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

406s Health Services Research
6098 General Poster Session (Board #8G), Mon, 1:15 PM-5:15 PM
Relationship between Oncotype DX testing and the use of chemotherapy in
high-risk patients (pts). Presenting Author: Winston Wong, CareFirst
BlueCross BlueShield, Baltimore, MD
Background: CareFirst BlueCross BlueShield (CFBCBS) insurance network
partnered with Cardinal Health Specialty Solutions (CHSS) to develop a
cancer care pathway for network physicians in 2008. The program included
a recommendation for molecular diagnostic testing with the Oncotype DX
assay for pts with early-stage estrogen receptor-positive breast cancer.
Based on NCCN guidelines, the pathway suggested adjuvant chemotherapy
for all pts with Oncotype DX Recurrence Scores (RS) in the high-risk
category. We aimed to determine the RS risk distribution among pts who
received Oncotype DX testing and assess the patterns of care that followed.
Methods: Using data from CFBCBS, CHSS proprietary claims software, and
Genomic Health, we retrospectively identified a cohort of women with
breast cancer who were treated on the CFBCBS clinical care pathways
program from 8/2008 to 6/2011 and received Oncotype DX testing. We
determined the number of pts with a RS value in the low- (RS �18),
intermediate- (RS 18-30), and high-risk (RS �31) groups along with the
number of pts who subsequently received chemotherapy in each category.
Results: Of 1174 women who received Oncotype DX testing, 53% of pts
were in the low-, 35% in intermediate-, and 12% in the high-risk groups.
Five percent of low-, 41% of intermediate-, and 74% percent of pts in the
high-risk category were treated with chemotherapy. Twenty-six percent of
pts in the high-risk group did not receive chemotherapy. Conclusions: The
proportionate use of chemotherapy in the low and intermediate risk groups
was as expected based on adjuvant chemotherapy guidelines; however, the
underuse of chemotherapy in 26% of high-risk pts was an unexpected
finding. Further study is needed to determine: (1) why physicians avoided
chemotherapy in 26% of high-risk pts; (2) the overall number of appropriate
pts who underwent Oncotype DX testing; and, (3) the tumor characteristics
that may have driven the underutilization of chemotherapy in the
high-risk population.
6100 General Poster Session (Board #9A), Mon, 1:15 PM-5:15 PM
Quality of life of elderly patients undergoing concomitant chemoradiation
therapy for head and neck cancers, including assessment of geriatric
parameters. Presenting Author: Martine Extermann, H. Lee Moffitt Cancer
Canter & Research Institute, Tampa, FL
Background: Data on the quality of life of older patients undergoing
concomitant chemoradiation therapy (CCRT) for head and neck (H&N)
cancer are very scarce and no study has focused specifically on them.
Furthermore, no study has assessed the contribution of geriatric symptoms
to their quality of life. Methods: We prospectively assessed patients aged 65
and older undergoing curative intent CCRT for H&N cancers, either alone or
adjuvantly after surgery. We used the Quality of life-Radiation Therapy
Instrument (QOL-RTI), with its H&N module (Trotti et al., 1998). In
addition we created a 12-items senior adult questionnaire (SAQ). Patients
were assessed at baseline, at 4 weeks, at the end of treatment (EOT), and 2
months after EOT (recovery). Results: Fifty patients were enrolled. Median
age was 69 years (range 65-87). Eighty-two percent of patients had locally
advanced stage IV disease. Twenty-eight percent had prior surgery. All
patients were treated with IMRT, 92% at 70 Gy. The most frequent
chemotherapy regimen was cisplatin q3wks (58%), followed by weekly
carboplatin (24%). Patients had on average 4 comorbidities (CIRS-G),
54% of them a grade 3 or 4 disease. Forty-four percent were independent
in IADL, and 98% were ECOG PS 0 or 1. The baseline scores were QOL-RTI:
7.72 (SD 1.36), H&N module 7.7 (SD 2.16), SAQ 8.21 (SD 1.54). At EOT,
the scores were 6.22 (1.26), 4.59 (1.82), 7.38 (1.38) respectively, and at
recovery 7.17 (1.25), 6.06 (1.66), 7.96 (1.16). The scores paralleled
functional evolution, as 24% of patients had an ECOG PS 2 and 76% were
IADL dependent at EOT; 16% ECOG 2-3 and 55% IADL dependent at
recovery. Cronbach alphas for the 3 QOL measures were 0.88, 0.89, and
0.81, suggesting adequate internal consistency reliability. The SAQ was
low-to-moderately correlated with the other two QOL measures (r�0.22 to
0.59) at different points of assessment. Conclusions: Older H&N cancer
patients experience significant impact of CCRT on their function, and on
their quality of life on all three measures. Most recover after two months,
although some may take longer. A geriatric module adds significant
information to the general QOL-RTI and H&N questionnaires.
6099 General Poster Session (Board #8H), Mon, 1:15 PM-5:15 PM
Utilization of bone densitometry and administration of bisphosphonates to
prevent osteoporosis in patients with nonmetastatic prostate cancer receiving
anti-androgen therapy. Presenting Author: Muhammad Atif Khan,
University of Arkansas for Medical Sciences Hospital, Little Rock, AR
Background: Prostate cancer subjects with PSA relapse who are treated with
androgen deprivation therapy (ADT) are recommended to have baseline and
serial bone densitometry (BD) and receive intravenous bisphsphonates
(BP). Utilization of BD and BP therapy was evaluated in a retrospective
SEER Medicare database analysis. Methods: A cohort study of men aged
aged � 65 years with a nonmetastatic incident diagnosis of prostate cancer
between 2004 and 2008 was conducted. Data were obtained from the
Surveillance, Epidemiology and End Results (SEER) linked Medicare
claims. Medicare claims were used to select prostate cancer cases who had
ever received ADT and intravenous BP as part of their treatment. ADT was
defined as an orchiectomy, goserelin, leuprolide, leuprolide implant, or
triptorelin. BD and treatment with pamidronate or zoledronic acid were
identified using Medicare HCPCS codes. One-sided exact binomial test of
proportion was used to determine if the physician compliance rate is
consistent with 80%; meaning equal to or higher than 80%. Results:
157,974 newly diagnosed prostate cancer cases were identified. Of those,
100,865 were age 65 and above and had no bone metastases. Subjects
who did not have ADT claims were excluded. 30,846 patients were eligible
for analysis. Cases were further stratified by use of BD and BP therapy.
Results revealed 86.8% (N�26,774) on ADT did not receive either a BD or
intravenous BP therapy. Approximately 2.9% (N�885) of the cases on ADT
received BP treatment without ever receiving a BD. 9.3% (N�2,863) of the
cases on ADT received a BD without receiving intravenous BP, while only
1.05% (N�324) of the cases on ADT received both a BD and BP. A
compliance rate of 1.05%, those patients receiving both bone densitometries
to screen for bone loss and preventive therapy, was well below the
expected rate of 80%. Conclusions: Contrary to the recommendations, BD
assessment and BP use is under utilized in men receiving ADT for non
metastatic prostate cancer. Education of practicing physicians regarding
better screening and preventative measures for osteoporosis in this population
is warranted.
6101 General Poster Session (Board #9B), Mon, 1:15 PM-5:15 PM
Long-term central venous catheter use among cancer patients in administrative
claims data. Presenting Author: Allison Nicole Lipitz Snyderman,
Memorial Sloan-Kettering Cancer Center, New York, NY
Background: This study’s objective was to examine administrative claims
data’s capacity to serve as a surveillance tool for long-term catheter use and
related bloodstream infections among cancer patients. Population-based
estimates and efforts to track catheter use and infections for this group are
limited. As such, we sought to explore catheter use documentation using a
cohort of colorectal cancer patients. Methods: We performed a retrospective
analysis using the population-based SEER-Medicare dataset for patients
66 years or older diagnosed with colorectal cancer in 2005-2007 (n �
54,870). Insertions and removals of long-term central venous catheters
(i.e., tunneled, ports/pumps, peripherally inserted central catheter [PICCs])
were identified by billing codes within 2 years of diagnosis. Factors
associated with catheter use were identified in multivariable logistic
regression analysis. Results: Findings were consistent with clinical expectations.
A total of 11,775 patients (21%) had at least one documented
long-term catheter insertion within 2 years of diagnosis, 19% within 6
months. Of those with catheters, approximately 25% had more than one
insertion. Sixty-eight percent had at least one port/pump, 8% at least one
tunneled catheter, and 33% at least one PICC. Seventy-four percent of
catheterized patients had IV chemotherapy. Of patients stages I, II, III, and
IV, 10%, 18%, 37%, and 39% had catheters, respectively. Adjusted for
other factors, patients with catheters were significantly more likely to be
younger, female, black (vs. white), and have comorbidities (vs. none
documented in year prior to diagnosis), compared to patients without
catheters. By the end of the study, 34% of patients with ports/pumps had
documented removal and 42% died (for patients with tunneled catheters,
28% and 52%, respectively). Conclusions: Findings support the use of
claims data to capture long-term catheter use in cancer patients, providing
a foundation for exploration of its capacity to capture infections. Given
extensive documented catheter use (21%), infections may be a significant
problem. Claims data may offer a low-burden method for surveillance and
study, aiding the development of targeted initiatives.
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