Influences on oncologists' adoption of new agents in adjuvant chemotherapy of breast cancer

Physicians’ relationship with the pharmaceutical industry and its reflection in introduction of a new drug

Purpose

This study aims to examine the attitudes of physicians towards the pharmaceutical industry and investigates how these are reflected when a new drug is introduced.

Design/methodology/approach

The qualitative theme-interview study adopts the innovation diffusion perspective and is conducted with 22 general practitioners and specialists.

Findings

Physicians’ positive relationship orientation and active interaction can result in early adoption of new drugs with product advantage. In comparison, negatively oriented and passively interacting physicians will adopt a new drug later based on research evidence- and experience-based reasoning and opinions of their colleagues.

Research limitations/implications

The objective was to obtain a deeper understanding of the research themes. Further qualitative studies in different countries and health care environments with a larger sample size would improve generalizability of results.

Practical implications

It’s necessary to find an optimal win – win situation that fulfils both parties’ needs, while decreasing unnecessary and time-consuming marketing activities and avoiding waste of limited resources and allowing physicians to participate in activities that better serve their primary needs. Managers in pharmaceutical companies should ensure their sales representatives act in appropriate and professional ways, interact openly and reciprocally and provide accurate and objective information.

Originality/value

The study demonstrates that the physician–pharmaceutical industry relationship has developed from being ethically precarious and having non-professional related personal benefits, towards becoming a more sustainable collaboration. The mutually beneficial collaboration supports physicians’ professional development, enabling better patient care and relieving strain on limited resources.

The diffusion of docetaxel in patients with metastatic prostate cancer

BACKGROUND

Diffusion of new cancer treatments can be both inefficient and incomplete. The uptake of new treatments over time (diffusion) has not been well studied. We analyzed the diffusion of docetaxel in metastatic prostate cancer.

METHODS

We identified metastatic prostate cancer patients diagnosed from 1995 to 2007 using the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare database. Medicare claims through 2008 were analyzed. We assessed cumulative incidence of docetaxel by socioeconomic, demographic, and comorbidity variables, and compared diffusion patterns to landmark events including release of phase III results and FDA approval dates. We compared docetaxel diffusion patterns in prostate cancer to those in metastatic breast, lung, ovarian, and gastric cancers. To model docetaxel use over time, we used the classic "mixed influence" deterministic diffusion model. All statistical tests were two-sided.

RESULTS

We identified 6561 metastatic prostate cancer patients; 1350 subsequently received chemotherapy. Among patients who received chemotherapy, docetaxel use was 95% by 2008. Docetaxel uptake was statistically significantly slower (P < .01) for patients older than 65 years, blacks, patients in lower income areas, and those who experienced poverty. Eighty percent of docetaxel diffusion occurred prior to the May, 2004 release of phase III results showing superiority of docetaxel over standard-of-care. The maximum increase in the rate of use of docetaxel occurred nearly simultaneously for prostate cancer as for all other cancers combined (in 2000).

CONCLUSION

Efforts to increase the diffusion of treatments with proven survival benefits among disadvantaged populations could lead to cancer population survival gains. Docetaxel diffusion mostly preceded phase III evidence for its efficacy in castration-resistant prostate cancer, and appeared to be a cancer-wide-rather than a disease-specific-phenomenon. Diffusion prior to definitive evidence indicates the prevalence of off-label chemotherapy use.

Uptake and patterns of use of gemcitabine for metastatic pancreatic cancer: a population-based study

Gemcitabine was approved for advanced pancreatic cancer in 1996. We investigated uptake and predictors of its use. We identified 3,231 individuals > 65 years in the SEER-Medicare database with stage IV pancreatic adenocarcinoma, diagnosed between 1998-2005, who survived > 30 days. Of these, 54% received chemotherapy, 93% with gemcitabine. Gemcitabine nonreceipt was associated with advanced age and unmarried (OR: 0.65, 95% CI: 0.55-0.76). Diagnosis in 2004-2005 versus 1998-2000 was more likely to receive gemcitabine (OR: 1.51, 95% CI: 1.23-1.84) as were higher SES patients (highest versus lowest quintile, OR: 2.14, 95% CI: 1.60-2.85). Gemcitabine was rapidly adopted among elderly advanced pancreatic cancer patients; several factors are associated with use.

Uptake of oxaliplatin and bevacizumab for treatment of node-positive and metastatic colon cancer

PURPOSE

In 2004, the US Food and Drug Administration approved bevacizumab and oxaliplatin for use in metastatic colon cancer and oxaliplatin for localized colon cancer. We investigated the diffusion and predictors of use of these medications in the year after approval.

PATIENTS AND METHODS

We used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients older than 65 years diagnosed with stages III and IV colon cancer in 2005. Characteristics of the treating oncologists were identified using the American Medical Association database. We used logistic regression and generalized estimating equations to analyze factors associated with bevacizumab and oxaliplatin use.

RESULTS

Among 1,547 patients with stage III colon cancer who had claims submitted by oncologists, 801 (51.8%) received adjuvant chemotherapy, and of those, 432 (54.1%) received oxaliplatin, whereas 54 (6.7%) received off-label bevacizumab. Among 859 patients with stage IV disease who saw oncologists, 435 (50.6%) received chemotherapy, and of those, 310 (71.3%) received bevacizumab, 289 (66.4%) received oxaliplatin, and 357 (82.1%) received oxaliplatin and/or irinotecan. Older patient age and more comorbidities were associated with nonreceipt of oxaliplatin for stage III disease and oxaliplatin and/or irinotecan for stage IV disease. Having a physician who graduated medical school after 1975 predicted receipt of both adjuvant oxaliplatin (odds ratio [OR], 1.65; 95% CI, 1.11 to 2.45) and oxaliplatin and/or irinotecan for stage IV disease (OR, 2.43; 95% CI, 1.47 to 4.01). None of the factors analyzed predicted bevacizumab receipt.

CONCLUSION

Uptake of new chemotherapy drugs for patients diagnosed with stages III and IV colon cancer in 2005 was rapid. Physician characteristics were consistently associated with this uptake.

Characterizing early prescribers of newly marketed drugs in Canada: a population-based study

BACKGROUND

The diffusion of innovations model proposes that early adopters of innovation influence others. This study was undertaken to determine if early prescribers and users of newly marketed drugs had different sociodemographic and professional characteristics as compared to majority and late users and prescribers.

METHODS

After market availability in Manitoba, Canada, of celecoxib, alendronate, clopiodogrel and pantoprazole, time to first prescriptions was determined. Early, majority and late adopters of the new drug were characterized by this diffusion time. The prescription, health and prescriber records were compared across adopter categories. The likelihood of being an early or late prescriber or user of the new medications according to patient demographic characteristics, physician factors (specialty and place of training) and neighborhood income was determined with polytomous logistic regression.

RESULTS

Celecoxib demonstrated a much more rapid uptake into routine use than the other drugs. More than 300 Manitoba physicians prescribed celecoxib within two weeks of market availability. Early prescribers of celecoxib were more likely than majority prescribers to be general practitioners (OR = 1.81, 95%CI: 1.40-2.35) and have hospital affiliations (OR = 1.35, 95%CI: 1.03-1.77). Early users of celecoxib were more likely than the majority to have arthritic conditions, have a high income and have paid out-of-pocket for their prescription. For alendronate, clopidogrel and pantoprazole, only prescription drug coverage predicted adopter category. Early prescribers of one new drug were not early prescribers of the other new drugs.

CONCLUSION

No common group of patients or physicians who were early prescribers or users of all four medications was described.

Systemic therapy

A large body of data on systemic therapy has been presented and published in the past year, including new information on primary risk reduction, patient selection for adjuvant systemic therapy, and anthracycline-analogs. New data on ongoing adjuvant trials (including taxane studies), unpublished updates from the fourth Oxford Overview in September 2000, and provocative data on ovarian ablation were important features of the November 2000 National Institutes of Health Consensus Development Conference on Adjuvant Therapy for Breast Cancer. Important new data on anti-estrogen therapy, including aromatase inhibitors and pure antiestrogens, further expand the role of the oldest targeted breast cancer therapy. Trastuzumab and other novel compounds are being investigated as single-agents and in combination with conventional systemic approaches. Discussions on the long-term effects of adjuvant therapy have taken center stage also. These and other important ongoing developments since 2000 are examined in this review article.