The State of Cancer Care in America, 2016: A Report by the American Society of Clinical Oncology

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doi:10.1200/jop.2015.010462

Cited by 115 publications

(40 citation statements)

References 52 publications

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“…26, 28 However, the fact that a relationship does not exist between value as defined by survival and out-of-pocket costs has not been previously demonstrated in the oncology realm. Possibly reflecting the increasing prevalence of oral chemotherapy parity laws, 29 we observed lower out-of-pocket payments for fills in more recent calendar years. As expected, we observed higher out-of-pocket payments for more expensive drugs.…”

Section: Discussionmentioning

confidence: 62%

Out-of-Pocket Spending Not Associated with Oral Oncolytic Survival Benefit

Rotenstein

Dusetzina

Keating

2018

JMCP

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Background: With total and out-of-pocket spending for oral oncolytics rising, there is increased interest in choosing oncology treatments based on their clinical value relative to cost. Objectives: We sought to determine if out-of-pocket spending varied for higher versus lower benefit oral oncology drugs reimbursed by commercial insurers. Methods: This was a retrospective analysis of commercial insurer prescription drug claims filed between 2007–2014 for 13 oral oncolytics approved before 2009. We calculated mean monthly out-of-pocket payment for each fill by patient. We then categorized oral oncolytics by their overall and progression-free survival benefits for each FDA-approved indication, using evidence from published studies. We assessed the relationship of survival benefit with mean monthly out-of-pocket payment, adjusting for demographic and plan characteristics. Results: Our population included 44,113 patients ages 18–65 (mean 52.5; SD: 9.4) with a cancer diagnosis who filled 731,354 prescriptions. The most commonly represented oncolytics were imatinib (37.4% of fills), lenalidomide (17.7% of fills), and dasatinib (10.0% of fills). Approximately 32.3% of fills were for drug-indication pairs with an overall survival benefit of 4+ years. In adjusted analyses, there was no clear pattern to suggest that out-of-pocket payments differed with drugs’ indication-specific survival benefits. Drugs for indications providing > 0 to 1 year of overall survival benefit were significantly more likely to have a lower out-of-pocket payment versus those prescribed off-label, but there were no significant differences in out-of-pocket payments between drugs and associated indications in any other survival category versus drugs used off-label. Conclusions: Out-of-pocket payments for oral oncolytics were not clearly related to indication-specific value in commercially insured patients. This suggests that despite increased attention to value- and indication-based drug pricing, cost-sharing for oral oncolytics does not currently reflect these goals.

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Section: Discussionmentioning

confidence: 62%

Out-of-Pocket Spending Not Associated with Oral Oncolytic Survival Benefit

Rotenstein

Dusetzina

Keating

2018

JMCP

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“…While new high-cost, cancer-directed therapies represent a significant driver of rising oncology care costs,(14, 80) few studies evaluated rates of overuse of cancer treatments, which can lead to financial harm even when used appropriately . We identified two studies evaluating overuse of newer, high-cost drugs, both of which focused on trastuzumab for patients with HER2-positive breast cancer; both reported relatively low rates of use in the absence of appropriate HER-2 testing.…”

Section: Discussionmentioning

confidence: 99%

“…(12) However, it is likely that additional studies have been undertaken in more recent years given the greater attention to overuse and value. (13, 14) To describe the current prevalence of overuse in cancer care and the state of the overuse literature in cancer, we performed a systematic review of published articles reporting rates of overuse of diagnostic tests, therapeutic procedures, and medications in the management of patients diagnosed with cancer. We chose to focus on patients with a cancer diagnosis and not on cancer screening since cancer care itself is particularly costly and since overuse of screening has been well discussed in the literature.…”

Section: Introductionmentioning

confidence: 99%

Overuse of Health Care Services in the Management of Cancer

et al. 2017

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Background Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology. Methods We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and two grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation’s Choosing Wisely initiative in 2012. We included original research articles quantifying overuse of any medical service in patients with a cancer diagnosis when utilizing an acceptable standard to define care appropriateness, excluding studies of cancer screening. One of 4 investigator reviewed titles and abstracts and 2 of 4 reviewed each full-text article and extracted data. Methodology used PRISMA Guidelines. Results We identified 59 articles measuring overuse of 154 services related to imaging, procedures, and therapeutics in cancer management. The majority of studies addressed adult or geriatric patients (98%) and focused on US populations (76%); the most studied services were diagnostic imaging in low-risk prostate and breast cancer. Few studies evaluated active cancer therapeutics or interventions aimed at reducing overuse. Rates of overuse varied widely among services and among studies of the same service. Conclusion Despite recent attention to overuse in cancer, evidence identifying areas of overuse remains limited. Broader investigation, including assessment of active cancer treatment, is critical for identifying improvement targets to optimize value in cancer care.

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“…However, PRD is not well appreciated by all medical providers: some consider it an inadequate and unfeasible screening tool, contrary to the patients' perspectives, which have shown moderate satisfaction with the screening process 13, 14, 15, 16. When cancer is diagnosed, psychosocial support should be initiated through an integrated medical collaboration 17, 18. Distress might increase during multiple cancer treatments and might peak approximately 2 weeks after the start of RT 19 .…”

Section: Discussionmentioning

confidence: 99%

Patient-reported distress and survival among patients receiving definitive radiation therapy

Habboush

Shannon

Niazi

et al. 2017

Advances in Radiation Oncology

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ObjectivePatient-reported distress (PRD) has not been well assessed in association with survival after radiation therapy (RT). The aims of this study were to evaluate the association between PRD level and survival after definitive RT and to identify the main causes of distress in definitive RT patients.Methods and materialsA total of 678 consecutive patients receiving definitive RT at our institution from April 2012 through May 2015 were included. All patients answered a PRD questionnaire that contained 30 items related to possible causes of distress, which could be rated from 1 (no distress) to 5 (high distress). Additionally, patients were asked to rate their overall distress level from 0 (no distress) to 10 (extreme distress). This overall distress level was our primary patient-reported distress measure and was examined as a continuous variable and as a categorical variable with 3 PRD levels (low, 0-3 [n = 295]; moderate, 4-6 [n = 222]; and high, 7-10 [n = 161]).ResultsAs a continuous variable in multivariable Cox regression analysis, a higher overall PRD level was associated with poorer survival after RT (hazard ratio [HR], 1.39; P = .004). As a categorical variable, compared with patients with low distress, survival was poorer for patients with moderate distress (HR, 1.62; P = .038) or high distress (HR, 1.49; P = .12), but the latter difference was not significant. When the moderate and high distress levels were combined, survival was significantly poorer compared with the low distress level (HR, 1.57; P = .034). The top 5 specific causes of distress that patients mentioned were “How I feel during treatment,” “Fatigue,” “Out-of-pocket medical costs,” “Pain that affects my daily functioning,” and “Sleep difficulties.”ConclusionsPRD before or during RT is a prognostic factor associated with decreased survival. Distress screening guidelines and interventions should be implemented for patients receiving definitive RT.

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The State of Cancer Care in America, 2016: A Report by the American Society of Clinical Oncology

Cited by 115 publications

References 52 publications

Out-of-Pocket Spending Not Associated with Oral Oncolytic Survival Benefit

Out-of-Pocket Spending Not Associated with Oral Oncolytic Survival Benefit

Overuse of Health Care Services in the Management of Cancer

Patient-reported distress and survival among patients receiving definitive radiation therapy

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