Annual Meeting Proceedings Part 1 - American Society of Clinical ...

400s Health Services Research
6073 General Poster Session (Board #5F), Mon, 1:15 PM-5:15 PM
Colorectal cancer survivors’ needs and preferences for survivorship information.
Presenting Author: Talya Salz, Memorial Sloan-Kettering Cancer
Center, New York, NY
Background: We assessed colorectal cancer (CRC) survivors’ needs and
preferences for information to guide development of a survivorship care
plan. Methods: We conducted a survey of survivors treated for stage I-III
CRC at two hospitals in New York City. Participants completed treatment
6-24 months before the interview and had not received a survivorship care
plan. We evaluated whether survivors knew their basic treatment history,
whether they understood ongoing risks, and their preferences for receiving
survivorship information. Results: 175 CRC survivors completed the survey
between June 2010 and November 2011. Survivors generally remembered
basic information about their diagnosis and treatment: 88% accurately
reported the location of their cancer; 95-100% accurately reported
whether they had surgery, chemotherapy, or radiation; and 90-95%
correctly reported the completion date (within 6 months) for each treatment.
Survivors knew less about the risks of local and distant recurrences
(69% and 77% correct, respectively) and of getting another CRC compared
to unaffected individuals (40% correct). More than three quarters of
participants received information about their cancer, their treatment
history, ongoing oncology visits, and testing to be done by the oncologist
(77-86% across categories). Across these categories of information,
93-99% of those who received information found it useful. Most survivors
did not receive information about symptoms to report to their doctors,
returning to work, financial issues, or legal issues (59-95% across
categories); but those who received this information found it useful
(67%-100% across categories). Conclusions: Even without receiving survivorship
care plans, CRC survivors generally understood their cancer
diagnosis and treatment. However, many lacked knowledge of ongoing
risks, prevention, and nonmedical survivorship issues. Most survivors found
the survivorship information they received useful. The greatest benefit of
survivorship care plans to survivors may not be summarizing past care as
much as helping survivors understand their risks and plan for the future.
6075 General Poster Session (Board #5H), Mon, 1:15 PM-5:15 PM
Out-of-pocket (OOP) health care expenditure burden for Medicare beneficiaries
with cancer. Presenting Author: Ilene H. Zuckerman, University of
Maryland School of Pharmacy, Baltimore, MD
Background: Concern is increasing about the OOP burden faced by cancer
patients (pts). Medicare beneficiaries have multiple comorbidities, have
limited financial resources, and may face substantial cost sharing under
traditional Medicare if they do not have generous supplemental coverage.
We examined OOP spending and burden relative to income for Medicare
beneficiaries with cancer, compared to a non-cancer comparison group.
Methods: We used Medicare Current Beneficiary Survey data (1997-2007).
Newly diagnosed cancer pts were selected using ICD-9CM codes on claims
after a 12 mos washout period. OOP spending was assessed using self
report for the index(diagnosis) and subsequent year. Pt characteristics were
self reported. Generalized Linear Models estimated effects of pt characteristics
on OOP spending; logistic regression identified pt characteristics
associated with high burden, defined as OOP spending �20% of income.
Results: The cohort included 1,869 beneficiaries with, and 10,057
beneficiaries without cancer. Relative to the non-cancer cohort, cancer pts
were older, had greater comorbidities, and were more likely to lack
supplemental coverage (22 vs 16%) (all at p�0.01).OOP spending was
$4,727 or 11.4% of total spending for cancer pts. The unadjusted
difference between cancer and non-cancer pts in OOP spending was
$1,518 (p�.001); with adjustment for patient characteristics, cancer
patients faced an incremental $956 (p�.01) in OOP spending. Median-
[mean] OOP/income was 10%[24%] for beneficiaries with, compared to
6%[14%] without cancer (p�.001). Over ¼ (28%) of beneficiaries with
cancer spent 20% of their income OOP, compared to 16% of beneficiaries
without cancer (p�.001). Supplemental insurance and higher income were
protective against high OOP burden, whereas assets, comorbidity, and
receipt of cancer-directed radiation and antineoplastic therapy were
associated with higher OOP burden. Conclusions: Medicare beneficiaries
with cancer face higher OOP burden than their counterparts without
cancer; some of the higher burden was explained by higher comorbidity
burden and lack of supplemental insurance. Financial pressures may
discourage some elderly patients from pursuing treatment.
6074 General Poster Session (Board #5G), Mon, 1:15 PM-5:15 PM
Speed of accrual into published phase III oncology trials: A comparison
across geographic locations. Presenting Author: Nancy R. Ruther, Gundersen
Lutheran Health System, La Crosse, WI
Background: There is a perception that patient accrual may be slower in the
US than it is in Europe (Wang-Gillam A et al, J Clin Oncol 2010;28:3803-
3807). However, a systematic study has not been performed. We seek to
determine the speed at which patients are accrued into published phase III
oncology trials across geographic locations and to identify factors that may
influence this process. Methods: We searched MEDLINE and identified all
original phase III oncology therapeutic trials published in 2006-2010 (N �
567). Trials with no reported activation and completion dates were
excluded (n � 20). Accrual speed per trial was expressed as patients per
month and was calculated by dividing the number of patients enrolled by
number of months a trial was open. Results: The 547 trials included in our
study enrolled 281,340 patients. Most trials were for adults only (95.6%),
late stage cancers (77.5%), and involved multinational participation
(44.1%). Funding sources were cooperative groups (45.5%), industry
(33.8%) and academic centers (20.5%). The top 5 cancers studied were
hematologic (19.2%), gastrointestinal (16.5%), lung (16.3%), breast
(15.4%), and gynecologic (8.4%). Trial results were negative (57.4%),
positive (38.2%), or equivalent (4.4%). The mean (�SD) accrual speeds
varied according to trial location (multinational [25.0�25.4], US
[13.3�16.5], other countries [11.4�15.7], Europe [8.7�11.8]; [P�
.001]), funding source (industry [28.3�24.7], cooperative groups
[13.3�19.0], academic [6.8�6.5]; [P� .001]), and cancer type (breast
[24.0�29.4], gastrointestinal [20.2�24.2], lung [19.3�22.7], gynecologic
[15.3�19.2], hematologic [11.2�10.7]; [P� .001]). After adjusting
for funding source, accrual speeds were significantly different across trial
locations only in 2 cancers: gastrointestinal (multinational [25.2�3.7], US
[24.1�8.2], Europe [11.5�3.7], other [7.5�8.5]; P� .046) and gynecologic
(multinational [28.9�5.4], other [10.5�7.8], US [6.6�5.3], Europe
[4.2�5.9]; P� .004) studies. Conclusions: Among published phase III
oncology trials, multinational studies accrued patients faster in gastrointestinal
and gynecologic cancers and at a similar speed in other cancers.
6076 General Poster Session (Board #6A), Mon, 1:15 PM-5:15 PM
Racial disparities in depressive symptom prevalence and selective serotonin
reuptake inhibitor (SSRI) utilization in cancer patients: An analysis
from ECOG E2Z02: Symptom Outcomes and Practice Patterns (SOAPP).
Presenting Author: Fengmin Zhao, Dana-Farber Cancer Institute, Boston,
MA
Background: Rates of diagnosis and treatment of depression in primary care
vary widely by race. It is unclear whether such disparity exists in oncology.
Methods: 3106 patients with cancer of the breast, prostate, colon/rectum,
or lung were enrolled from multiple sites in a longitudinal study of
symptoms. Patient-reported depressed mood (PRD) on a 0-10 numerical
rating scale and clinician-reported psychological distress (CRD) were used
to identify depressive patients at baseline. Patients also rated depressed
mood 4-5 weeks after baseline. A 2-point change was considered clinically
significant for change in PRD. Logistic regression models were used to
examine the effect of race on prevalence of depression and antidepressant
use. Ordinal logistic regression models examined the effect of race on
changes in depression. Results: Of the 3106 patients, 2648 were white,
364 were black, and 94 were other race. At baseline, 20% had moderate/
severe PRD; CRD was 28%. Black patients had higher rates of depression
than whites, but the difference was not significant after adjusting for other
covariates (PRD: 24% vs. 20%, adjusted OR�1.1, P�0.6; CRD: 30% vs.
27%, adjusted OR�1.06, P�0.8). Improvement in depressed mood varied
by baseline PRD score (57% with severe depression, 51% with moderate,
and 14% with mild). In patients with moderate/severe depression at
baseline, blacks were less likely to have depression improvement than
whites (adjusted OR�0.41, P�0.008 for moderate depression, adjusted
OR�0.35, P�0.01 for severe depression). Among patients with depression
defined by CRD, 29% were taking an SSRI (blacks: 14%, whites: 31%),
Blacks were less likely to take an SSRI than whites (adjusted OR�0.38,
P�0.01). Conclusions: Less than one third of patients with depressive
symptoms are taking SSRI antidepressants. Black race is not only associated
with less improvement in depressive symptoms over time but also
lower probability of SSRI utilization.
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