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Hussaini SMQ, Rocque GB. Closing the Gap: Evaluating Medicare's Low-Income Subsidy Support for Optimal Cancer Care. J Clin Oncol 2025; 43:484-486. [PMID: 39661926 PMCID: PMC11798711 DOI: 10.1200/jco-24-02197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 10/30/2024] [Accepted: 11/07/2024] [Indexed: 12/13/2024] Open
Affiliation(s)
- S. M. Qasim Hussaini
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham
- Division of Hematology and Oncology, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Gabrielle B. Rocque
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham
- Division of Hematology and Oncology, Heersink School of Medicine, The University of Alabama at Birmingham
- Division of Gerontology, Geriatrics, and Palliative Care, Heersink School of Medicine, The University of Alabama at Birmingham
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Mitchell AP, Persaud S, Mishra Meza A, Fuchs HE, De P, Tabatabai S, Chakraborty N, Dey P, Trivedi NU, Mailankody S, Blinder V, Green A, Epstein AS, Daly B, Roeker L, Bach PB, Gönen M. Quality of Treatment Selection for Medicare Beneficiaries With Cancer. J Clin Oncol 2025; 43:524-535. [PMID: 39393041 DOI: 10.1200/jco.24.00459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 09/06/2024] [Accepted: 09/13/2024] [Indexed: 10/13/2024] Open
Abstract
PURPOSE The Medicare part D Low-Income Subsidy (LIS) improves access to oral cancer drugs, but provides no assistance for clinician-administered/part B drugs. This analysis assessed the association between LIS participation and receipt of optimal cancer treatment. METHODS We investigated initial systemic therapy using SEER-Medicare data (2015-2017) and National Comprehensive Cancer Network (NCCN) Evidence Blocks (EB) as the standard for treatment recommendations. We included cancer clinical scenarios wherein (1) ≥one treatment was optimal (higher efficacy and safety scores) versus other treatments; (2) identifiable in SEER-Medicare (eg, not defined by clinical data unavailable in registry data or claims); and (3) both EB and ASCO Value Framework agreed regarding optimal treatment. We fit logistic regression models to assess the association between receipt of systemic therapy (v no therapy) and patient and provider characteristics. Contingent on receipt of treatment, we modeled the likelihood of receiving a treatment ranked (by EB scores) within the highest or lowest quartile for that cancer type. RESULTS Nine thousand two hundred and ninety patients were included across 11 clinical scenarios. Fifty-seven percent (5,336) of patients received any systemic therapy and 43% (3,954) received no systemic therapy. Compared with non-LIS participants, LIS participants were less likely to receive any systemic therapy versus no systemic therapy (odds ratio, 0.64 [95% CI, 0.57 to 0.72]). Contingent on receiving systemic therapy, LIS participants received treatment ranked within the worst quartile 24.8% of the time, compared with 21.9% of non-LIS patients (adjusted prevalence difference, 4.3% [95% CI, 0.5 to 8.2]). CONCLUSION LIS participants were less likely to receive systemic therapy at all and were more likely to receive treatments that receive low NCCN EB scores.
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Affiliation(s)
- Aaron P Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sonia Persaud
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Akriti Mishra Meza
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hannah E Fuchs
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prabal De
- Department of Economics and Business, City College of New York, New York, NY
| | - Sara Tabatabai
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nirjhar Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pranam Dey
- Yale University School of Medicine, New Haven, CT
| | | | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victoria Blinder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela Green
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bobby Daly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsey Roeker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Taylor EA, Khodyakov D, Predmore Z, Buttorff C, Kim A. Assessing the feasibility and likelihood of policy options to lower specialty drug costs. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae118. [PMID: 39416396 PMCID: PMC11482634 DOI: 10.1093/haschl/qxae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/26/2024] [Accepted: 09/25/2024] [Indexed: 10/19/2024]
Abstract
Specialty drugs are high-cost medications often used to treat complex chronic conditions. Even with insurance coverage, patients may face very high out-of-pocket costs, which in turn may restrict access. While the Inflation Reduction Act of 2022 included policies designed to reduce specialty drug costs, relatively few policies have been enacted during the past decade. In 2022-2023, we conducted a scoping literature review to identify a range of policy options and selected a set of 9 that have been regularly discussed or recently considered to present to an expert stakeholder panel to seek consensus on (1) the feasibility of implementing each policy and (2) its likely impact on drug costs. Experts rated only 1 policy highly on both feasibility and impact: grouping originator biologics and biosimilars under the same Medicare Part B reimbursement code. They rated 3 policies focused on setting payment limits as likely to have positive (downward) impact on costs but of uncertain feasibility. They considered 4 policies as uncertain on both criteria. Experts rated capping monthly out-of-pocket costs as feasible but unlikely to reduce specialty drug costs. Based on these results, we offer 4 recommendations to policymakers considering ways to reduce specialty drug costs.
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Affiliation(s)
| | | | | | | | - Alice Kim
- RAND, Health Care, Santa Monica, CA 90401, USA
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Zhou M, Chen Y, Gong Y, Zhu M, Cen J, Pan J, Yan L, Shang J, Jin S, Shi X, Yao W, Yan S, Wu D, Chen S, Fu C, Yao L. Evaluation of next-generation sequencing versus next-generation flow cytometry for minimal-residual-disease detection in Chinese patients with multiple myeloma. Discov Oncol 2024; 15:78. [PMID: 38502423 PMCID: PMC10951185 DOI: 10.1007/s12672-024-00938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To evaluate the efficacy of next-generation sequencing (NGS) in minimal-residual-disease (MRD) monitoring in Chinese patients with multiple myeloma (MM). METHODS This study analyzed 60 Chinese MM patients. During MRD monitoring in these patients' post-therapy, clonal immunoglobulin heavy chain (IGH) rearrangements were detected via NGS using LymphoTrack assays. MRD monitoring was performed using NGS or next-generation flow cytometry (NGF), and the results were compared. Additionally, the sensitivity and reproducibility of the NGS method were assessed. RESULTS The MRD detection range of the NGS method was 10-6-10-1, which suggested good linearity, with a Pearson correlation coefficient of 0.985 and a limit of detection of 10-6. Intra- and inter-assay reproducibility analyses showed that NGS exhibited 100% reproducibility with low variability in clonal cells. At diagnosis, unique clones were found in 42 patients (70.0%) with clonal IGH rearrangements, which were used as clonality markers for MRD monitoring post-therapy. Comparison of NGS and NGF for MRD monitoring showed 79.1% concordance. No samples that tested MRD-positive via NGF were found negative via NGS, indicating the higher sensitivity of NGS. MRD could be detected using NGS in 6 of 7 samples before autologous hematopoietic stem-cell transplantation, and 5 of them tested negative post-transplantation. In contrast, the NGF method could detect MRD in only 1 sample pre-transplantation. CONCLUSION Compared with NGF, NGS exhibits higher sensitivity and reproducibility in MRD detection and can be an effective strategy for MRD monitoring in Chinese MM patients.
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Affiliation(s)
- Mo Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
- Hematology Department, Yancheng Third People's Hospital, Yancheng, People's Republic of China
| | - Yan Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Yanlei Gong
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Mingqing Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Jiannong Cen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Jinlan Pan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Lingzhi Yan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Jingjing Shang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Song Jin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Xiaolan Shi
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Weiqin Yao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Shuang Yan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Chengcheng Fu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Li Yao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China.
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Gasoyan H, Fiala MA, Doering M, Vij R, Halpern M, Colditz GA. Disparities in Multiple Myeloma Treatment Patterns in the United States: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e420-e427. [PMID: 37659966 PMCID: PMC10844924 DOI: 10.1016/j.clml.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
We performed a systematic review of the literature investigating the demographic and insurance-related factors linked to disparities in multiple myeloma (MM) care patterns in the United States from 2003 to 2021. Forty-six observational studies were included. Disparities in MM care patterns were reported based on patient race in 76% of studies (34 out of 45 that captured race as a study variable), ethnicity in 60% (12 out of 20), insurance in 77% (17 out of 22), and distance from treating facility, urbanicity, or geographic region in 62% (13 out of 21). A smaller proportion of studies identified disparities in MM care patterns based on other socioeconomic characteristics, with 36% (9 out of 25) identifying disparities based on income estimate or employment status and 43% (6 out of 14) based on language barrier or education-related factors. Sociodemographic characteristics are frequently associated with disparities in care for individuals diagnosed with MM. There is a need for further research regarding modifiable determinants to accessing care such as insurance plan design, patient out-of-pocket costs, preauthorization criteria, as well as social determinants of health. This information can be used to develop actionable strategies for reducing MM health disparities and enhancing timely and high-quality MM care.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH.
| | - Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ravi Vij
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Wondmagegn MT, Nabaasa E, Melesse EA, Kassaw EA. A Framework for Locating Prescribed Medication at Pharmacies. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:127-136. [PMID: 37378052 PMCID: PMC10292612 DOI: 10.2147/iprp.s415674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Accessibility of available medication at pharmacies is one of the core problems in the health sector of developing countries. The mechanism for optimally accessing the available drugs in pharmacies is unclear. Usually, patients in need are compelled to haphazardly switch between pharmacies in search of their prescription medications due to lack of information about the locations of pharmacies with required drug. Objective The primary objective of this study is to develop a framework that will simplify the process of identifying and locating nearest pharmacy when searching for prescribed medications. Methods Primary constraints (distance, drug cost, travel time, travel cost, opening and closing hours of pharmacies) in accessing required prescribed medications from pharmacies were identified from literature, and the client's and pharmacies' latitude and longitude coordinates were used to find the nearest pharmacies that have the required prescribed medication in stock. Results The framework with web application was developed and tested on simulated patients and pharmacies and was successful in optimizing the identified constraints. Discussions The framework will potentially reduce patient expenses and prevent delays in obtaining medication. It will also contribute for future pharmacy and e-Health information systems.
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Affiliation(s)
| | - Evarist Nabaasa
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Ewunate Assaye Kassaw
- Department of Biomedical Engineering, Institute of Technology, University of Gondar, Gondar, Ethiopia
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Jazowski SA, Samuel-Ryals CA, Wood WA, Zullig LL, Trogdon JG, Dusetzina SB. Association between low-income subsidies and inequities in orally administered antimyeloma therapy use. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:246-254. [PMID: 37229783 PMCID: PMC10268034 DOI: 10.37765/ajmc.2023.89357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The Medicare Part D low-income subsidy program drastically reduces patient cost sharing and may improve access to and equitable use of high-cost antimyeloma therapy. We compared initiation of and adherence to orally administered antimyeloma therapy between full-subsidy and nonsubsidy enrollees and assessed the association between full subsidies and racial/ethnic inequities in orally administered antimyeloma treatment use. STUDY DESIGN Retrospective cohort study. METHODS We used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. Separate Cox proportional hazards models assessed time from diagnosis to treatment initiation and time from therapy initiation to discontinuation. Modified Poisson regression examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. RESULTS Receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% (adjusted HR [aHR], 1.22; 95% CI, 1.08-1.38) more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Receipt of full subsidies did not appear to reduce racial/ethnic inequities in orally administered antimyeloma therapy use. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment (full subsidy: aHR, 0.86; 95% CI, 0.73-1.02; nonsubsidy: aHR, 0.86; 95% CI, 0.74-0.99). CONCLUSIONS Full subsidies alone are insufficient to increase uptake or equitable use of orally administered antimyeloma therapy. Addressing known barriers to care (eg, social determinants of health, implicit bias) could improve access to and use of high-cost antimyeloma therapy.
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Affiliation(s)
- Shelley A Jazowski
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, Ste 1200, Nashville, TN 37203.
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Voruganti T, Soulos PR, Mamtani R, Presley CJ, Gross CP. Association Between Age and Survival Trends in Advanced Non-Small Cell Lung Cancer After Adoption of Immunotherapy. JAMA Oncol 2023; 9:334-341. [PMID: 36701150 PMCID: PMC9880865 DOI: 10.1001/jamaoncol.2022.6901] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/21/2022] [Indexed: 01/27/2023]
Abstract
Importance The introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non-small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice. Objective To assess temporal trends in ICI use and survival among patients with advanced NSCLC across age strata. Design, Setting, and Participants This cohort study was performed in approximately 280 predominantly community-based US cancer clinics and included patients aged 18 years or older who had stage IIIB, IIIC, or IV NSCLC diagnosed between January 1, 2011, and December 31, 2019, with follow-up through December 31, 2020. Data were analyzed April 1, 2021, to October 19, 2022. Main Outcomes and Measures Median overall survival and 2-year survival probability. The predicted probability of 2-year survival was calculated using a mixed-effects logit model adjusting for demographic and clinical characteristics. Results The study sample included 53 719 patients (mean [SD] age, 68.5 [9.3] years; 28 374 men [52.8%]), the majority of whom were White individuals (36 316 [67.6%]). The overall receipt of cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019. After the first US Food and Drug Administration approval of an ICI for NSCLC, the use of ICIs increased from 4.7% in 2015 to 45.6% in 2019 (P < .001). Use of ICIs in 2019 was similar between the youngest and oldest patients (aged <55 years, 45.2% vs aged ≥75 years, 43.8%; P = .59). From 2011 to 2018, the predicted probability of 2-year survival increased from 37.7% to 50.3% among patients younger than 55 years and from 30.6% to 36.2% in patients 75 years or older (P < .001). Similarly, median survival in patients younger than 55 years increased from 11.5 months to 16.0 months during the study period, while survival among patients 75 years or older increased from 9.1 months in 2011 to 10.2 months in 2019. Conclusions and Relevance This cohort study found that, among patients with advanced NSCLC, the uptake of ICIs after US Food and Drug Administration approval was rapid across all age groups. However, corresponding survival gains were modest, particularly in the oldest patients.
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Affiliation(s)
- Teja Voruganti
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | - Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Carolyn J. Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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Galleria mellonella as a Novel In Vivo Model to Screen Natural Product-Derived Modulators of Innate Immunity. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136587] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunomodulators are drugs that either stimulate or suppress the immune system in response to an immunopathological disease or cancer. The majority of clinically approved immunomodulators are either chemically synthesised (e.g., dexamethasone) or protein-based (e.g., monoclonal antibodies), whose uses are limited due to toxicity issues, poor bioavailability, or prohibitive cost. Nature is an excellent source of novel compounds, as it is estimated that almost half of all licenced medicines are derived from nature or inspired by natural product (NP) structures. The clinical success of the fungal-derived immunosuppressant cyclosporin A demonstrates the potential of natural products as immunomodulators. Conventionally, the screening of NP molecules for immunomodulation is performed in small animal models; however, there is a growing impetus to replace animal models with more ethical alternatives. One novel approach is the use of Galleria melonella larvae as an in vivo model of immunity. Despite lacking adaptive antigen-specific immunity, this insect possesses an innate immune system comparable to mammals. In this review, we will describe studies that have used this alternative in vivo model to assess the immunomodulating activity of synthetic and NP-derived compounds, outline the array of bioassays employed, and suggest strategies to enhance the use of this model in future research.
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Mitchell AP. We Should Treat Financial Toxicity With Curative, Rather Than Palliative, Intent. JCO Oncol Pract 2022; 18:95-96. [PMID: 34546800 PMCID: PMC9213194 DOI: 10.1200/op.21.00540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Aaron P. Mitchell
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Li M, Diao Y, Ye J, Sun J, Jiang Y. The Public Health Insurance Coverage of Novel Targeted Anticancer Medicines in China-In Favor of Whom? A Retrospective Analysis of the Insurance Claim Data. Front Pharmacol 2022; 12:778940. [PMID: 34992534 PMCID: PMC8724523 DOI: 10.3389/fphar.2021.778940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives: This study took Fuzhou city as a case, described how the public health insurance coverage policy in 2016 of novel anti-lung cancer medicines benefited patients, and who benefited the most from the policy in China. Methods: This was a retrospective study based on health insurance claim data with a longitudinal analysis of the level and trend changes of the monthly number of patients to initiate treatment with the novel targeted anti-lung cancer medicines gefitinib and icotinib before and after health insurance coverage. The study also conducted a multivariate linear regression analysis to predict the potential determinants of the share of patient out-of-pocket (OOP) expenditure for lung cancer treatment with the study medicines. Results: The monthly number of the insured patients in Fuzhou who initiated the treatment with the studied novel targeted anti-lung cancer medication abruptly increased by 26 in the month of the health insurance coverage (95% CI: 14–37, p < 0.01) and kept at an increasing level afterward (p < 0.01). By controlling the other factors, the shares of OOP expenditure for lung cancer treatment of the patients who were formal employee program enrollees not entitled to government-funded supplementary health insurance coverage and resident program enrollees were 18.3% (95% CI: 14.1–22.6) and 26.7% (95% CI: 21.0–32.4) higher than that of the patients who were formal employee program enrollees with government-funded supplementary health insurance coverage. Conclusion: The public health insurance coverage of novel anti-lung cancer medicines benefited patients generally. To enable that patients benefit from this policy more equally and thoroughly, in order to achieve the policy goal of not to leave anyone behind, it is necessary to strengthen the benefits package of the resident program and to optimize the current financing mechanism of the public health insurance system.
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Affiliation(s)
- Mingshuang Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yifan Diao
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Ye
- Healthcare Security Administration of Fujian Province, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Murphy CC, Fullington HM, Gerber DE, Bowman IA, Puligandla M, Dutcher JP, DiPaola RS, Haas NB. Adherence to oral therapies among patients with renal cell carcinoma: Post hoc analysis of the ECOG-ACRIN E2805 trial. Cancer Med 2021; 10:5917-5924. [PMID: 34405965 PMCID: PMC8419781 DOI: 10.1002/cam4.4140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND As use of oral cancer therapies increases, patient adherence has become critical when evaluating the effectiveness of therapy. In a phase III trial for renal cell carcinoma, we: (a) characterized adherence to sorafenib, sunitinib, and/or placebo and (b) identified factors associated with non-adherence. METHODS ECOG-ACRIN E2805 was a double-blind, placebo-controlled, randomized trial comparing adjuvant sorafenib or sunitinib in patients with resected primary renal cell carcinoma at high risk for recurrence. We used patient-completed pill diaries to measure adherence as the number of pills taken divided by the number of pills prescribed. Log-binomial regression was used to identify correlates of non-adherence (<80% of prescribed pills reported as taken). RESULTS Mean adherence was 90.7% among those assigned to sunitinib (n = 613) and 84.8% among those assigned to sorafenib (n = 616). Among those assigned to placebo, mean adherence was 94.9% and 92.4% to sunitinib and sorafenib placebo, respectively. Non-adherence was associated with race/ethnicity (non-Hispanic Black: prevalence ratio [PR] 2.22, 95% CI 1.63, 3.01; Hispanic: PR 1.54, 95% CI 1.05, 2.26), high volume enrollment (≥10 patients: PR 1.30, 95% CI 1.03, 1.64), treatment group (sunitinib: PR 2.24, 95% CI 1.66, 3.02; sorafenib: PR 2.37, 95% CI 1.74, 3.22), and skin rash (PR 1.36, 95% CI 1.03, 1.80). CONCLUSION Among patients participating in a randomized clinical trial, adherence to oral cancer therapies was lower compared to placebo. Adherence was also worse in racial/ethnic minorities, those experiencing toxicities, and high volume enrolling sites. Our findings highlight several challenges to address in clinical practice as use of oral therapies continues to increase. CLINICAL TRIAL REGISTRATION NUMBER This trial is registered with ClinicalTrials.gov, number NCT00326898.
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Affiliation(s)
- Caitlin C Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hannah M Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Maneka Puligandla
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Naomi B Haas
- Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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13
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Joshi H, Lin S, Fei K, Renteria AS, Jacobs H, Mazumdar M, Jagannath S, Bickell NA. Multiple myeloma, race, insurance and treatment. Cancer Epidemiol 2021; 73:101974. [PMID: 34243048 DOI: 10.1016/j.canep.2021.101974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Multiple Myeloma (MM), the second leading blood malignancy, has complex and costly disease management. We studied patterns of treatment disparities and unplanned interruptions among the MM patients after the Affordable Care Act to assess their prevalence and effect on survival. MATERIALS AND METHODS This retrospective study of 1002 MM patients at a tertiary referral center used standard guidelines as a reference to identify underuse of effective treatments. We used multivariate logistic regression and Cox proportionate hazard to study the prognostic effect on survival. RESULTS Median age in the cohort was 63.0 [IQR: 14] years. Non-Hispanic White (NHW) patients were older (p = 0.007) and more likely to present with stage I disease (p = 0.02). Underuse of maintenance therapy (aOR = 1.98; 95 % CI 1.12-3.48) and interruptions in treatment were associated with race/ethnicity and insurance (aOR = 4.14; 95 % CI: 1.78-9.74). Only underuse of induction therapy was associated with overall patient survival. CONCLUSION Age, race, ethnicity and primary insurance contribute to the underuse of treatment and in unplanned interruptions in MM treatment. Addressing underuse causes in such patients is warranted.
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Affiliation(s)
- Himanshu Joshi
- Institute for Healthcare Delivery Science, NY, NY, United States; Department of Population Health Science and Policy, NY, NY, United States; Tisch Cancer Institute all at the Icahn School of Medicine at Mount Sinai, NY, NY, United States
| | - Sylvia Lin
- Department of Population Health Science and Policy, NY, NY, United States
| | - Kezhen Fei
- Department of Population Health Science and Policy, NY, NY, United States; Tisch Cancer Institute all at the Icahn School of Medicine at Mount Sinai, NY, NY, United States
| | - Anne S Renteria
- Department of Hematology and Medical Oncology, NY, NY, United States
| | - Hannah Jacobs
- Department of Population Health Science and Policy, NY, NY, United States
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, NY, NY, United States; Department of Population Health Science and Policy, NY, NY, United States; Tisch Cancer Institute all at the Icahn School of Medicine at Mount Sinai, NY, NY, United States
| | - Sundar Jagannath
- Department of Hematology and Medical Oncology, NY, NY, United States
| | - Nina A Bickell
- Department of Population Health Science and Policy, NY, NY, United States; Center for Health Equity and Community Engaged Research, NY, NY, United States; Tisch Cancer Institute all at the Icahn School of Medicine at Mount Sinai, NY, NY, United States.
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14
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Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
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15
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Silveira LP, Pádua CAMD, Drummond PLDM, Malta JS, Santos RMMD, Costa NL, Machado TRL, Hauck LM, Reis AMM. Adherence to thalidomide in patients with multiple myeloma: A cross-sectional study in a Brazilian metropolis. J Oncol Pharm Pract 2021; 28:373-380. [PMID: 33583251 DOI: 10.1177/1078155221993528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE The treatment of multiple myeloma (MM) has advanced with the introduction of immunomodulators (IMiDS). Thalidomide is the IMiD available in Brazil with free access to MM patients. Adherence to treatment with IMiDs is essential for a successful therapy. The study proposed to describe adherence to thalidomide treatment in patients diagnosed with MM in onco-hematological outpatient clinics. METHODS This is a cross-sectional study with patients over 18 years of age diagnosed with MM undergoing thalidomide treatment. Adherence was measured by the Proportion of Days Covered (PDC), which is an indirect method of measuring adherence that uses database-related medication dispensing information. Patients with PDC ≥90 were classified as adherent. The association between adherence and independent variables was assessed in univariate and multivariate analyses using logistic regression. RESULTS A total of 65 patients with a median age of 62.6 years were identified. The median PDC was 93.7%. The frequency of adherence to thalidomide was 56.9%. Adherence to thalidomide showed a negative association with hospitalization in the last 12 months (OR = 0.202; 95% CI = 0.060-0.687) and with higher schooling (OR =0.161; 95% CI = 0.039-0.667) and a positive association with higher income (OR = 5.115; 95% CI = 1.363-19.190). CONCLUSION Most patients from onco-hematological outpatient clinics in a metropolitan region of southeastern Brazil showed high adherence to thalidomide, which was independently associated with higher income, hospitalization, and higher schooling. More studies are required to understand better the determinants of adherence to thalidomide in the country.
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Affiliation(s)
- Lívia Pena Silveira
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paula Lana de Miranda Drummond
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Jéssica Soares Malta
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Naiane Lima Costa
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Lucas Motta Hauck
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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16
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Chou YT, Farley JF, Stinchcombe TE, Proctor AE, Lafata JE, Dusetzina SB. The Association Between Medicare Low-Income Subsidy and Anticancer Treatment Uptake in Advanced Lung Cancer. J Natl Cancer Inst 2021; 112:637-646. [PMID: 31501872 DOI: 10.1093/jnci/djz183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND High out-of-pocket costs may impact anticancer treatment uptake. The Low-Income Subsidy (LIS) program can reduce patient out-of-pocket cost for Medicare Part D-covered treatments. We examined whether the LIS increased uptake and reduced time to initiate orally administered anticancer drugs in patients with advanced non-small cell lung cancer (NSCLC). METHODS Using Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified older adults (aged 65 years and older) diagnosed with advanced NSCLC from 2007 through 2013 and categorized them as full LIS, partial LIS, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control because supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided. RESULTS Among 19 746 advanced NSCLC patients, approximately 10% initiated Part D treatments. Patients with partial or no LIS were less likely to initiate Part D treatments than were those with full subsidies (partial LIS vs full LIS HRIPTW = 0.77, 95% confidence interval = 0.62 to 0.97; non-LIS vs full LIS HRIPTW = 0.87, 95% confidence interval = 0.79 to 0.95). Time to initiate Part D treatments was also slightly shorter among full-LIS patients (full LIS mean [SD] = 10.8 [0.04] months; partial LIS mean [SD] = 11.3 [0.08] months; and non-LIS mean [SD] = 11.1 [0.03] months, P < .001). Conversely, patients with partial or no LIS had shorter time to initiation of Part B drugs. CONCLUSIONS Patients receiving the full LIS had higher orally administered anticancer treatment uptake than patients without LIS. Notably, patients with partial LIS had the lowest treatment uptake, likely because of their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full LIS.
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Affiliation(s)
- Yi-Ting Chou
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Joel F Farley
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Thomas E Stinchcombe
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Durham, NC
| | - Amber E Proctor
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC.,Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.,UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN.,Vanderbilt-Ingram Cancer Center, Nashville, TN
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17
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Barth P, Giri S, Reagan JL, Olszewski AJ. Outcomes of lenalidomide- or bortezomib-based regimens in older patients with plasma cell myeloma. Am J Hematol 2021; 96:14-22. [PMID: 32918301 DOI: 10.1002/ajh.25996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/05/2020] [Accepted: 09/06/2020] [Indexed: 11/12/2022]
Abstract
The "triplet" regimen of lenalidomide, bortezomib, and dexamethasone (RVD) showed survival advantage over lenalidomide-dexamethasone (RD) in clinical trials, but older patients with myeloma often receive doublet regimens (RD or bortezomib-dexamethasone, VD), or VD plus cyclophosphamide (VCD). We compared these first-line regimens using real-world data from Medicare beneficiaries receiving therapy between 2007 and 2015. In each comparative analysis, we balanced confounding characteristics using a propensity score. Outcomes included overall (OS) and event-free survival (EFS, reporting hazard ratios [HR] with 95% confidence intervals [CI]), adverse events, and costs. We identified 6076 patients with median age 76 and median OS of 2.6 years. In the comparison of RVD vs RD/VD doublets, RVD showed significantly better OS (HR = 0.83; 95% CI, 0.72-0.95) and EFS (HR = 0.68; 95% CI, 0.61-0.76). So, RVD was associated with more frequent hospitalizations, anemia, and neuropathy, but no increase in thromboembolism or secondary cancers. Costs were higher with RVD. In the comparison of RD vs VD, RD demonstrated better EFS (HR = 0.74; 95% CI, 0.68-0.81) and marginally better OS (HR = 0.91; 95% CI, 0.83-0.99). And, RD resulted in significantly more thromboembolic events, less neuropathy, and no significant difference in hospitalizations, transfusions, or secondary cancers. In the comparison of VCD vs VD, we observed no significant difference in any outcome. Superior survival favors RVD over doublet regimens, but even in 2015 RVD was applied for only about 25% of Medicare beneficiaries with myeloma. For patients not eligible for RVD due to toxicity, VCD offers no survival benefit over VD. Lenalidomide-dexamethasone may be the preferred line doublet considering its advantage over VD.
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Affiliation(s)
- Peter Barth
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology/Oncology Rhode Island Hospital/The Miriam Hospital Providence Rhode Island
| | - Smith Giri
- Division of Hematology/Oncology University of Alabama at Birmingham Birmingham Alabama
| | - John L Reagan
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology/Oncology Rhode Island Hospital/The Miriam Hospital Providence Rhode Island
| | - Adam J Olszewski
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology/Oncology Rhode Island Hospital/The Miriam Hospital Providence Rhode Island
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18
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Périchou J, Ranchon F, Herledan C, Huot L, Larbre V, Carpentier I, Lazareth A, Karlin L, Beny K, Vantard N, Schwiertz V, Caffin AG, Baudouin A, Sesques P, Brisou G, Ghesquières H, Salles G, Rioufol C. Immunomodulatory drugs in multiple myeloma: Impact of the SCARMET (Self CARe and MEdication Toxicity) educational intervention on outpatients' knowledge to manage adverse effects. PLoS One 2020; 15:e0243309. [PMID: 33275634 PMCID: PMC7717911 DOI: 10.1371/journal.pone.0243309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Long-term multiple myeloma therapy by immunomodulatory drugs (IMiDs) raises the question of management of adverse effects. The aim of this study is to assess the impact of an educational session for patients on the acquisition of knowledge to manage hematologic and thromboembolic adverse effects of IMiDs. In this prospective single-center study, patients attended an educational session with a hospital clinical pharmacist and a nurse. The primary endpoint was the patient's level of knowledge for the management of IMiDs adverse effects, assess with a dedicated questionnaire administered before the session then 1 and 6 months after. Assessment of knowledge was combined with self-assessment of certainty. The secondary endpoints were adherence and IMiD treatment satisfaction. 50 patients were included. Patient knowledge increased at 1 month (p<0.001) despite a loss of knowledge at 6 months (p<0.05). Six months after the educational intervention, the number of patients with skills considered satisfactory by the pharmacist and nurse increased (p<0.01). Most patients showed satisfactory adherence, with medication possession ratio ≥ 80%. The Self CARe and MEdication Toxicity (SCARMET) study highlighted the impact of multidisciplinary follow-up in multiple myeloma patients to improve knowledge of toxicity self-management.
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Affiliation(s)
- Juliette Périchou
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Laure Huot
- Département de la Recherche Clinique et de l’Innovation, Cellule Innovation, Hospices Civils de Lyon, Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | | | - Anne Lazareth
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Lionel Karlin
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Karen Beny
- Pharmacie Centrale, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicolas Vantard
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Vérane Schwiertz
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Anne Gaelle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Pierre Sesques
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gabriel Brisou
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Ghesquières
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gilles Salles
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Université Lyon 1, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
- * E-mail:
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19
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Hartung DM, Johnston KA, McGregor JC, Bourdette DN. The effect of out-of-pocket costs on initiation of disease-modifying therapies among medicare beneficiaries with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102554. [DOI: 10.1016/j.msard.2020.102554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 02/08/2023]
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20
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Seymour EK, Ruterbusch JJ, Winn AN, George JA, Beebe-Dimmer JL, Schiffer CA. The costs of treating and not treating patients with chronic myeloid leukemia with tyrosine kinase inhibitors among Medicare patients in the United States. Cancer 2020; 127:93-102. [PMID: 33119175 DOI: 10.1002/cncr.33267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with high cost-sharing of tyrosine kinase inhibitors (TKIs) experience delays in treatment for chronic myeloid leukemia (CML). To the authors' knowledge, the clinical outcomes among and costs for patients not receiving TKIs are not well defined. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors evaluated differences in TKI initiation, health care use, cost, and survival among patients with CML with continuous Medicare Parts A and B and Part D coverage who were diagnosed between 2007 and 2015. RESULTS A total of 941 patients were included. Approximately 29% of all patients did not initiate treatment with TKIs within 6 months (non-TKI users), and had lower rates of BCR-ABL testing and more hospitalizations compared with TKI users. Approximately 21% were not found to have any TKI claims at any time. TKI initiation rates within 6 months of diagnosis increased for all patients over time (61% to 85%), with greater improvements observed in patients receiving subsidies (55% to 90%). Total Medicare costs were greater in patients treated with TKIs, with approximately 50% because of TKI costs. Non-TKI users had more inpatient costs compared with TKI users. Trends in cost remained significant when adjusting for age and comorbidities. The median overall survival was 40 months (95% confidence interval [95% CI], 34-48 months) compared with 86 months (95% CI, 73 months to not reached), respectively, for non-TKI users versus TKI users, a finding that remained consistent when adjusting for age, comorbidities, and subsidy status (hazard ratio, 2.23; 95% CI, 1.77-2.81). CONCLUSIONS Approximately 21% of all patients with CML did not receive TKIs at any time. Cost-sharing subsidies consistently are found to be associated with higher initiation rates. Non-TKI users had higher inpatient costs and poorer survival outcomes. Interventions to lower TKI costs for all patients are desirable.
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Affiliation(s)
- Erlene K Seymour
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Julie J Ruterbusch
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Aaron N Winn
- Department of Clinical Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julie A George
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Charles A Schiffer
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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21
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Ziakas PD, Mylonakis E. Medicare Part D Spending on Drugs Prescribed by Oncologists: Temporal Trends and Regional Variation. JCO Oncol Pract 2020; 17:e433-e439. [PMID: 32813601 DOI: 10.1200/op.20.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Drug cost is a significant factor in the ever-increasing expenditures for cancer health care. METHODS We used Medicare Part D administrative data to explore prescribing patterns and attributed drug costs of oncologists from 2013 to 2017. We highlighted regional variation in spending and potential associations. We used the location quotient (LQ) to measure the relative concentration of oncologists compared with the national average by hospital referral regions. Costs were reported in 2017 US dollars (inflation adjusted) for cross-year comparisons. RESULTS Oncology's share in Part D spending showed an uninterrupted increasing trend. In 2017, oncologists prescribed medicines with $12.8 billion in Part D costs (8.3% of all Part D payments), which exceeded 2013 costs by $7.3 billion, when their claim payments were $5.5 billion (5.0% of all Part D payments). Oncology contributed a higher annual growth in Part D drug costs compared with all other providers (15.1% and 3.1%, respectively, for 2017). The top 3 drugs increased cost by approximately $3.5 billion from 2013 to 2017. Across hospital referral regions, the oncologists' Part D share varied (median in 2017, 7.7%; interquartile range, 6.2%-9.3%) and was higher across regions where oncologists had an LQ significantly > 1 (mostly in areas with centers that excel in cancer care) and lower for an LQ significantly < 1 (median, 9.7% v 6.2%, respectively; P < .001). CONCLUSION Oncology increased its share in Part D drug spending, disproportionately to all other providers, with regional differences partially moderated by the oncology workforce and quality of cancer care.
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Giri S, Barth P, Costa LJ, Olszewski AJ. Second primary malignancy among older adults with multiple myeloma receiving first-line lenalidomide-based therapy: A population-based analysis. J Geriatr Oncol 2020; 12:256-261. [PMID: 32684352 DOI: 10.1016/j.jgo.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Clinical trials have suggested that patients with myeloma treated with lenalidomide may have an increased risk of second primary malignancies (SPM). Whether such risks are of significant relevance in the real-world clinical practice, particularly among older patients receiving first-line lenalidomide based therapy, remains unclear. METHODS Using Surveillance Epidemiology and End Results-Medicare database, we identified adults ≥ 65 years with plasma cell myeloma diagnosed in 2007-2015 who received at least one oral anti-myeloma agent. We defined first-line lenalidomide-containing therapy as use within 90 days of diagnosis. SPM was defined as a malignancy reported to a cancer registry > 90 days after myeloma diagnosis. We computed cumulative incidence of SPM (with death being a competing event) and compared SPM rates between patients treated with or without first-line lenalidomide using a Fine-Gray's model, adjusting for age, sex, race, ethnicity, prior malignancy, and histologic subtype. RESULTS Of 9850 Medicare beneficiaries, 4009 (41%) received first-line lenalidomide. During median follow up of 5.0 years, 423 patients (4.3%) developed SPM, including 361 solid tumors (85%) and 61 hematologic malignancies (14%). The cumulative incidence of any SPM at 5 years was similar among those who received first-line lenalidomide and those who did not (5.3% vs 4.4%; sub-hazard ratio, SHR 1.06, P = .53). Consistent results were seen in the risk of solid tumor (4.7% vs 3.6%; SHR 1.13, P = .24) or hematologic malignancy (4.7 vs 3.6%, SHR 0.73; P = .72). CONCLUSION First-line lenalidomide therapy among older adults with myeloma was not associated with a significantly increased risk of any SPM.
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Affiliation(s)
- Smith Giri
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States of America; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Peter Barth
- Alpert Medical School of Brown University, Providence, RI, United States of America; Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States of America
| | - Luciano J Costa
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Adam J Olszewski
- Alpert Medical School of Brown University, Providence, RI, United States of America; Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States of America
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Saphire ML, Prsic EH, Canavan ME, Wang SYJ, Presley CJ, Davidoff AJ. Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer. J Pain Symptom Manage 2020; 59:767-777.e1. [PMID: 31778783 PMCID: PMC7338983 DOI: 10.1016/j.jpainsymman.2019.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. OBJECTIVES We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. METHODS This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. RESULTS Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. CONCLUSION Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patient-provider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.
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Affiliation(s)
- Maureen L Saphire
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | - Maureen E Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, Connecticut, USA
| | - Shi-Yi J Wang
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA; Yale Cancer Center, New Haven, Connecticut, USA
| | - Carolyn J Presley
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA; Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, Connecticut, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA; Yale Cancer Center, New Haven, Connecticut, USA.
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Olszewski AJ, Butera JN, Reagan JL, Castillo JJ. Outcomes of bendamustine- or cyclophosphamide-based first-line chemotherapy in older patients with indolent B-cell lymphoma. Am J Hematol 2020; 95:354-361. [PMID: 31849108 DOI: 10.1002/ajh.25707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
Clinical trials comparing bendamustine/rituximab (BR) with cyclophosphamide-based regimens (RCHOP/RCVP) have pooled various histologies of indolent B-cell lymphomas. We examined real-life outcomes of older patients with follicular (FL), mantle cell (MCL), or marginal zone/lymphoplasmacytic lymphoma (MZL/LPL), treated with these first-line regimens. We identified Medicare beneficiaries with FL, MCL, or MZL/LPL, who received either first-line BR or RCHOP/RCVP in 2009-2016, and matched groups using a propensity score. Outcomes of claims-based event-free survival (EFS), overall survival (OS), toxicity, secondary cancers, and costs were compared in the aggregate cohort (N = 2736), and in separately matched histology-specific subcohorts. In the aggregate cohort, EFS was better with BR than with RCHOP/RCVP (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70-0.87). Acute toxicity was lower with BR, including rates of hospitalizations (33% vs 45%), infections (21% vs 30%), cardiovascular events, and transfusions, yet OS did not differ (HR, 1.03; 95% CI, 0.91-1.17) and Medicare spending was higher. There was no difference in the cumulative incidence of secondary cancers (subhazard ratio, 1.11; 95% CI, 0.83-1.48). The EFS advantage of BR was pronounced in MCL (N = 690; HR, 0.64; 95% CI, 0.54-0.76), but less so in FL (N = 1330; HR, 0.83; 95% CI, 0.69-0.98) and absent in MZL/LPL (N = 574; HR, 0.92; 95% CI, 0.73-1.17). Despite improved EFS and lower toxicity, the shift from RCHOP/RCVP to BR in clinical practice did not improve OS for older patients with indolent B-cell lymphomas. Frequent infections and hospitalizations underscore the need for safer treatment approaches in this population. Secondary cancers do not appear to be increased after BR compared with RCHOP/RCVP.
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Affiliation(s)
- Adam J. Olszewski
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - James N. Butera
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - John L. Reagan
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Jorge J. Castillo
- Division of Hematologic Oncology Dana Farber Cancer Institute Boston Massachusetts
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Leng S, Bhutani D, Lentzsch S. How I treat a refractory myeloma patient who is not eligible for a clinical trial. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:125-136. [PMID: 31808850 PMCID: PMC6913488 DOI: 10.1182/hematology.2019000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Myeloma patients not eligible for clinical trials have many treatment options. Choosing the next best therapy starts with careful assessment of the biology and dynamics of the disease at relapse, as well as the condition and situation of the patient. Fit patients should be considered for triplet regimens, whereas intermediate and frail patients warrant dose-reduced triplets or doublets. An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress.
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Affiliation(s)
- Siyang Leng
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Divaya Bhutani
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Suzanne Lentzsch
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Huntington SF, Davidoff AJ, Gross CP. Precision Medicine in Oncology II: Economics of Targeted Agents and Immuno-Oncology Drugs. J Clin Oncol 2019; 38:351-358. [PMID: 31804866 DOI: 10.1200/jco.19.01573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Murphy CC, Lee SJC, Gerber DE, Cox JV, Fullington HM, Higashi RT. Patient and provider perspectives on delivery of oral cancer therapies. PATIENT EDUCATION AND COUNSELING 2019; 102:2102-2109. [PMID: 31239181 PMCID: PMC6777994 DOI: 10.1016/j.pec.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The introduction of oral cancer therapies presents new challenges to delivery of quality cancer care. Little is known about how patients and providers address and overcome these challenges. We conducted a qualitative study exploring the range of patient and provider perspectives on oral cancer therapies. METHODS We conducted semi-structured interviews with patients and providers at a tertiary referral center and county safety-net hospital in Dallas, TX. Interviews probed perspectives on differences between parenteral chemotherapy and oral therapies, adherence, communication, and cost/insurance. Interview transcripts were analyzed thematically using a deductively-driven coding scheme corresponding to the interview guide. RESULTS We conducted 22 patient (13 at tertiary referral center, 9 at safety-net hospital) and 10 provider (7 oncologists, 2 nurses, 1 pharmacist) interviews. Key themes from interviews included: (1) differences in parenteral chemotherapy vs. oral therapy; (2) adherence and dosing; and (3) experiences related to cost and communication. CONCLUSIONS Nearly all providers described challenges engaging with and educating patients about oral cancer therapies. Despite our initial hypothesis, safety-net patients encountered few barriers accessing oral therapies compared to patients receiving care in the tertiary referral center. PRACTICE IMPLICATIONS Our findings will guide future interventions to monitor and support cancer patients receiving oral therapies.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - John V Cox
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA; Parkland Health & Hospital System, Dallas, TX, USA
| | - Hannah M Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robin T Higashi
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Patterns of pain medication use associated with reported pain interference in older adults with and without cancer. Support Care Cancer 2019; 28:3061-3072. [PMID: 31637515 DOI: 10.1007/s00520-019-05074-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. OBJECTIVES To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer. METHODS Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy. RESULTS Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication. CONCLUSIONS Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.
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Mian H, Fiala M, Wildes TM. Adherence to Lenalidomide in Older Adults With Newly Diagnosed Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:98-104.e1. [PMID: 31843543 DOI: 10.1016/j.clml.2019.09.618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION One of the most common orally administered antimyeloma agents, lenalidomide, has significantly improved outcomes in multiple myeloma, including in older patients. However, despite its utilization and cost, the rates and factors related to adherence to lenalidomide in older adults with newly diagnosed multiple myeloma remain unknown. PATIENTS AND METHODS Data were collected from adults with newly diagnosed multiple myeloma over age 65 years being treated with lenalidomide therapy between the years 2007 and 2014 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Adherence was measured as medication possession ratio (MPR), which was defined as the ratio of the number of days the patient had pills in their possession to the number of days in the observation period in the first year after myeloma diagnosis. MPR of < 90% was considered poor adherence. RESULTS A total of 793 patients were included in the analysis. The mean MPR in our cohort was 89.5 ± 9.3%. Overall, 38% (n = 302) of the patients were considered to have poor adherence. Factors associated with poor adherence included increasing age (adjusted odds ratio [aOR] = 1.03 per year; 95% confidence interval [CI], 1.00-1.05; P = .024), black race (aOR = 1.72; 95% CI, 1.08-2.73; P = .022), and polypharmacy (aOR = 1.04 per medication; 95% CI, 1.01-1.08; P = .008). CONCLUSION Over a third of older adults with newly diagnosed multiple myeloma were considered to have poor adherence to lenalidomide, using the MPR as a surrogate for adherence. This highlights the need to further understand factors and devise strategies to support adherence in this patient cohort.
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Affiliation(s)
- Hira Mian
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada.
| | - Mark Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
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Olszewski AJ, Barth PM, Reagan JL. Use of bone-modifying agents and clinical outcomes in older adults with multiple myeloma. Cancer Med 2019; 8:6945-6954. [PMID: 31566898 PMCID: PMC6853813 DOI: 10.1002/cam4.2591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/04/2019] [Accepted: 09/04/2019] [Indexed: 12/28/2022] Open
Abstract
Background Guidelines recommend bone‐modifying agents (BMAs) for all patients initiating treatment for myeloma. We examined adherence to this recommendation, and BMA effectiveness in the era of bortezomib/lenalidomide‐based therapy among Medicare beneficiaries. Methods From the linked Surveillance, Epidemiology, and End Results‐Medicare registry, we selected beneficiaries receiving anti‐myeloma chemotherapy in 2007‐2013. We matched BMA recipients (within 90 days of first chemotherapy) to nonrecipients using a propensity score, balancing patient‐, disease‐, and therapy‐related confounders. Cumulative incidence of skeletal‐related events (SREs) and overall survival (OS) was compared in proportional hazard models accounting for competing risks and immortal‐time bias. Results Among 4611 patients with median age of 76 years, 51% received BMA. Bone‐modifying agents use remained steady over time (P = .87) and was significantly less frequent for patients who were older, with comorbidities, without prior SRE, and those treated without bortezomib or lenalidomide. In a propensity score‐matched cohort, BMA recipients experienced a lower incidence of SRE (11.0% vs 14.6% at 3 years; subhazard ratio, 0.73; 95% CI, 0.60‐0.89) and better OS (53.3% vs 47.8% at 3 years; hazard ratio, 0.86; 95% CI, 0.77‐0.95). The results were consistent in the subgroup (76%) treated with bortezomib and/or immunomodulatory drugs (IMiDs). The incidence of osteonecrosis of the jaw (ONJ) was 3.2% at 3 years. Conclusions In this observational study, the observed benefits of early BMA administration among patients treated with contemporary anti‐myeloma regimens were similar to historical clinical trials. Frequent omission of BMA highlights a remediable deficiency in the quality of supportive care, and suggests that timely administration may be a useful indicator of quality care in myeloma.
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Affiliation(s)
- Adam J Olszewski
- Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, USA
| | - Peter M Barth
- Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, USA
| | - John L Reagan
- Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, USA
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Li P, Jahnke J, Pettit AR, Wong YN, Doshi JA. Comparative Survival Associated With Use of Targeted vs Nontargeted Therapy in Medicare Patients With Metastatic Renal Cell Carcinoma. JAMA Netw Open 2019; 2:e195806. [PMID: 31199450 PMCID: PMC6575152 DOI: 10.1001/jamanetworkopen.2019.5806] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Targeted therapies for advanced renal cell carcinoma (RCC) have shown increased tolerability and survival advantages over older treatments in clinical trials, but understanding of real-world survival improvements is still emerging. OBJECTIVE To compare overall and RCC-specific survival associated with use of targeted vs nontargeted therapy for metastatic RCC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data from 2000 to 2013 to examine patients with stage IV (distant) clear cell RCC at the time of diagnosis who received any targeted or nontargeted therapy. A 2-stage residual inclusion model was fitted to estimate the survival advantages of targeted treatments using an instrumental variable approach to account for both measured and unmeasured group differences. Data analyses were conducted from July 24, 2017, to April 4, 2019. EXPOSURES Targeted therapy (study group) or nontargeted therapy (control group). MAIN OUTCOMES AND MEASURES Overall survival and RCC-specific survival, defined as the interval between the date of first drug treatment and date of death or end of the observation period. RESULTS The final sample included 1015 patients (mean [SD] age, 71.2 [8.1] years; 392 [39%] women); 374 (37%) received nontargeted therapy and 641 (63%) received targeted therapy. The targeted therapy group had a greater percentage of disabled patients (ie, those <65 years old who were eligible for Medicare because of disability) and older patients (ie, those ≥75 years old) and higher comorbidity index and disability scores compared with the nontargeted therapy group. Unadjusted Kaplan-Meier survival curves showed higher overall survival for targeted vs nontargeted therapy (log-rank test, χ21 = 5.79; P = .02); median survival was not statistically significantly different (8.7 months [95% CI, 7.3-10.2 months] vs 7.2 months [95% CI, 5.8-8.8 months]; P = .14). According to the instrumental variable analysis, the median overall survival advantage was 3.0 months (95% CI, 0.7-5.3 months), and overall survival improvements associated with targeted therapy vs nontargeted therapy were statistically significant: 8% at 1 year (44% [95% CI, 39%-50%] vs 36% [95% CI, 30%-42%]; P = .01), 7% at 2 years (25% [95% CI, 20%-30%] vs 18% [95% CI, 13%-23%]; P = .009), and 5% at 3 years (15% [95% CI, 11%-19%] vs 10% [95% CI, 6%-13%]; P = .01). Receipt of targeted therapy was associated with a lower hazard of death compared with nontargeted therapy (overall survival hazard ratio, 0.78 [95% CI, 0.65-0.94]; RCC-specific survival hazard ratio, 0.77 [95% CI, 0.62-0.96]). CONCLUSIONS AND RELEVANCE Targeted therapies were associated with modest survival advantages despite a treatment group with more medical complexity, likely reflecting appropriateness for an expanded population of patients. As advances in cancer treatment continue, rigorous methods that account for unobserved confounders will be needed to evaluate their real-world impact on outcomes.
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Affiliation(s)
- Pengxiang Li
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jordan Jahnke
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy R. Pettit
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Yu-Ning Wong
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Now with Janssen Scientific Affairs, Titusville, New Jersey
| | - Jalpa A. Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
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Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, Lacy M, Lipe B, Little RF, Nikonova A, Omel J, Peswani N, Prica A, Raje N, Seth R, Vesole DH, Walker I, Whitley A, Wildes TM, Wong SW, Martin T. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. J Clin Oncol 2019; 37:1228-1263. [PMID: 30932732 DOI: 10.1200/jco.18.02096] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others. METHODS ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.
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Affiliation(s)
- Joseph Mikhael
- 1 City of Hope Cancer Center, Phoenix, AZ.,2 International Myeloma Foundation, North Hollywood, CA
| | | | | | | | | | | | | | - Brea Lipe
- 8 University of Rochester Medical Center, Rochester, NY
| | | | - Anna Nikonova
- 10 Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - James Omel
- 11 Education and Advocacy, Grand Island, NE
| | | | - Anca Prica
- 13 Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Noopur Raje
- 14 Massachusetts General Hospital, Boston, MA
| | - Rahul Seth
- 15 Upstate Medical University, Syracuse, NY
| | - David H Vesole
- 16 Hackensack University Medical Center, Hackensack, NJ.,17 Georgetown University, Washington, DC
| | - Irwin Walker
- 18 McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sandy W Wong
- 21 University of California San Francisco, San Francisco, CA
| | - Tom Martin
- 21 University of California San Francisco, San Francisco, CA
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Barth P, Castillo JJ, Olszewski AJ. Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study. Cancer 2018; 125:550-558. [DOI: 10.1002/cncr.31853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Barth
- Department of Medicine, Warren Alpert Medical School Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Jorge J. Castillo
- Division of Hematologic Malignancies, Dana‐Farber Cancer Institute Boston Massachusetts
- Department of Medicine Harvard Medical School Boston Massachusetts
| | - Adam J. Olszewski
- Department of Medicine, Warren Alpert Medical School Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
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Olszewski AJ, Dusetzina SB, Trivedi AN, Davidoff AJ. Prescription Drug Coverage and Outcomes of Myeloma Therapy Among Medicare Beneficiaries. J Clin Oncol 2018; 36:2879-2886. [PMID: 30113885 PMCID: PMC6366642 DOI: 10.1200/jco.2018.77.8894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Novel parenteral (bortezomib) and oral (lenalidomide) therapies have improved survival in myeloma, but the standard Medicare benefit covers only parenteral drugs. We examined the association between prescription drug coverage, receipt of therapy, and survival among Medicare beneficiaries with myeloma. METHODS Using SEER-Medicare data, we identified enrollment in a Medicare Part D plan (PDP) or other creditable prescription drug coverage (OCC) among 9,755 beneficiaries who were diagnosed with myeloma in 2006 to 2011. We examined the receipt of active myeloma therapy and that of classic cytotoxic agents or bortezomib as first-line regimen and overall survival. We report relative risk (RR) for binary outcome comparisons and 3-year restricted mean survival time (RMST) ratios, with 95% CI, adjusting for baseline patient- and disease-related characteristics. Beneficiaries with diffuse large B-cell lymphoma, a cancer that is uniformly treated with parenteral chemotherapy, served as a comparison cohort. RESULTS Compared with beneficiaries without prescription drug coverage, PDP or OCC enrollees were more likely to receive active myeloma care, and PDP enrollees were less frequently treated with parenteral agents (adjusted RR, 0.86; 95% CI, 0.80 to 0.93) or classic cytotoxic agents in particular (RR, 0.62; 95% CI, 0.51 to 0.76). Overall survival was significantly better for beneficiaries with PDP coverage (adjusted RMST ratio, 1.16; 95% CI, 1.11 to 1.20) or OCC (RMST ratio, 1.16; 95% CI, 1.12 to 1.21). In contrast, we observed no survival differences by prescription drug coverage status in the control cohort with lymphoma. CONCLUSION Prescription drug coverage is associated with decreased use of classic cytotoxic chemotherapy and better survival among Medicare beneficiaries with myeloma, which suggests improved access to all existing treatment options. As oral targeted agents increasingly replace parenteral chemotherapy in oncology, adjustments in coverage policy are needed to ensure access to optimal treatment.
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Affiliation(s)
- Adam J. Olszewski
- Adam J. Olszewski and Amal N. Trivedi, Brown University; Adam J. Olszewski, Rhode Island Hospital; Amal N. Trivedi, Providence VA Medical Center, Providence, RI; Stacie B. Dusetzina, Vanderbilt University Medical Center, and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Amy J. Davidoff, Yale University, New Haven, CT
| | - Stacie B. Dusetzina
- Adam J. Olszewski and Amal N. Trivedi, Brown University; Adam J. Olszewski, Rhode Island Hospital; Amal N. Trivedi, Providence VA Medical Center, Providence, RI; Stacie B. Dusetzina, Vanderbilt University Medical Center, and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Amy J. Davidoff, Yale University, New Haven, CT
| | - Amal N. Trivedi
- Adam J. Olszewski and Amal N. Trivedi, Brown University; Adam J. Olszewski, Rhode Island Hospital; Amal N. Trivedi, Providence VA Medical Center, Providence, RI; Stacie B. Dusetzina, Vanderbilt University Medical Center, and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Amy J. Davidoff, Yale University, New Haven, CT
| | - Amy J. Davidoff
- Adam J. Olszewski and Amal N. Trivedi, Brown University; Adam J. Olszewski, Rhode Island Hospital; Amal N. Trivedi, Providence VA Medical Center, Providence, RI; Stacie B. Dusetzina, Vanderbilt University Medical Center, and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Amy J. Davidoff, Yale University, New Haven, CT
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LeBlanc TW, Egan PC, Olszewski AJ. Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia. Blood 2018; 132:717-726. [PMID: 29848484 PMCID: PMC6097134 DOI: 10.1182/blood-2018-03-842575] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022] Open
Abstract
Hospice provides high-quality end-of-life care, but patients with leukemias use hospice services less frequently than those with solid tumors. Transfusion dependence (TD) may hinder or delay enrollment, because hospice organizations typically disallow transfusions. We examined the association between TD and end-of-life outcomes among Medicare beneficiaries with leukemia. From the Surveillance, Epidemiology, and End Results-Medicare database, we selected beneficiaries with acute and chronic leukemias who died in 2001-2011. We defined TD as ≥2 transfusions within 30 days before death or hospice enrollment. End points included hospice enrollment and length of stay, reporting relative risk (RR) adjusted for key covariates. Among 21 033 patients with a median age of 79 years, 20% were transfusion dependent before death/hospice enrollment. Use of hospice increased from 35% in 2001 to 49% in 2011. Median time on hospice was 9 days and was shorter for transfusion-dependent patients (6 vs 11 days; P < .001). Adjusting for baseline characteristics, TD was associated with a higher use of hospice services (RR, 1.08; 95% confidence interval [CI], 1.04-1.12) but also with 51% shorter hospice length of stay (RR, 0.49; 95% CI, 0.44-0.54). Hospice enrollees had a lower likelihood of inpatient death and chemotherapy use and lower median Medicare spending at end-of-life, regardless of TD status. In conclusion, relatively increased hospice use combined with a markedly shorter length of stay among transfusion-dependent patients suggests that they have a high and incompletely met need for hospice services and that they experience a barrier to timely referral. Policy solutions supporting palliative transfusions may maximize the benefits of hospice for leukemia patients.
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Affiliation(s)
- Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Pamela C Egan
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI; and
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI; and
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
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Olszewski AJ, Zullo AR, Nering CR, Huynh JP. Use of Charity Financial Assistance for Novel Oral Anticancer Agents. J Oncol Pract 2018; 14:e221-e228. [PMID: 29443649 PMCID: PMC5951296 DOI: 10.1200/jop.2017.027896] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Novel oral targeted drugs are increasingly used for cancer therapy, but their extreme cost, often exceeding $10,000 per month, poses a significant barrier for patients and insurers alike, leading to the potential breakdown of traditional cost-sharing strategies. Insured patients' routine use of charity assistance to supplement their coverage would indicate a major deficiency in the current health care policies. By using data from a specialty pharmacy affiliated with an academic center (1,557 prescriptions dispensed between January 2014 and March 2017), we examined sources of payment for novel oral anticancer agents, distinguishing contributions from health insurance, patients, and from charitable assistance organizations. Thirty-six percent of 211 patients received charity assistance, including 47% of patients who were 65 years old or older. Charity sources covered 4% of total drug costs and 64% of out-of-pocket expenditures. The proportion of patients receiving financial assistance ranged from 7% when the upfront out-of-pocket requirement was less than $100 to 67% when it exceeded $1,000. When patients' out-of-pocket requirement exceeded $1,000, the median direct cash contribution paradoxically fell to $0 because of extensive use of charity support. Receipt of upfront charity assistance was associated with a longer time to filling the first prescription (median 9 v 7 days; P = .011) and with longer overall duration of therapy (median, 261 v 134 days; P = .014). These findings indicate that high out-of-pocket burden for expensive novel oral anticancer drugs leads to widespread use of charity support in the United States and that a significant financial barrier disparately affects older Medicare beneficiaries.
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Affiliation(s)
- Adam J. Olszewski
- Rhode Island Hospital, Alpert Medical School of Brown University, and Brown University School of Public Health, Providence, RI
| | - Andrew R. Zullo
- Rhode Island Hospital, Alpert Medical School of Brown University, and Brown University School of Public Health, Providence, RI
| | - Christopher R. Nering
- Rhode Island Hospital, Alpert Medical School of Brown University, and Brown University School of Public Health, Providence, RI
| | - Justin P. Huynh
- Rhode Island Hospital, Alpert Medical School of Brown University, and Brown University School of Public Health, Providence, RI
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Fakhri B, Fiala MA, Tuchman SA, Wildes TM. Undertreatment of Older Patients With Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 18:219-224. [PMID: 29429818 PMCID: PMC5837946 DOI: 10.1016/j.clml.2018.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND With the expanding armamentarium of therapeutic agents for multiple myeloma (MM), it is important to identify any undertreated patient populations to mitigate outcome disparities. MATERIALS AND METHODS We extracted the data for all plasma cell myeloma cases (International Classification of Disease for Oncology, third revision [ICD-O-3] code 9732) in the Surveillance, Epidemiology, End Results (SEER)-Medicare database from 2007 to 2011. The ICD-O-3 histologic code 9732 captures both active MM and smoldering/asymptomatic myeloma. We defined active MM as either claims indicating receipt of treatments approved for MM or ICD-9 codes for MM-defining clinical features, referred to as the CRAB criteria (calcium [elevated], renal failure, anemia, bone lesions). Multivariate logistic regression was performed to determine the variables that were independently associated with receipt of no treatment. RESULTS Of the initial 4187 patients included in the present study, 373 had no claims indicating receipt of treatments approved for MM and had no ICD-9 codes associated with the CRAB criteria and were excluded from the analyses. Of the 3814 patients with active MM, 1445 (38%) did not have any claims confirming that they had received systemic treatment. Older age, poor performance indicators, comorbidities, African-American race, and lower socioeconomic status, including enrollment in Medicaid, were statistically significant factors associated with the receipt of no systemic treatment. CONCLUSIONS In the present retrospective study of data from the SEER-Medicare database, we found that age, health status, race, and socioeconomic status were associated with receipt of MM treatment. These factors have previously been linked to reduced usage of specific treatments for MM, such as stem cell transplantation. To the best of our knowledge, however, ours is the first study to show their association with the receipt of any MM therapy.
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Affiliation(s)
- Bita Fakhri
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Sascha A Tuchman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine, St. Louis, MO.
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