Author of

• 17556

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  P2.03a - Poster Session with Presenters Present (ID 464)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 17600

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    P2.03a-044 - Severe Adverse Events Impact Overall Survival (OS) and Costs in Elderly Patients with Advanced NSCLC on Second-Line Therapy (ID 5064)

    14:30 - 14:30  |  Author(s): Y.M. Yim
    • Abstract

    Background:
    Among elderly patients with advanced non-small cell lung cancer (aNSCLC), treatment beyond first-line therapy may be associated with higher risk of adverse events (AEs) due to patients’ poorer performance status and higher disease burden and comorbidities. This study assessed the impact of severe AEs during second-line (2L) therapy on OS and cost of care in elderly with aNSCLC.
    
    Methods:
    Patients aged ≥65 years, diagnosed with aNSCLC between 2007-2011 and receiving 2L chemotherapy/targeted therapy, were identified in the SEER-Medicare database (2006-2013). 57 AEs were identified by literature review and consultation with an oncologist. Severe AEs were operationalized as hospitalizations during which a diagnosis for ≥1 AEs was recorded. OS and all-cause healthcare costs post-initiation of 2L chemotherapy/targeted therapy were compared between patients with and without severe AEs.
    
    Results:
    Among 3967 patients initiating 2L, 1624 (41%) had ≥1 severe AEs where hypertension (26%), anemia (24%), and pneumonia (23%) were most commonly reported. Patients with and without severe AEs were similar in demographic and cancer characteristics at diagnosis and 2L treatment regimens; although patients with severe AEs had more comorbidities, notably anemia (69% vs 60%). Median OS for patients with severe AEs was almost half of that for patients without severe AEs (6 vs 11 months). After adjustment for potential confounders, patients with severe AEs had more than double risk of death than patients without severe AEs. Cost of caring for patients with severe AEs was more than twice higher than those patients without severe AEs ($16,135 vs $7,559 per-patient-per-month).

    OS	With severe AEs cohort N = 1,624	Without severe AEs cohort N = 2,343
    Kaplan-Meier rates (95% CI)
    1 year post 2L initiation	26% (24 - 28)	46% (44 - 48)
    2 years post 2L initiation	11% (9-13)	23% (21-25)
    Median survival time (in months)	6	11
    Adjusted hazard ratio[1] (95% CI)	2.31 (2.16 - 2.47)
    [1] Patients with vs without severe AEs
    AE: adverse event; 2L: second line chemotherapy/targeted therapy; CI: confidence intervals

    
    
    Conclusion:
    Occurrence of severe AEs among elderly aNSCLC patients who are receiving 2L chemotherapy/targeted therapy is associated with worse clinical outcomes and a higher economic burden. Results of this analysis suggest that better tolerated therapies may improve outcomes for patients and reduce cost to the healthcare system.