Impact of Metastatic Colorectal Cancer Stage and Number of Treatment Courses on Patient Health Care Costs and Utilization

Chastek, Benjamin; Kulakodlu, Mahesh; Valluri, Satish; Seal, Brian

doi:10.3810/pgm.2013.03.2642

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…More specifically, a Canadian study on patients with CRC as cause of death (2006‐2010), reported 50% of deaths in SSH, a lower proportion than that observed in this study, with variations according to the zone of residence . The proportion of each place of death and the mode of management can vary according to the definition of the cases included, either people who died while being managed for cancer or people for whom cancer was the main cause of death, the study period, but also according to age, the type of cancer, its stage and its history, and comorbidities, including associated cancers, as well as the development and organization of palliative care . Observed frequencies vary according to organization of end‐of‐life care or palliative care in each country, either mainly in short‐stay hospitals, as in France, or by preferring discharge from hospital and management at home or in hospices.…”

Section: Discussioncontrasting

confidence: 57%

Management and intensity of medical end‐of‐life care in people with colorectal cancer during the year before their death in 2015: A French national observational study

et al. 2019

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The care pathway of patients with colorectal cancer (CRC) 1 year prior to death, their causes of death and the healthcare use, and associated expenditure remain poorly described together. People managed for CRC (2014‐2015), covered by the national health insurance general scheme and who died in 2015 were selected from the national health data system. A total of 15 361 individuals (mean age: 75 years, SD: 12.5 years) were included, almost 66% of whom died in short‐stay hospital (SSH), 9% in hospital at home (HaH), 4% in rehabilitation units (Rehab), 6% in skilled nursing homes (SNH), and 15% at home. At least one other cancer was identified for one‐third of these people. Almost one‐half of people presented cardiovascular comorbidity, 21% had chronic respiratory disease, and 13% had a neurological or degenerative disease. During the last month of life, 83% were admitted at least once to SSH, 39% had at least one emergency department admission, 17% were admitted to an intensive care unit, 15% received at least one chemotherapy session (<60 years: 27%), and 5% received oral chemotherapy. Eighty‐eight percent of the 60% of individuals who received hospital palliative care (HPC) vs 75% of those without HPC were admitted to SSH at least once during the last month. Cancer was the main cause of death for 84% (SSH: 85%, home: 77%) and corresponded to CRC for 64% of them. The mean annual expenditure per person during the last year of life was €43 398 (SSH: €48 804). This study suggests a relatively high level of HPC use during the year before death for people with CRC in France. High rates of emergency department, intensive care, and chemotherapy use were observed during the last month of life. However, management is very largely SSH‐based with a small proportion of deaths at home.

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Section: Discussioncontrasting

confidence: 57%

Management and intensity of medical end‐of‐life care in people with colorectal cancer during the year before their death in 2015: A French national observational study

et al. 2019

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“…First, identification of lines of treatment administered was limited to the first three lines. Since, 80–90 % of mCRC patients receive a maximum of three lines of treatment [ 11 , 61 ], this limitation should not substantially reduce the applicability of our findings. Second, only drugs that require administration by a healthcare provider were considered for our analysis, and orally administered drugs (e.g., capecitabine) were not included because Medicare part D data were not available.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Treatment Sequences in Chemotherapy and Targeted Biologics for Metastatic Colorectal Cancer: Findings from a Large Community-Based Cohort of Elderly Patients

Parikh

Morgan

et al. 2016

Drugs - Real World Outcomes

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BackgroundOver the last decade, multiple chemotherapies/targeted biologics have been approved for metastatic colorectal cancer (mCRC). However, evidence is limited with regards to the array of treatments received by mCRC patients.ObjectiveThis study examines treatment sequences (first- to third-line chemotherapy/targeted biologics) and the factors associated with first-line targeted biologics and common treatment sequences for elderly mCRC patients treated in a community setting.MethodsA retrospective cohort study was conducted in mCRC patients diagnosed from January 2004 through December 2009 using the Surveillance, Epidemiology and End Results Medicare-linked database. The treatment sequences administered to elderly mCRC patients were empirically identified.ResultsOf 4418 mCRC patients who received treatment, 1370 (31 %) received first, second, and third line; 1164 (26 %) received first and second line; and 1884 (43 %) received only first line. The most common first line of treatment for mCRC patients was 5-fluorouracil/leucovorin + oxaliplatin (FOLFOX) + bevacizumab (23 %) and FOLFOX (23 %). 5-fluorouracil/leucovorin + irinotecan (FOLFIRI)-based regimens were commonly (22 %) administered in second line. The most common treatment sequence was first-line oxaliplatin or irinotecan followed by second-line oxaliplatin or irinotecan + bevacizumab followed by a third-line targeted biologic. Of patients who received first-line therapy, 47 % also received a targeted biologic, and the factors associated were age, comorbidity score, cancer site, geographic location, and year of diagnosis.ConclusionElderly mCRC patients receive a multitude of treatments in various sequences. Further exploration of the comparative effectiveness of treatment sequences may yield important information for improving mCRC survival.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-015-0059-9) contains supplementary material, which is available to authorized users.

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“…A claims-based algorithm, similar to those previously published 8,9 , was used to identify the first-line therapy based on the presence of claims for NCCN-recommended chemotherapy, hormonal therapy, and biologics within the first 30 days following the index date. The first-line continued until the earliest of initiation of a new agent, a gap of 90 days or more between agents (including discontinuation of all agents), or death.…”

Section: Treatment Cohortsmentioning

confidence: 99%

Clinical and economic outcomes by first-line treatment among women with HR+/HER2– metastatic breast cancer in a large US health plan database

Burton

Byfield

Smith

et al. 2016

Current Medical Research and Opinion

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Observed use of first-line chemotherapy (>50%) was higher than expected given the HR + molecular profile of the tumors. Chemotherapy use during first-line did not appear to be associated with a survival benefit, but was associated with significantly higher costs compared with the use of hormonal therapy during first-line; however, this comparison is limited by demographic and baseline characteristic differences between the two cohorts. This study contributes to understanding real-world treatment patterns and the associated clinical and economic outcomes of using chemotherapy vs hormonal therapy as a first-line treatment option for the HR+/HER2- mBC population.

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Impact of Metastatic Colorectal Cancer Stage and Number of Treatment Courses on Patient Health Care Costs and Utilization

Cited by 19 publications

References 26 publications

Management and intensity of medical end‐of‐life care in people with colorectal cancer during the year before their death in 2015: A French national observational study

Management and intensity of medical end‐of‐life care in people with colorectal cancer during the year before their death in 2015: A French national observational study

Patterns of Treatment Sequences in Chemotherapy and Targeted Biologics for Metastatic Colorectal Cancer: Findings from a Large Community-Based Cohort of Elderly Patients

Clinical and economic outcomes by first-line treatment among women with HR+/HER2– metastatic breast cancer in a large US health plan database

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