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A. Ravelo
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MINI 04 - Clinical Care of Lung Cancer (ID 102)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:L. Gaspar, V. Westeel
- Coordinates: 9/07/2015, 16:45 - 18:15, Mile High Ballroom 2c-3c
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MINI04.03 - Real-World Patterns of Access to Cancer Specialist Care Among Patients With Lung Cancer in the United States: A Claims Database Analysis (ID 1592)
16:55 - 17:00 | Author(s): A. Ravelo
- Abstract
- Presentation
Background:
Timely access to specialist care is an important first step in the care of patients with lung cancer (LC). This study describes real-world patterns of access to cancer specialist (CS) care in all LC patients and those with metastatic LC (mLC).
Methods:
Adult patients diagnosed with primary LC or mLC were identified in a US commercial claims database (01/01/2008 - 03/31/2014). Patients’ specialist visits were assessed before and after their first biopsy (index date). All patients had ≥3 months follow-up after index date. CS was defined as oncologists or hematologists. Patients were divided in four mutually exclusive groups based on the specialists seen in the 6 weeks pre-index period: patients seen by CS (± other specialists), pulmonologists (no CS, ± other specialists), internists or family physicians (no CS/pulmonologist, ± other specialists), and other. CS visits in the 8-weeks post-index were assessed for each group. Reversed Kaplan-Meier plots were used to describe time from index date to first CS visit.
Results:
The analysis included 75,163 LC and 25,191 mLC patients, with a median age of 67 [interquartile range (IQR): 59-76)] and 63 (IQR: 57-73) years and a median follow-up of 11 and 9 months, respectively. In the 8-week post-index period, over half of LC patients (54%) and nearly two-thirds of mLC patients (66%) had their first CS visit (Figure 1), while 38% of LC patients and 28% of mLC patients never saw a CS within 1-year of biopsy (Figure 1). In both samples, patients in the CS and pulmonologist pre-index groups were more likely to see a CS in follow-up (Figure 2; p<0.001 for all groups). Figure 1 Figure 1 Figure 2 Figure 2
Conclusion:
A substantial proportion of patients diagnosed with LC and mLC did not see any CS after biopsy, which may negatively affect access to optimal and timely treatment.
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ORAL 30 - Community Practice (ID 141)
- Event: WCLC 2015
- Type: Oral Session
- Track: Community Practice
- Presentations: 1
- Moderators:P.S.S. Kho, R. Jotte
- Coordinates: 9/08/2015, 16:45 - 18:15, Mile High Ballroom 2c-3c
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ORAL30.03 - Access to Cancer Directed Therapies and Cancer Specialists in Patients with Metastatic Lung Cancer (ID 2899)
17:07 - 17:18 | Author(s): A. Ravelo
- Abstract
- Presentation
Background:
Access to cancer specialists and directed therapies is critical in the management of patients with metastatic lung cancer (mLC). This study aims to assess treatment patterns overall and stratified based on whether patients were seen or not by a cancer specialist in patients with de novo mLC.
Methods:
Adult patients diagnosed with de novo mLC between January 1, 2008 and March 31, 2014 were selected from a US commercial health claims database. All patients were followed for a minimum 3 months after the index date, defined as their first biopsy date. Patients who saw an oncologist/hematologist from 6 weeks before index date until the end of follow-up (end of data availability or health plan eligibility) were included in the cohort of patients who saw a cancer specialist. The remaining patients were included in the cohort of patients who did not see a cancer specialist. In both cohorts, the use of systemic antineoplastic therapy (Table 1) and radiation therapy was assessed following the index date.
Results:
The study sample consisted of 25,191 mLC patients, followed for a median of 9 months. Median age was 63 years (interquartile range: 57-73). 28.4% of the patients did not see a cancer specialist. Overall, 89.9% of the mLC patients received a cancer directed therapy during the follow-up (Table 1). The proportion of patients who received a cancer directed therapy during the follow-up was larger among patients seen by a cancer specialist (91.2% vs. 86.7%, p < .0001) (Table 1). Among patients who did not see a cancer specialist, 86.7% received antineoplastic therapy and/or radiotherapy during the follow-up, 2.6% were untreated and admitted to hospice, and 10.6% were untreated and were not admitted to hospice. The majority of patients who were not seen by a cancer specialist and received treatment were seen prior to the initiation of therapy by pulmonologists, internists, family physicians, and/or radiologists. Figure 1
Conclusion:
Approximately one in ten patients with de novo mLC did not receive any cancer directed therapy and a little more than one in four patients were not seen directly by a cancer specialist. Among patients not seen by a cancer specialist many received some form of cancer directed therapy. However, the access to cancer directed therapy of these patients remained significantly lower than that of mLC patients seen by a cancer specialist. Further research should be directed towards understanding and addressing disparities in access to appropriate cancer care.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-040 - Survival Gains From Systemic Therapy in Advanced Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities (ID 1563)
09:30 - 09:30 | Author(s): A. Ravelo
- Abstract
Background:
Approximately 180,000 Americans are diagnosed with non-small cell lung cancer (NSCLC) annually, and more than half have advanced (Stage IIIB/IV) disease. Historically, survival for these patients has been poor. Moreover, even though standard systemic therapies (e.g. platinum-doublet chemotherapy) provide a modest survival advantage, a substantial proportion(~60%) of patients do not initiate or complete treatment. The advent of newer systemic therapies with more favorable effectiveness and toxicity profiles affords opportunities to improve NSCLC outcomes. The objectives of this study were: 1)to quantify survival gains from 1990-2015, ranging from a period when best supportive care(BSC) only was standard, to the present, where multiple cytotoxic and targeted therapies are available, and 2)to project the potential impact of increasing use of modern systemic therapies in clinically appropriate patients.
Methods:
We developed a simulation model to estimate observed and potential survival gains for patients diagnosed with advanced NSCLC in 1990 and 2015. Survival inputs were derived from Phase III clinical trials referenced in National Comprehensive Cancer Network guidelines, and extrapolated to a lifetime horizon by fitting Weibull curves. Proportions of patients receiving available therapies were derived from SEER (for % receiving BSC only) and a commercial treatment registry. Outcomes included one-year survival proportion, mean expected overall survival(OS), expected OS if the proportion receiving systemic therapy is increased by 10% (“Scenario 1”) and 30% (“Scenario 2”) relative to current use, and population-level estimates of total life years. Results were calibrated with SEER overall survival curves. Annual incidence of advanced NSCLC was assumed to be 92,000 in both years.
Results:
In the expected survival analysis, from 1990 to 2015, one-year survival proportion increased by 15.8% and mean per-patient survival improved by 4.3 months (33,412 population life years)(Table 1). In scenarios 1 and 2, the improvement in survival increased to 4.6 months (35,684 population life years) and 5.2 months (40,279 population life years), respectively. Considering the proportion receiving each treatment, and the size of overall survival treatment effects, the majority of the survival gains were attributable to the advent of platinum-doublet chemotherapy (49%), followed by EGFR (35%), VEGF (10%), and ALK (6%) targeted therapies.Table 1: Advanced non-small cell lung cancer outcomes by year of diagnosis.
Diagnosis Year Expected: One-Year Survival (%) Expected: Mean Per-Patient Survival (Months) Expected: Population Life Years Scenario 1: Population Life Years with 10% Relative Increase in Proportion Treated Scenario 2: Population Life Years with 30% Relative Increase in Proportion Treated 2015 29.3% 11.4 87,287 89,559 95,154 1990 13.5% 7.1 53,875 53,875 53,875 Difference +15.8% +4.3 +33,412 +35,684 +40,279
Conclusion:
Though survival remains poor in advanced NSCLC relative to other common cancers, meaningful progress in per-patient and population-level outcomes has been realized over the past 25 years. These advances can be improved even further by increasing use of systemic therapies in the substantial proportion of patients who are suitable for treatment, yet currently receive BSC only.
