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

6093 General Poster Session (Board #8B), Mon, 1:15 PM-5:15 PM
Unanticipated hospital admissions in patients undergoing radiotherapy
with or without concurrent chemotherapy: Incidence and predictive factors.
Presenting Author: Nabeel H. Arastu, University of North Carolina at Chapel
Hill and Brody School of Medicine at East Carolina University, Greenville,
NC
Background: Unanticipated admissions are burdensome for patients and
the healthcare system. An improved understanding of their frequency and
predictive factors can inform initiatives to prevent such admissions and
mitigate their associated human and financial costs. Methods: Electronic
medical records of 500 patients undergoing external beam radiotherapy
(RT) at our center in 2010 were reviewed. Unanticipated admission within
90 days of initiating RT, and associated clinical factors, were recorded.
Chi-squared and uni- and multivariate logistic regression was used to
examine factors associated with admission. Results: Unanticipated admissions
occurred in 20% (101/500) of patients, mean length of stay was 4
days (range 1-16), and the mean interval between the start of RT and
admission was 32 days (0-86 days). The most common indications for
admissions were pain (19% of admissions), respiratory distress (15%), and
neurologic symptoms (13%). On univariable analysis, 33% of patients
treated for palliative intent were admitted (vs. 16% of curative intent
patients, p�0.001), as were 26% of patients receiving concurrent chemotherapy
(vs. 17% receiving RT alone, p�0.02). Multivariable analysis
showed treatment intent, chemotherapy, and marital status to be associated
with unplanned admissions (Table). A highly variable rate of unanticipated
admission per diagnosis was observed (e.g. 4% for breast, 19% for
GI/GU/GYN/ENT, and 37% for metastatic sites). Conclusions: Rates of
unanticipated admissions are �20% in patients undergoing RT. Approximately
1/3 of patients receiving palliative RT, and more than 1/4 receiving
concurrent chemoradiation, experienced an unplanned admission. Prophylactic
measures should be studied in these high-risk patients to reduce
admission rates, as unplanned admission may be an important quality of
care indicator in oncology.
Odds of an unanticipated admission: Multivariate analysis.
Covariate OR P value
Concurrent chemotherapy (vs. RT alone) 3.4 �0.001
Palliative intent (vs. curative) 2.7 �0.001
Not married (vs. married) 2.3 �0.001
6096 General Poster Session (Board #8E), Mon, 1:15 PM-5:15 PM
Cost-effectiveness of adjuvant radiotherapy for older women with early
hormone-receptor positive breast cancer. Presenting Author: Katherine
Elizabeth Reeder-Hayes, University of North Carolina Hospital, Chapel Hill,
NC
Background: Radiation therapy (XRT) following breast conserving surgery
decreases local recurrence at the expense of additional morbidity and
treatment costs. However, its utility in elderly women at low risk of
recurrence has been questioned. This study assessed the cost-effectiveness
of adding XRT to hormonal therapy (HT) in women over 70 with stage I,
hormone-receptor positive (HR�) breast cancer after breast conserving
surgery. Methods: A decision tree model was used to assess the costs and
benefits of XRT � HT versus HT alone in 10,000 women age 70� with
stage I HR� breast cancer. Using a societal perspective, we considered
medical costs and quality of life effects of initial treatment, recurrences,
and metastatic disease as well as long-term XRT-associated complications
including breast fibrosis, chronic pneumonitis and cardiac disease. Probabilities
of recurrence and death were modeled on recent clinical trial
results, while toxicity probabilities were taken from literature review. The
primary health outcome was incremental quality-adjusted life years (QALYs)
gained. One-way and probabilistic sensitivity analyses (PSA) were performed
to assess the sensitivity of model results and conclusions to various
parameter estimates. Results: In the base-case scenario, the incremental
cost-effectiveness ratio (ICER) for the addition of XRT was $923,017/
QALY. The ICER was highly sensitive to variations in utility weights,
particularly those reflecting patient preferences for initial treatment with or
without XRT and those reflecting the decrement in quality of life resulting
from breast fibrosis. In PSA, XRT was associated with lower qualityadjusted
life expectancy at higher cost in 58% of simulations. Conclusions:
In women over 70 with stage I HR� breast cancer, the addition of XRT to
HT is not cost-effective at a willingness-to-pay threshold of $100,000/
QALY, and is associated with little or no improvement in quality-adjusted
life expectancy. Providers should be aware that the cost-effectiveness of
XRT in this population is strongly influenced by patient preferences
surrounding recurrence and toxicity risks, and should weigh these factors
when making shared decisions with patients.
Health Services Research
405s
6095 General Poster Session (Board #8D), Mon, 1:15 PM-5:15 PM
Association between financial relationships with commercial interests and
research merit at the ASCO Annual Meeting (AM). Presenting Author:
Beverly Moy, Massachusetts General Hospital, Boston, MA
Background: Financial relationships with commercial interests (COI) are
common in cancer research. There are few data examining the correlation
between COI and research merit. Meeting placement prominence (MP) and
peer review score (PRS) are indicators of research merit. We examined the
association between ASCO AM abstracts whose authors disclose COI and
both MP and PRS. Methods: We reviewed abstracts presented at the ASCO
AM in 2006 and 2008-2011. We evaluated associations between COI
disclosed by any author and PRS and MP (order of prominence: plenary
session (PS), clinical science symposium (CSS), oral presentation (OP),
poster discussion session (PDS), vs. general poster session (GPS)). Chisquare
tests, T-tests, and logistic regressions of COI were used to assess
associations with MP, PRS, and year. Results: Of 12,446 total abstracts
accepted for presentation, 78% of PS, 59% of CSS, 54% of OP, 52% of
PDS, and 39% of GPS report at least one COI. Abstracts selected for PS,
CSS, OP, and PDS had more COI compared to those selected for GPS (p �
0.05). Stock ownership COI were more frequently disclosed in PS (30%),
CSS (30%), OP (22%), and PDS (22%) compared to GPS (16%) (p �
0.05). Employment COI were more frequently reported among abstracts
presented at PS (39%), CSS (37%), OP (27%), and PDS (27%) compared
to GPS (21%) (p � 0.05). Consultant COI were more likely to have higher
MP than GPS placement (OR for PS�5.5; CSS�2.4; OP�2.2; PDS�1.9).
Similarly, honoraria COI were more likely to have higher MP than GPS
placement (OR for PS�3.9; CSS�1.8; OP�2.1; PDS�1.7). Better PRS
was associated with COI (OR 0.17; p � 0.05). The relationship of better
PRS with any COI strengthened over time from 2006, 2008-2011 (PRS
times year interaction OR�0.65, p�0.001). Conclusions: ASCO abstracts
whose authors report COI have higher merit as measured by MP and PRS.
This suggests a dependence on industry relationships for access to
important data that will lead to prominent cancer research. These relationships
will require further investigation and ongoing management. To our
knowledge, this is the first study examining the scientific merit of research
with relation to COI.
6097 General Poster Session (Board #8F), Mon, 1:15 PM-5:15 PM
The impact of race/ethnicity concordance between patients and their
navigators in time to diagnostic resolution of breast and cervical cancer
screening abnormalities. Presenting Author: Marjory Charlot, Boston University
Medical Center, Boston, MA
Background: Patient navigators have been shown to reduce cancer disparities
among racial/ethnic minorities by improving timely diagnosis and
treatment of cancer. For a group of navigators who received cultural
competency training, we sought to determine if racial/ ethnic concordance
of the navigator and patient improved time to diagnostic resolution of
cancer screening abnormalities. Methods: Demographic data on 1466
patients and their 23 navigators from the Boston Patient Navigation
Research Program were used to assess concordance by race and ethnicity.
All participants with either breast (n�751) or cervical (n�715) screening
abnormalities were followed up to one year. Kaplan-Meier survival curves
and proportional hazards regression models examined the effect of race/
ethnicity concordance on time to definitive diagnosis, adjusting for age,
race, language, economic status, insurance status, and severity of screening
abnormality. Analyses were performed separately for the breast and
cervical groups. Results: Of the 1466 patients, 32% were White, 27%
Black, 31% Hispanic, and 10% Asian. Navigators were 61% White, 17%
Black, 13% Hispanic and 9% Asian. Fifty eight percent of patientnavigator
pairs were concordant by race/ethnicity. Overall rate of diagnostic
resolution of cancer screening abnormalities within 365 days was high at
90%. In both the breast and cervical cancer screening groups, racial/ethnic
concordance was not associated with time to diagnostic resolution, with an
aHR 1.03 (95% CI: 0.85, 1.25) for breast patients and HR 1.02 (95% CI:
0.85, 1.21) for cervical patients. Conclusions: Patient-navigator racial/
ethnic concordance is not associated with time to diagnostic resolution of
cancer screening abnormalities, in part because overall rates of diagnostic
resolution were high. Our data suggest that with cultural competency
training, navigators can be equally effective with patients from different
ethnic and cultural backgrounds.
Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.