >80 years. Severity of illness in each category was comparable. The <70 age group had the greatest percentage (29.5%) in the bottom median household income quartile and the age >80 group had the greatest percentage (26.2%) in the top median household income quartile. As the number of comorbidities in each age category increased, there were higher hospitalization costs and longer LOS. Conclusions: Hyponatremia contributes to hospitalizations in a significant subset of lung cancer patients and is associated with a mortality of nearly 12%. There was a higher cost and longer LOS with an increasing number of comorbid conditions. Author Disclosure: H.A. Kazi: None. M. Behera: None. C. Steuer: None. R.N. Pillai: None. T.K. Owonikoko: None. F.R. Khuri: None. S.S. Ramalingam: None.
241 Quantification of ALK From Non-Small Cell Lung Cancer (NSCLC) FFPE Tissue by Targeted Mass Spectrometry Outcomes/Health Services Research T. Hembrough,1 W. Liao,1 C.P. Hartley,2 S. Thyparambil,1 E. An,1 J. Burrows,1 and L.J. Tafe2,3; 1OncoPlex Diagnostics, Rockville, MD, 2 Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Geisel School of Medicine at Dartmouth, Hanover, NH Purpose/Objective(s): Crizotinib has significant antitumor activity in ALK-rearranged (AR) NSCLC. The current diagnostic test for AR, breakapart FISH, is a low throughput assay and not ideal for the detection of low-frequency oncogenic drivers. We sought to develop a quantitative ALK mass spectrometric (MS) assay and correlate the findings with ALK FISH, IHC results, and clinical outcomes. Materials/Methods: We used trypsin digestion mapping of recombinant ALK to identify optimal peptides. Labeled peptides were synthesized as internal standards, and the assay was predclinically validated in the