Background: Rural cancer patients often travel long distances to access specialty care. The time and cost of travel and spending an extended period of time away from home can be [ Read More ]
October 2016 VOL 7, NO 9
49. The Association Between Guideline-Recommended Treatment Initiation, Healthy Days, and Patient-Reported Symptoms in Patients with Non–Small Cell Lung Cancer
Adrianne W. Casebeer, PhD, MPP, MS1; Dana Drzayich Antol, MS1; Yong Li, PhD1; Richard W. DeClue, PhD1; Sari Hopson, PhD, MSPH1; Raya Khoury, MPH2; Aparna Parikh, MD2; Alisha Stein, RN-NC, MSN, OCN2; Todd Michael, PharmD, RPh2; Stephen Stemkowski, PhD, MHA1; Mikele Bunce, PhD, MPH2
1Comprehensive Health Insights, Humana Inc, Louisville, KY; 2Genentech Inc, South San Francisco, CA
Objectives: Previous studies have suggested that guideline-recommended therapy improves survival and reduces cost among patients with metastatic non–small cell lung cancer (mNSCLC). The purpose of this study was to explore the relationship between guideline-recommended initiation of therapy (GRI) in patients with mNSCLC and patient-reported outcomes (PROs), such as health-related quality of life (HRQOL) and patient-reported cancer symptoms.
Methods: A retrospective cohort of patients with mNSCLC was identified from medical claims and treatment authorization data for 2013-2014 from Humana, Inc, a large health insurance provider. GRI was defined as receipt of >1 cycle of a National Comprehensive Cancer Network–recommended therapy based on age and performance status (PS) or targeted therapies regardless of age and PS. To evaluate PROs, data from a HRQOL survey conducted in 2014 were merged with claims data. HRQOL was measured by the Centers for Disease Control and Prevention’s Healthy Days measures of overall, physical, and mental unhealthy days in the past 30 days. Patient-reported presence of cancer-related symptoms (pain, fatigue, shortness of breath, nausea/vomiting, diarrhea/constipation) were also captured by the survey. Data were reported as median (interquartile range), with P values generated from Wilcoxon rank sum and chi-square tests.
Results: Of the 1458 patients with mNSCLC, 125 completed the survey. The median age was 72 years, and 44.8% were female. GRI therapy was reported in 82% of patients. There were no differences in age, gender, race/ethnicity, health plan type, comorbidities in the prior 6 months, or Deyo-Charlson Comorbidity Index between patients with GRI and non-GRI therapy. There was no difference in patient-reported pain (50%), fatigue (73%), shortness of breath (62%), nausea/vomiting (20%), or diarrhea/constipation (39%) by GRI. Furthermore, there were no differences in the number of overall (18), physical (10), or mental (4) unhealthy days by GRI, indicating no difference in HRQOL by GRI.
Conclusions: This study did not find an association between GRI and patient-reported HRQOL or cancer-related symptoms in a small cohort of patients with mNSCLC. Future studies should evaluate and consider the relationship between different aspects of guideline recommendations and PROs in a larger cohort.
Sponsor: This work was sponsored by Genentech, Inc.
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