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Use of Alternative Medicine for Cancer and Its Impact on Survival
Poster Viewing E401
Volume 99 Number 2S Supplement 2017
2951 Patterns of Referral for Palliative Radiation Therapy C.J. Jin, and W. MacKillop; Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, ON, Canada Purpose/Objective(s): Palliative radiotherapy (PRT) is effective in alleviating the symptoms of many patients with advanced cancer, but there is evidence that it is underutilized, particularly in the elderly and in patients who live further from an RT center. Efforts to optimize access to PRT require an understanding of patterns of referral. The purpose of this study was to identify the sources of referral for PRT to a regional RT program. Our hypothesis is that the source of referral for PRT varies with the characteristics the patient. Materials/Methods: Medical and billing records were reviewed to identify the source of referral of patients who received PRT at a regional cancer center in Ontario between 2010 and 2015. Multivariate analysis was used to identify characteristics of the patient that are associated with the source of referral for PRT. Only the first course of PRT was considered. Results: In total, 3,258 patients received PRT between 2010 and 2015. The patients’ median age was 70, 55% were male, and the median distance from patient residence to the radiotherapy center was 38.5 miles. The most common primary cancer sites were lung (37.2%), genitourinary (GU) (17.2%), gastrointestinal (GI) (12.8%), and breast (9.0%). PRT was given for locoregional disease in 36.0%, for distant metastases in 47.8%, and for indeterminate or multiple sites in 16.2%. Patients were referred by medical oncologists (MOs) (30.1%), other internists (26.4%), surgeons (24.2%), and family practitioners (FPs) (13.4%). In the remaining 5.9%, the need for PRT was identified by a radiation oncologist during follow-up after adjuvant or radical RT. The sources of PRT referrals varied significantly by primary cancer site (p<0.0001). Most lung cancer patients were referred by respirologists (34%), MOs (19%), or general internists (13%); most GU patients were referred by urologists (36%), FPs (20%), or MOs (19%); most GI patients were referred by MOs (47%), surgical oncologists (15%), or FPs (12%); and most breast patients were referred by MOs (61.2%), FPs (15%), or surgical oncologists (7%). The proportion of patents referred by their FP varied widely by disease site (range 7%-21%; p<0.0001). A multivariate analysis that controlled for primary site, showed that older patients were significantly more likely to be referred by their FP [>80 vs 60, OR 2.34 (1.67-3.27); 71-80 vs 60, OR 1.57 (1.15-2.14)], and that patients who lived further from the RT center were more likely be referred by their FP [>31 miles vs 31 miles, OR 1.37 (1.08-1.72)]. Conclusion: Diverse groups of doctors are involved in referring patients for PRT. Strategies for improving access to PRT should address the needs of specific patient groups by targeting the doctors who are most responsible for their care. FPs may be a key target for interventions aimed at enhancing access to PRT for older patients, and for those who reside further from an RT center. Author Disclosure: C. Jin: None. W. MacKillop: Stock; GSK.
2952 Use of Alternative Medicine for Cancer and Its Impact on Survival S.B. Johnson,1 H.S.M. Park,2 C.P. Gross,3 and J.B. Yu2; 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 3Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT Purpose/Objective(s): There is limited available information on the patterns of utilization and efficacy of alternative medicine for patients with cancer. The primary objective was to compare survival between patients with cancer receiving alternative medicine and conventional cancer treatment. The secondary objective was to determine cancer patient characteristics associated with selection of alternative medicine. Materials/Methods: Patients diagnosed with non-metastatic breast, prostate, lung, or colorectal cancer were identified between 2004-2013 using
the National Cancer Database (NCDB). Alternative medicine use was defined as ’Other-Unproven: Cancer treatments administered by nonmedical personnel’ administered as sole anti-cancer treatment among patients who did not receive chemotherapy, radiotherapy, surgery, and/or hormone therapy. Treatment selection was evaluated by the chi-square test, t-test, and logistic regression. Patients were 2:1 matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race, year of diagnosis, and cancer type. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. Results: We identified 281 patients who chose alternative medicine in lieu of conventional cancer treatment. Approximately 44% of these patients had breast cancer, followed by prostate (25.5%), lung (18.4%) and colorectal cancer (12.1% of patients). Independent covariates associated with increased likelihood of alternative medicine use included breast or lung primary site (vs. prostate), higher socioeconomic status, Intermountain West or Pacific location (vs. Northeast), stages II or III (vs. I) and Charlson-Deyo comorbidity score of 0 (vs. 1). Alternative medicine was independently associated with greater risk of death compared to conventional cancer treatment overall (HR: 2.50, 95% confidence interval 1.88-3.27) and in subgroups of patients with breast (HR: 5.68, 95%CI 3.22-10.04), lung (HR: 2.17, 95%CI 1.423.32), and colorectal cancer (HR: 4.57, 95%CI 1.66-12.61). Conclusion: Alternative medicine utilization in patients with cancer is rare and varied by geographic, socioeconomic, and disease-related factors. Patients who chose alternative medicine for primary treatment of their curable cancer had greater risk of death compared to those who chose conventional cancer treatment. Author Disclosure: S.B. Johnson: None. H.S. Park: Employee; Yale-New Haven Hospital. C.P. Gross: Research Grant; 21st Century Oncology. J.B. Yu: None.
2953 Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement J. Kao,1 A. Zucker,1 E. Mauer,2 A.T. Wong,3 P. Christos,2 and J. Kang4; 1 Good Samaritan Hospital Medical Center, West Islip, NY, 2Weill Cornell Medicine, New York, NY, 3Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 4Cornell University Medicine, New York, NY Purpose/Objective(s): In recent years, significant changes in health care policy have been reported to dramatically affect oncology practice. In this context, we examined the effect of practice structure on volume and payments for radiation oncology services using the 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for New York State radiation oncologists. Materials/Methods: The Medicare POSPUF data was utilized, and individual physicians classified into freestanding office-based and hospitalbased practices. Freestanding practices were further subdivided in urology, hematology-oncology and other ownership structures. Additional variables analyzed include gender, year of medical school graduation and Herfindahl-Hirschman Index (HHI) as a measure of economic competition. Results: There were 236 New York State radiation oncologists identified in the 2013 Medicare POSPUF dataset, with total reimbursement of $91,525,855. Among freestanding centers, mean global Medicare reimbursement was $832,974. Global Medicare reimbursement was $1,328,743 for urology practices compared to $754,567 for hematology-oncology practices and $691,821 for other ownership structures (p<0.05). Mean volume of on treatment visits (OTVs) was 240.5 per year, varying by practice structure. The mean annual OTVs for urology practices, hematologyoncology practices, other freestanding practices and hospital-based programs was 424.6, 311.5, 247.5 and 209.3, respectively (p<0.001). After correcting for gender, physician experience and HHI, practice structure was associated with freestanding reimbursement and on treatment visit volume. Conclusion: Higher Medicare payment was significantly predicted by type of practice structure, with urology-based and hematology-oncology practices accounting for highest reimbursement and treatment visit volume.
Volume 99 Number 2S Supplement 2017
2951 Patterns of Referral for Palliative Radiation Therapy C.J. Jin, and W. MacKillop; Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, ON, Canada Purpose/Objective(s): Palliative radiotherapy (PRT) is effective in alleviating the symptoms of many patients with advanced cancer, but there is evidence that it is underutilized, particularly in the elderly and in patients who live further from an RT center. Efforts to optimize access to PRT require an understanding of patterns of referral. The purpose of this study was to identify the sources of referral for PRT to a regional RT program. Our hypothesis is that the source of referral for PRT varies with the characteristics the patient. Materials/Methods: Medical and billing records were reviewed to identify the source of referral of patients who received PRT at a regional cancer center in Ontario between 2010 and 2015. Multivariate analysis was used to identify characteristics of the patient that are associated with the source of referral for PRT. Only the first course of PRT was considered. Results: In total, 3,258 patients received PRT between 2010 and 2015. The patients’ median age was 70, 55% were male, and the median distance from patient residence to the radiotherapy center was 38.5 miles. The most common primary cancer sites were lung (37.2%), genitourinary (GU) (17.2%), gastrointestinal (GI) (12.8%), and breast (9.0%). PRT was given for locoregional disease in 36.0%, for distant metastases in 47.8%, and for indeterminate or multiple sites in 16.2%. Patients were referred by medical oncologists (MOs) (30.1%), other internists (26.4%), surgeons (24.2%), and family practitioners (FPs) (13.4%). In the remaining 5.9%, the need for PRT was identified by a radiation oncologist during follow-up after adjuvant or radical RT. The sources of PRT referrals varied significantly by primary cancer site (p<0.0001). Most lung cancer patients were referred by respirologists (34%), MOs (19%), or general internists (13%); most GU patients were referred by urologists (36%), FPs (20%), or MOs (19%); most GI patients were referred by MOs (47%), surgical oncologists (15%), or FPs (12%); and most breast patients were referred by MOs (61.2%), FPs (15%), or surgical oncologists (7%). The proportion of patents referred by their FP varied widely by disease site (range 7%-21%; p<0.0001). A multivariate analysis that controlled for primary site, showed that older patients were significantly more likely to be referred by their FP [>80 vs 60, OR 2.34 (1.67-3.27); 71-80 vs 60, OR 1.57 (1.15-2.14)], and that patients who lived further from the RT center were more likely be referred by their FP [>31 miles vs 31 miles, OR 1.37 (1.08-1.72)]. Conclusion: Diverse groups of doctors are involved in referring patients for PRT. Strategies for improving access to PRT should address the needs of specific patient groups by targeting the doctors who are most responsible for their care. FPs may be a key target for interventions aimed at enhancing access to PRT for older patients, and for those who reside further from an RT center. Author Disclosure: C. Jin: None. W. MacKillop: Stock; GSK.
2952 Use of Alternative Medicine for Cancer and Its Impact on Survival S.B. Johnson,1 H.S.M. Park,2 C.P. Gross,3 and J.B. Yu2; 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 3Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT Purpose/Objective(s): There is limited available information on the patterns of utilization and efficacy of alternative medicine for patients with cancer. The primary objective was to compare survival between patients with cancer receiving alternative medicine and conventional cancer treatment. The secondary objective was to determine cancer patient characteristics associated with selection of alternative medicine. Materials/Methods: Patients diagnosed with non-metastatic breast, prostate, lung, or colorectal cancer were identified between 2004-2013 using
the National Cancer Database (NCDB). Alternative medicine use was defined as ’Other-Unproven: Cancer treatments administered by nonmedical personnel’ administered as sole anti-cancer treatment among patients who did not receive chemotherapy, radiotherapy, surgery, and/or hormone therapy. Treatment selection was evaluated by the chi-square test, t-test, and logistic regression. Patients were 2:1 matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race, year of diagnosis, and cancer type. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. Results: We identified 281 patients who chose alternative medicine in lieu of conventional cancer treatment. Approximately 44% of these patients had breast cancer, followed by prostate (25.5%), lung (18.4%) and colorectal cancer (12.1% of patients). Independent covariates associated with increased likelihood of alternative medicine use included breast or lung primary site (vs. prostate), higher socioeconomic status, Intermountain West or Pacific location (vs. Northeast), stages II or III (vs. I) and Charlson-Deyo comorbidity score of 0 (vs. 1). Alternative medicine was independently associated with greater risk of death compared to conventional cancer treatment overall (HR: 2.50, 95% confidence interval 1.88-3.27) and in subgroups of patients with breast (HR: 5.68, 95%CI 3.22-10.04), lung (HR: 2.17, 95%CI 1.423.32), and colorectal cancer (HR: 4.57, 95%CI 1.66-12.61). Conclusion: Alternative medicine utilization in patients with cancer is rare and varied by geographic, socioeconomic, and disease-related factors. Patients who chose alternative medicine for primary treatment of their curable cancer had greater risk of death compared to those who chose conventional cancer treatment. Author Disclosure: S.B. Johnson: None. H.S. Park: Employee; Yale-New Haven Hospital. C.P. Gross: Research Grant; 21st Century Oncology. J.B. Yu: None.
2953 Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement J. Kao,1 A. Zucker,1 E. Mauer,2 A.T. Wong,3 P. Christos,2 and J. Kang4; 1 Good Samaritan Hospital Medical Center, West Islip, NY, 2Weill Cornell Medicine, New York, NY, 3Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 4Cornell University Medicine, New York, NY Purpose/Objective(s): In recent years, significant changes in health care policy have been reported to dramatically affect oncology practice. In this context, we examined the effect of practice structure on volume and payments for radiation oncology services using the 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for New York State radiation oncologists. Materials/Methods: The Medicare POSPUF data was utilized, and individual physicians classified into freestanding office-based and hospitalbased practices. Freestanding practices were further subdivided in urology, hematology-oncology and other ownership structures. Additional variables analyzed include gender, year of medical school graduation and Herfindahl-Hirschman Index (HHI) as a measure of economic competition. Results: There were 236 New York State radiation oncologists identified in the 2013 Medicare POSPUF dataset, with total reimbursement of $91,525,855. Among freestanding centers, mean global Medicare reimbursement was $832,974. Global Medicare reimbursement was $1,328,743 for urology practices compared to $754,567 for hematology-oncology practices and $691,821 for other ownership structures (p<0.05). Mean volume of on treatment visits (OTVs) was 240.5 per year, varying by practice structure. The mean annual OTVs for urology practices, hematologyoncology practices, other freestanding practices and hospital-based programs was 424.6, 311.5, 247.5 and 209.3, respectively (p<0.001). After correcting for gender, physician experience and HHI, practice structure was associated with freestanding reimbursement and on treatment visit volume. Conclusion: Higher Medicare payment was significantly predicted by type of practice structure, with urology-based and hematology-oncology practices accounting for highest reimbursement and treatment visit volume.