- Email: [email protected]
P-329 Treatment-associated toxicities in US Medicare non-small celllung cancer (NSCLC) patients
$202
Posters / H e a f h s e r v i c e s r e s e a r c h
and increasing availabil~y of this modalP:y of staging, and improve the correlation between clinical and surgical staging in those receiving curative intent therapy Staging practices were assessed in relation to current guidelines Treatment medalibes: The iittial tTeatment modallty was surgery in 613. chest radiotherapy in 497. extra-thoracic radiotherapy in 142. chemotherapy in 302. chemoradiation in 142 15% of ,50 59 year olds had surgery compared to 19% in over 80 year olds Chemotherapy (alone) usage increased from 9 5% to 125% of cases between 2000 and 2003 Survival to date is consistent with intemational benchmarks. Updated data analysis will be presented together with analyses of time b'ends, diagnostic and staging investigations and treatment outcomes. Thanks to dini(al input. QILCOP has enabled large scale multicentor, real time lung Cancer clirlcal outcomes tracking to be embedded into routine dini(al practice. Clinical practice and outcomes can be evaluated in light of Io(al factors and evidence based guidelines, and ongoing measurements possible following any change processes
Health services research
Tuesday, 5 July 2005
10:00-17:00
P - 3 2 7 Can performance status (PS) be dsterrnlned accurately by patients? Results of a prospective tdal evaluaUng ECOG and Karnofsky PS as well as patient-rated PS In non-small cell lung cancer (NSCLC) R. Gralla I . P Hollen 2. P KunJvilla 3. J Meharchand3. H ~olew 3. N Leigit 4. C. Chin ~. J. Stewart ~. ~New York LLRg Cancer A]hance, New York, USA.
2University of Virginia, Charlottesville, Virginia, USA, 3The COMET Group, Toronto, Ont, Canada: 4Pnncess Margaret Hospital, Toronto, Ont, Canada: ~Sanofi-AvantJs Canada, Lava/, Qc, Canada Background: PS is accepted as a key factor in companng arms of dini(al tnals, in patient morltorlng, and in determining treatment eligibility. While both the ECOG and KPS scales have validity and wide aocsptance, there are several factors of some concem. First. accuracy for use in these important areas depends on a clear understanding of the scale definitions Second. because both are observer-rated, they are prone to rater or investigator bias Additionally. observer scenng contrasts to the preferred approach (rating by the patient himself or herself) in pabent-reported outcomes Methods: We prospec0vely evaluated both PS scales as well as a PabentRated PS (a visual analog scale [VAS] of activity) in pabents with NSCLC Observers rating the ECOG and KPS had whtten definitions of each scale category at the time of the sconng. The PatientJ:~ated PS VAS is part of the validated quality of life scale, the LCSS. Patients completed the VAS on paper. and on a computerized (electronic) handheld device ([_CSSQL). All patients were part of the Quality of IJl~ COMET study, and wore enlisted in 9 clinics in Ontario. Eligibility included: a clageosis of advanced NSCLC (stage III or IV). KPS ~> 60. and no pnor chemotherapy. All patients were receiving their initial ceursea of dcoetaxel + platinum. Patients completed all three scales immediately pnor to chemotherapy Results: The 7,5 patients entered had the ~llowlng characteristics: ,59% women: median age: 68. (range 46 91): Stage IV: 73%: KPS median: 8.0% (range 60%-100%): ECOG marian: 1 (range 3~)) Using the elecb'onic ~rmat. there was moderately Itgh correlation between the Patient~ated PS VAS and a) the KPS (Pearson r. O 66) and b) the ECOG (Pearson r. 0 62) A similar result was obtained between the elecb'onic (computerized) and paper formats for the VAS scale (Pearson r. 0.69). Use of the Patient Rated PS VAS had high patient acceptance, and was easily aocomplished in busy outpatient settings. When the computerized handheld device was used. only one was needed per clinic. Conclusions: These results indicate that patients (an rate their own performance status rapidly and easily with one VAS question. There is moderately high correlation between PatientHated PS and that scored by observers (ECOG and KPS) Future prespec0ve tTials should evaluate whether the Patient-Rated PS more accurately predicts or correlates with other outcomes such as survival and response than either the ECOG or KPS scales If similar or subedor results are found in such analyses, patient-rated PS could become accepted as the pre~rred assessment method to help with clinical decision maid ng
[ P ~ 8 ] The direct mecllcal and non-medical management costs of lung cancer patients at an Australian tertiary t h o r a d c o n t o l o g y hospital D K,avat1,2. P Souf~am 3. E MoCaul I . K Fong I . M Windsor I . A Green 4. R. Abraham ~. ~The Pnnce Charles Hospital, Brisbane, Austral/a: 2Monash
Universir~, Me/bourns, Australia, 3Univsrsirty or Queens/and, Brisbane, Austra/ta: '=Queens~and/nst/tute et Medtcal Research, Brisbane, Austra/ta Background: The worldwide incidence of lung cancer continues to increase on the backdrop of limited health resources The objectives of tlts study were to: - Determine the direct costs lung Cancer management from a health system perspec0ve and Determine the add~]onal indrect (non medcal) costs borne by patients and their families. Methods: A prospective study 130 patients with a diagnos~s of SCLC and NSCLC admitted to the Prince Charles Hospital was conducted between 1996-2000. Patients eligible for the study had to provide informed consent. Direct medical costs (including inpatient and outpatient episodes of(are) for a 25 month period were sourced from hospital financial databases (including the month pnor to histological conrrmation of the diagnosis) and for24 months post ciagnosis, but not including the costs of best supportive ¢~e (BSC) In addition. all patients completed questionnaires on enrolment, one month subsequently and then at three monthly intervals Questionnaires sought data about the frequency and cost of doctor visits, alternative therapy use and t~ansport in addition to quality of life Data from the initial 13 months of follew-ub and without quality of life have been analysed and will be presented in full Results: Of the 130 patients enrolled 7 withdrew. The mean age of the remaining patients was 66 years. 95% had a recorded smoking history (mean 60 pack years). The vast majority of patients had NSCLC (91%) and/or were male (81%). 43% of patients usually resided outside Bnsbane metrepolltan area. More than tw(~thirds of patients had early clsease (stage UII NSCLC. localized SCLC) and 67% survived for 13 months. The mean cast of lung cancer management to the health Care system over the period of study was $16 072 for SCLC and $ 22 673 for NSCLC Management of eady disease (stage 1/11NSCLC or limited SCLC) was approximately b0% more e~(pensive than advanced cJsease Patients incurred a mean of $ 392 in out of pocket mecicel e~penses which included $ 1 152 E)r transportation. $ 121 for home aids/alterations and $ 1 7 2 for alternative mecicines More than 14% of patients reported using alternative mecicines Conclusions: This is the first prespe~ve lung cancer cost-of-illness study we are aware of. In this cohort referred to a tertiary referral cantor, we found the cost of lung cancer management to be Censiderable. and estimate a total mean case management cost (Including BSC based on hespltal estimates Ibr palliative inpatient Care) of $ 31 000. This figure is consistent with the limited number of reb'ospective stu~es published in the area. We found patients bore substantial costs with implications for health services policy. A signlfi(ant percentage of patients utilized alternative therapies and whilst tits represented a relatively modest amount of money, in a cohort of older pabents of was lesser secio-economic status this may well have significant impact on families The increasing incidence of lung Cancer worldwide and proliferation of expensive interventions (such as chemotherapy) on the backdrop of limited health resources makes economic analyses such as this a useful tool for understancing 'resources use' and planning for future needs toxlcltles 1•--329]Trestment-assoclated lung cancer (NSCLC) paUants
In US Medlcara non-small cell
S. Leader. G. Baker. K. McLaurln. Medtmmune, Inc. Gaethersburg, Maryland,
USA Background: NSCLC is the most common type of lung cancer with a global incidence of 991.089 About 17% of incident Cases occur in the US It is also the leading cause of cancer~'clated mortality worldwide with over 882.49,5 deaths annually. Raclcthoragy and chemotherapy are Imown to cause toxiclties ir'~luding nausea and vomiting, debydration, oral cemplicatior'~. myelosuppression and respiratory cemplicabons. Populationbased inodences of these toxiclt]es in NSCLC patients have not been documented previously in the US. Methods: Data from the US National Cancer Instltute's 1999 Surveillance. Epidemiology and End Results registry linked to Medicare claims for 1998 2001 (SEER-Medicare) were used SEER. the only population~ased cancer registTy in the US. covers approximately 26% of the population Medicare is a national health insurance program for people 6b+ years. cisebled persons <65 and End Stage Renal Disease HCPCS and ICD9-CM procedure Cedes on paid Medicare claims were used to identify types of therapy: combination radio-chemotherapy, chemotherapy or raclation Treatment associated toxicmes were counted only if the diagnosis occurred on or after the first b-eatment date and net in the prior year. Subjects with a pro existing toxicity clagnos~s were net included in the denominator for toxicity rate calculations. Hospitalizations were Ceunted if a diagnosis code for a toxicity was listed on the claim.
Posters / H e a f h s e r v i c e s r e s e a r c h
and increasing availabil~y of this modalP:y of staging, and improve the correlation between clinical and surgical staging in those receiving curative intent therapy Staging practices were assessed in relation to current guidelines Treatment medalibes: The iittial tTeatment modallty was surgery in 613. chest radiotherapy in 497. extra-thoracic radiotherapy in 142. chemotherapy in 302. chemoradiation in 142 15% of ,50 59 year olds had surgery compared to 19% in over 80 year olds Chemotherapy (alone) usage increased from 9 5% to 125% of cases between 2000 and 2003 Survival to date is consistent with intemational benchmarks. Updated data analysis will be presented together with analyses of time b'ends, diagnostic and staging investigations and treatment outcomes. Thanks to dini(al input. QILCOP has enabled large scale multicentor, real time lung Cancer clirlcal outcomes tracking to be embedded into routine dini(al practice. Clinical practice and outcomes can be evaluated in light of Io(al factors and evidence based guidelines, and ongoing measurements possible following any change processes
Health services research
Tuesday, 5 July 2005
10:00-17:00
P - 3 2 7 Can performance status (PS) be dsterrnlned accurately by patients? Results of a prospective tdal evaluaUng ECOG and Karnofsky PS as well as patient-rated PS In non-small cell lung cancer (NSCLC) R. Gralla I . P Hollen 2. P KunJvilla 3. J Meharchand3. H ~olew 3. N Leigit 4. C. Chin ~. J. Stewart ~. ~New York LLRg Cancer A]hance, New York, USA.
2University of Virginia, Charlottesville, Virginia, USA, 3The COMET Group, Toronto, Ont, Canada: 4Pnncess Margaret Hospital, Toronto, Ont, Canada: ~Sanofi-AvantJs Canada, Lava/, Qc, Canada Background: PS is accepted as a key factor in companng arms of dini(al tnals, in patient morltorlng, and in determining treatment eligibility. While both the ECOG and KPS scales have validity and wide aocsptance, there are several factors of some concem. First. accuracy for use in these important areas depends on a clear understanding of the scale definitions Second. because both are observer-rated, they are prone to rater or investigator bias Additionally. observer scenng contrasts to the preferred approach (rating by the patient himself or herself) in pabent-reported outcomes Methods: We prospec0vely evaluated both PS scales as well as a PabentRated PS (a visual analog scale [VAS] of activity) in pabents with NSCLC Observers rating the ECOG and KPS had whtten definitions of each scale category at the time of the sconng. The PatientJ:~ated PS VAS is part of the validated quality of life scale, the LCSS. Patients completed the VAS on paper. and on a computerized (electronic) handheld device ([_CSSQL). All patients were part of the Quality of IJl~ COMET study, and wore enlisted in 9 clinics in Ontario. Eligibility included: a clageosis of advanced NSCLC (stage III or IV). KPS ~> 60. and no pnor chemotherapy. All patients were receiving their initial ceursea of dcoetaxel + platinum. Patients completed all three scales immediately pnor to chemotherapy Results: The 7,5 patients entered had the ~llowlng characteristics: ,59% women: median age: 68. (range 46 91): Stage IV: 73%: KPS median: 8.0% (range 60%-100%): ECOG marian: 1 (range 3~)) Using the elecb'onic ~rmat. there was moderately Itgh correlation between the Patient~ated PS VAS and a) the KPS (Pearson r. O 66) and b) the ECOG (Pearson r. 0 62) A similar result was obtained between the elecb'onic (computerized) and paper formats for the VAS scale (Pearson r. 0.69). Use of the Patient Rated PS VAS had high patient acceptance, and was easily aocomplished in busy outpatient settings. When the computerized handheld device was used. only one was needed per clinic. Conclusions: These results indicate that patients (an rate their own performance status rapidly and easily with one VAS question. There is moderately high correlation between PatientHated PS and that scored by observers (ECOG and KPS) Future prespec0ve tTials should evaluate whether the Patient-Rated PS more accurately predicts or correlates with other outcomes such as survival and response than either the ECOG or KPS scales If similar or subedor results are found in such analyses, patient-rated PS could become accepted as the pre~rred assessment method to help with clinical decision maid ng
[ P ~ 8 ] The direct mecllcal and non-medical management costs of lung cancer patients at an Australian tertiary t h o r a d c o n t o l o g y hospital D K,avat1,2. P Souf~am 3. E MoCaul I . K Fong I . M Windsor I . A Green 4. R. Abraham ~. ~The Pnnce Charles Hospital, Brisbane, Austral/a: 2Monash
Universir~, Me/bourns, Australia, 3Univsrsirty or Queens/and, Brisbane, Austra/ta: '=Queens~and/nst/tute et Medtcal Research, Brisbane, Austra/ta Background: The worldwide incidence of lung cancer continues to increase on the backdrop of limited health resources The objectives of tlts study were to: - Determine the direct costs lung Cancer management from a health system perspec0ve and Determine the add~]onal indrect (non medcal) costs borne by patients and their families. Methods: A prospective study 130 patients with a diagnos~s of SCLC and NSCLC admitted to the Prince Charles Hospital was conducted between 1996-2000. Patients eligible for the study had to provide informed consent. Direct medical costs (including inpatient and outpatient episodes of(are) for a 25 month period were sourced from hospital financial databases (including the month pnor to histological conrrmation of the diagnosis) and for24 months post ciagnosis, but not including the costs of best supportive ¢~e (BSC) In addition. all patients completed questionnaires on enrolment, one month subsequently and then at three monthly intervals Questionnaires sought data about the frequency and cost of doctor visits, alternative therapy use and t~ansport in addition to quality of life Data from the initial 13 months of follew-ub and without quality of life have been analysed and will be presented in full Results: Of the 130 patients enrolled 7 withdrew. The mean age of the remaining patients was 66 years. 95% had a recorded smoking history (mean 60 pack years). The vast majority of patients had NSCLC (91%) and/or were male (81%). 43% of patients usually resided outside Bnsbane metrepolltan area. More than tw(~thirds of patients had early clsease (stage UII NSCLC. localized SCLC) and 67% survived for 13 months. The mean cast of lung cancer management to the health Care system over the period of study was $16 072 for SCLC and $ 22 673 for NSCLC Management of eady disease (stage 1/11NSCLC or limited SCLC) was approximately b0% more e~(pensive than advanced cJsease Patients incurred a mean of $ 392 in out of pocket mecicel e~penses which included $ 1 152 E)r transportation. $ 121 for home aids/alterations and $ 1 7 2 for alternative mecicines More than 14% of patients reported using alternative mecicines Conclusions: This is the first prespe~ve lung cancer cost-of-illness study we are aware of. In this cohort referred to a tertiary referral cantor, we found the cost of lung cancer management to be Censiderable. and estimate a total mean case management cost (Including BSC based on hespltal estimates Ibr palliative inpatient Care) of $ 31 000. This figure is consistent with the limited number of reb'ospective stu~es published in the area. We found patients bore substantial costs with implications for health services policy. A signlfi(ant percentage of patients utilized alternative therapies and whilst tits represented a relatively modest amount of money, in a cohort of older pabents of was lesser secio-economic status this may well have significant impact on families The increasing incidence of lung Cancer worldwide and proliferation of expensive interventions (such as chemotherapy) on the backdrop of limited health resources makes economic analyses such as this a useful tool for understancing 'resources use' and planning for future needs toxlcltles 1•--329]Trestment-assoclated lung cancer (NSCLC) paUants
In US Medlcara non-small cell
S. Leader. G. Baker. K. McLaurln. Medtmmune, Inc. Gaethersburg, Maryland,
USA Background: NSCLC is the most common type of lung cancer with a global incidence of 991.089 About 17% of incident Cases occur in the US It is also the leading cause of cancer~'clated mortality worldwide with over 882.49,5 deaths annually. Raclcthoragy and chemotherapy are Imown to cause toxiclties ir'~luding nausea and vomiting, debydration, oral cemplicatior'~. myelosuppression and respiratory cemplicabons. Populationbased inodences of these toxiclt]es in NSCLC patients have not been documented previously in the US. Methods: Data from the US National Cancer Instltute's 1999 Surveillance. Epidemiology and End Results registry linked to Medicare claims for 1998 2001 (SEER-Medicare) were used SEER. the only population~ased cancer registTy in the US. covers approximately 26% of the population Medicare is a national health insurance program for people 6b+ years. cisebled persons <65 and End Stage Renal Disease HCPCS and ICD9-CM procedure Cedes on paid Medicare claims were used to identify types of therapy: combination radio-chemotherapy, chemotherapy or raclation Treatment associated toxicmes were counted only if the diagnosis occurred on or after the first b-eatment date and net in the prior year. Subjects with a pro existing toxicity clagnos~s were net included in the denominator for toxicity rate calculations. Hospitalizations were Ceunted if a diagnosis code for a toxicity was listed on the claim.