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

6102 General Poster Session (Board #9C), Mon, 1:15 PM-5:15 PM
Assessment of cancer registries (CR) in low- and middle-income countries
(LMCs). Presenting Author: Leah L. Zullig, Department of Health Policy and
Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: CRs are crucial for cancer control, yet few global standards
exist. This study identifies characteristics of quality CRs in LMCs and
globally. Methods: A Medline search was conducted in PubMed to identify
peer-reviewed articles describing: 1) CR development and functionality 2)
types of CRs and 3) implementation, development and utility of CRs in
LMCs. We examined articles describing CRs and assessed benchmarking
data that could be used to define quality characteristics. Full-text,
English-language articles were reviewed. References cited were searched
for additional articles. We categorized characteristics into 4 domains:
comparability, completeness, validity and timeliness. Results: The literature
search yielded 16 key characteristics within 4 domains that may define
high quality CRs. In the “comparability” domain, the key characteristic was
use of standard definitions. CRs in the US, Europe and China generally
adhere to the International Classification of Diseases for Oncology and
histological verification of disease; in 2007 only 40% of African registries
did so. In the “completeness” domain the key characteristic was population
coverage. African CRs monitor 8% of the population, the Costa Rican
registry covers 90%, US and Madras cancer registries reach 96%. In the
“validity” domain the key criterion was pathologic diagnosis confirmation.
Most LMC CRs are not pathology-based. CRs in wealthier settings like Hong
Kong report histologic confirmation in �85% of cases. In the “timeliness”
domain standards for timely data reporting are largely undocumented.
Conclusions: No consensus exists on characteristics of quality CRs in a
global context. The current study provides an initial set of metrics. A Delphi
panel of international experts is planned to further address this. Based on
this literature review, CRs in LMCs have limited reporting, validation and
regional population coverage.
6104 General Poster Session (Board #9E), Mon, 1:15 PM-5:15 PM
Differential receipt of sentinel lymph node biopsy within practice-based
research networks. Presenting Author: Anne-Marie Meyer, University of
North Carolina at Chapel Hill, Chapel Hill, NC
Background: Sentinel lymph node biopsy (SLNB) for breast cancer was
introduced into clinical practice in the late 1990s as an alternative to
axillary lymph node dissection (ALND). Provider-based research networks
(PBRNs) are believed to promote diffusion of innovations like SLNB into
clinical practice; however, evidence of this association is limited. This
study examines the diffusion of SLNB for early-stage breast cancer through
the Community Clinical Oncology Program (CCOP), a community-based
PBRN. Methods: We identified women undergoing breast conserving
surgery with axillary staging for stage I or II breast cancer between January
2000 and December 2003 using Surveillance Epidemiology and End
Results-Medicare data (n�6,226). The primary outcome was receipt of
SLNB vs. ALND, and exposure was care received from CCOP physicians or
institutions between diagnosis and surgery. Exposure was quantified as
both a binary measure of ever seeing a CCOP, and as a proportion of all their
claims associated with a CCOP. Covariates included race, age, marital
status, education, Medicaid eligibility, comorbidity, tumor grade, stage,
estrogen receptor status, year of diagnosis, SEER region, and other
institutional characteristics such as NCI center designation, cooperative
group, and medical school affiliation. Multivariable generalized linear
modeling with generalized estimating equations was used to measure
association between CCOP exposure and receipt of SLNB. Results: Women
who received a higher proportion of their care from a CCOP-affiliated
physician or hospital were more likely to receive SLNB. A 10% increase in
the proportion of CCOP-affiliated claims was associated with a greater odds
of receiving SLNB (OR 1.14; 95% CI 1.08, 1.20), after controlling for
covariates. Similarly, sensitivity analysis of the binary indicator of CCOP
exposure also showed greater odds of receiving SLNB (OR 1.32; 95%CI
1.01, 1.74). Conclusions: The quality of cancer care delivered in community
settings can be influenced by provider-based research networks. Our
findings contribute to the growing body of evidence that community-based
PBRNs can facilitate adoption of cancer innovations outside of academic
medical centers.
Health Services Research
407s
6103 General Poster Session (Board #9D), Mon, 1:15 PM-5:15 PM
Development of a disease-specific measure of quality of life in myelodysplastic
syndromes (MDS): The “QUALMS-1”. Presenting Author: Gregory Alan Abel,
Dana-Farber Cancer Institute, Boston, MA
Background: Studies assessing the quality of life (QoL) experienced by patients
with MDS have almost universally relied upon generic measures; however,
disease-specific QoL tools can allow for more sensitive assessments of the
impact of changes in disease status. Methods: Using a clinical impact method of
instrument development, individual and combined focus groups were conducted
with 32 members of our institution’s MDS community (patients, their caregivers,
and health care providers) to identify MDS-relevant QoL domains and associated
question topics. Participants’ rankings of the importance of the domains and
question topics were compared, collapsing patients/caregivers into one group
and physicians/other providers into another. A draft scale was constructed taking
a greater number of questions from the more highly-ranked domains. Results:
“Fatigue” was ranked as the most important domain (see table). None of the 12
domains were ranked significantly differently by patients/caregivers versus
providers. The two groups ranked 5 of 60 question topics differently: “Too tired
for routine tasks” (providers higher; p� .05); “limited availability of support
beyond the family” (providers higher; p� .02); “organizing life around transfusion/MD
appointments” (providers higher, p� .03); “bruising” (patients/
caregivers higher, p� .05) and “anger over diagnosis” (providers higher, p�
.03). Conclusions: A high level of agreement in the rankings of domains and
question topics between MDS patients/caregivers and providers suggests that
the QoL experience of MDS patients is consistently compromised. The resulting
38-item draft QUALMS-1 tool is now being piloted (cognitive debriefing and
behavioral coding) in a new cohort of MDS patients, with the ultimate goal of
validation in a multi-institutional setting.
Domain
Mean ranking
(n�32; 1� most important,
12� least important)
Fatigue 1.4
Emotional health 3.3
Uncertainty/sense of control 4.6
Disease information 5.5
Disruption of life/logistics of care 5.7
Family relationships 6.6
Symptoms other than fatigue 6.6
Financial concerns 7.0
Awareness of positives/hope 7.1
Social/role functioning 7.9
Sexual health 11.0
Appearance/self-image 11.0
6105 General Poster Session (Board #9F), Mon, 1:15 PM-5:15 PM
Comparative effectiveness of erlotinib versus no treatment for advanced
non-small cell lung cancer patients in the Veterans Administration.
Presenting Author: Benjamin Kim, UCSF School of Medicine, San Francisco,
CA
Background: Erlotinib (E) is FDA-approved for second-line treatment of
unselected advanced non-small cell lung cancer (aNSCLC) patients.
Clinical trials have shown increased response rates with E in aNSCLC
patients having East Asian ethnicity, female gender, never-smoking history,
or adenocarcinoma histology. The objective of this study was to compare
the real-world effectiveness of E versus no treatment (NT) for first- and
second-line treatment of aNSCLC patients in the Veterans Administration
(VA). Methods: All incident aNSCLC cases diagnosed in the VA during 2007
were identified through the VA Central Cancer Registry, a subset of which
underwent medical record abstraction through the VA External Peer Review
Program. Abstracted records were then merged with national VA Decision
Support System pharmacy and Corporate Data Warehouse encounters data
through 2010. Treatment lines were determined through adaptation of a
published algorithm. The impact of E versus NT on overall survival for each
treatment line was then evaluated using 1:N greedy propensity score
matching (PSM) and 2-stage residual inclusion (2SRI) estimation. Results:
Among 1965 aNSCLC patients assessed for first-line treatment, 78 (4%)
received E and 782 (40%) received NT; among 1124 assessed for
second-line treatment, 128 received E (7%) and 638 (33%) received NT.
1:3 PSM of E cases to NT controls showed no difference in overall survival
by Kaplan-Meier estimation in the first- (median 2.6 vs. 2.9 mos.,
p-value�0.86) and second-line (3.4 vs. 3.2 mos., p�0.85) settings.
Chemotherapy use by Veterans Integrated Service Network was selected as
the instrumental variable for 2SRI. Expected mean survival of E versus NT
was similarly not statistically prolonged in the first- (E:NT survival time ratio
2.55, p�0.35) and second-line (2.49, p�0.32) settings. Conclusions: For
a population with few aNSCLC patients having 3 out of the 4 clinicopathologic
characteristics associated with improved response, E did not appear
to confer a survival advantage over NT. Linking mutation results to
observational datasets may improve comparative effectiveness research of
personalized medicine in oncology.
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