Hospital-based health care use correlates with incidence of adverse events among elderly Medicare patients treated in adjuvant chemotherapy trials (Alliance 70802)

Abstract

Objective Medicare claims can be useful in chemotherapy-related comparative effectiveness research (CER) estimating survival, but methods for estimating patients’ treatment morbidity are currently lacking. We sought to determine if patients’ health care use in the claims is a marker of treatment morbidity. Materials and Methods For 249 elderly Medicare patients with breast or colon cancer who were treated in two adjuvant clinical trials, we merged patients’ National Cancer Institute Common Toxicity Criteria for Adverse Events (CTC AEs) trial data with their contemporaneous Medicare claims. We estimated associations of patients’ grade ≥3 CTC AE counts and their use of two types of hospital-based health care in claims (i.e., emergency room (ER) visits and hospitalizations). Results ER visits and hospitalizations were significantly positively associated with grade ≥3 CTC AE counts incurred by patients during the study. Eight percent of patients without any grade ≥3 CTC AEs had one or more hospitalizations during the observation period compared to 43% of patients with three or more grade ≥3 CTC AEs (p < 0.01). Those who were hospitalized at least once had more than three times the rate of grade ≥3 CTC AEs (IRR 3.70, 95% CI: 2.53–5.40) compared to those who were not. With each hospitalization, the daily incidence rate of any grade ≥3 CTC AE more than doubled (IRR 2.10, 95% CI: 1.54–2.86). Conclusions Because hospitalization is strongly associated with clinically significant toxicity it may be a useful outcome for Medicare claim-based CER comparing treatment morbidity for elderly patients receiving different adjuvant chemotherapy regimens.

Superiority of Carboplatin-Based Doublets to Cisplatin-Based Doublets among Medicare Patients Aged 70 and Older with Advanced Lung Cancer

“…For example, our measure of patient toxicity or morbidity is hospital-based health care use. While we have previously shown that hospital-based health care use is a good proxy for chemotherapy-related toxicity among patients with colon and breast cancer treated on clinical trials, we are extrapolating those findings to patients with NSC lung cancer treated off clinical trials [26]. In addition, we studied patients living in SEER areas only; generalizability of our findings to other areas requires further study.…”

“…To assess morbidity we examined health care use following initiation of chemotherapy including hospitalization, intensive care unit (ICU) stays, emergency room (ER) visits, home health, skilled nursing facility (SNF) stays, hospice and death in a hospital. The hospital-based health care that elderly Medicare patients with cancer use while they are on chemotherapy trials is strongly associated with their clinical trial measure of post-treatment morbidity [26]. Finally we examined claims for hemodialysis as cisplatin-based regimens are associated with nephrotoxicity.…”

Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia

“…A previous Australian study reported poor agreement between chemotherapy side effects identified using administrative data compared with self-reported side effects, with the latter being significantly more common (Pearce et al, 2015). Nevertheless, hospitalisations and emergency room visits can be useful outcomes when examining different treatment options in real-world patient populations, with hospitalisations having the strongest association with a toxicity measure used in RCTs (Lamont et al, 2014). If different chemotherapy regimens are associated with only small differences in absolute efficacy, considering adverse effects becomes even more important (Ruddy et al, 2017).…”

Survival and Toxicity After Cisplatin Plus Etoposide Versus Carboplatin Plus Etoposide for Extensive-Stage Small-Cell Lung Cancer in Elderly Patients

“…30 We computed survival time from the first chemotherapy administration claim to date of death from the Medicare enrollment file. Follow-up was very complete, with only 68 patients (3%) censored for survival at the end of the study period.…”