ASCO Studies Cover Healthcare Utilization, Quality of Life Data

Dozens of studies presented during the 2021 American Society of Clinical Oncology Annual Meeting involved healthcare utilization, the cost of adverse events that result from cancer treatment, and patient quality of life. Selected studies are below:

Cost of treatment-related diarrhea

Gastrointestinal events occur frequently in cancer treatment, especially when therapies are used in combination. Studies funded by Napo Pharmaceuticals, developer of a treatment to prevent non-infectious diarrhea, examined the cost of diarrhea on the health system and the effects on patients’ quality of life.^1,2 Led by Pablo C. Okhuysen, MD, of The University of Texas MD Anderson Cancer Center; Lee S. Schwartzberg, MD, of West Cancer Center; and Eric Roeland, MD, of Harvard Medical School, the studies examined 104,135 matched pairs of patients with either solid tumor or hematologic cancer, with and without cancer-related diarrhea (CRD), who received chemotherapy or targeted therapy. Researchers used the IQVIA PharMetrics database to calculate all healthcare costs over a 12-month period, with the index date being the first cancer claim; patients were re-indexed after the first claim based on treatment for diarrhea. Results showed:

Patients with CRD incurred significantly higher healthcare costs per patient, with a mean of $104,880 vs $39,664 for those without CRD, with P< .0001.

Patients who had inadequate treatment for CRD had the highest mean healthcare costs, at $129,531, compared with adequately CRD-treated patients, $107,050; or untreated CRD patients, $56,350, all P < 0.0001.

Mean pharmacy costs were $35,190 for CRD patients compared with $15,883 for non-CRD patients; emergency department visits cost $1107 for CRD patients vs $431 for non-CRD patients. Costs for physicians’ office visits, lab costs, and ancillary services were all higher for CRD patients.¹

Researchers also used the data set to gain insights about discontinuation rates by type of treatment for patients with and without CRD. Patients with CRD taking chemotherapy with CRD stopped therapy more frequently than non-CRD patients, 81.5% vs 62.3%. Patients taking a targeted therapy who had CRD also stopped more frequently, but the gap was not as large, 69.2% vs 64.3%. Discontinuation rates were highest for patients taking both, 96% for those with CRD and 85.5% for those without, all P < .0001.²

More payers, including Medicare, are interested in patient-reported outcomes for cancer therapies, and FDA recently issued a guidance for industry on the topic.³

Cancer raises readmission risk

Payment models such as the Oncology Care Model have sought to reduce the risk of hospital readmission within 30 days of discharge, as this has been a priority across Medicare under the Affordable Care Act, as these trips back to the hospital boost costs and are typically associated with poor patient outcomes. A study funded by the National Institutes of Health sought to quantity how much having cancer elevated the 30-day readmission risk.⁴ Researchers identified non-procedural hospital readmissions between January through November 2017 from the National Readmission Database (NRD), including those patients with and without a cancer diagnosis admitted for non-procedural causes. Results showed:

Of 18.9 million weighted readmissions, 1.68 million (8.9%) had a cancer diagnosis, which was associated with a significantly higher risk of readmission compared with patients without cancer, 23.5% vs 13.6%, P < .001.

However, among readmissions, cancer patients were less likely to have a preventable readmission; 6.5% of cancer readmissions were seen as preventable, compared with 12.1% among patients without cancer readmitted for the same diagnoses, P < .001.

Younger patients (ages 45 to 64) with cancer were more likely to be have a higher readmission risk, (overall risk [OR], 1.29; 95% CI, 1.24-1.34), while younger patients without cancer had a lower readmission risk (OR 0.65, 95% CI, 0.64-0.66).

The site of cancer was the greatest predictor of readmission risk, with liver, pancreatic, and non-Hodgkin’s lymphoma having the highest readmission rates.

Perceptions linked to end-of-life healthcare use

Patients who have an inaccurate view of their cancer prognosis will be unprepared to make difficult decisions regarding end-of-life care, which can lead to late treatment that will not be effective or late hospital stays. Researchers funded by the Leukemia and Lymphoma Society conducted a secondary analysis using longitudinal data from a randomized controlled trial of a palliative care intervention for patients with incurable lung or gastrointestinal cancer.⁵ Using the Prognosis and Treatment Perceptions Questionnaire, they assessed patients at weeks 12 and 24 after diagnosis and conducted a final assessment close to death. There were 350 patients in the parent trial, of which 80.5% died during the study period and were included in the analysis. Results showed:

• 59.4% of the patients reported being terminally ill, while 66.1% said their cancer was likely curable at the assessment closest to death.
• The patients who said their cancer was curable were least likely to use hospice (OR = 0.25, 95% CI, 0.10-0.61, P = .002) or die at home, (OR = 0.56, 95% CI, 0.32-0.98, P = .043), and more likely to be hospitalized in the last 30 days of life (OR 2.28, 95% CI, 1.20-4.32, P = .011).
• Patients who reported being terminally ill were less likely to be hospitalized in the last 30 days of life (OR = 0.52, 95% CI, 0.29-0.92, P = .025). However, these patients’ perceptions did not affect hospital length of stay or chemotherapy administration in the last 30 days of life.

References

1. Roeland E, Schwartzberg LS, Okhuysen PC, et al. Healthcare utilization and costs associated with cancer-related diarrhea. J Clin Oncol. 2021; 39(Suppl_15): abstr e18623. DOI: 10.1200/JCO.2021.39.15_suppl.e18623
2. Okhuysen PC, Schwartzberg LS, Roeland E, et al. The impact of cancer-related diarrhea on changes in cancer therapy patterns. J Clin Oncol. 2021; 39(Suppl_15): abstr 12111. DOI: 10.1200/JCO.2021.39.15_suppl.12111
3. FDA in brief: FDA provides guidance measuring patient reported outcomes for cancer clinical trials. News release. FDA newsroom. June 9, 2021. Accessed July 3, 2021. https://www.fda.gov/news-events/press-announcements/fda-brief-fda-provides-guidance-measuring-patient-reported-outcomes-cancer-clinical-trials
4. Qian A, Qiao E, Nalawade V, et al. Impact of cancer on the risk of unplanned 30-day readmissions. J Clin Oncol. 2021; 39(Suppl_15): abstr 6581 DOI: 10.1200/JCO.2021.39.15_suppl.6581
5. Topping CEW, Elyze M, Plotke R, et al. Association between perception of prognosis and end-of-life outcomes for patients with advanced lung and gastrointestinal cancer. J Clin Oncol. 2021; 39(Suppl_15): abstr 6503 DOI: 10.1200/JCO.2021.39.15_suppl.6503