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Comparative Effectiveness of Chemotherapy  Regimens for Advanced Lung Cancer                     Nikki Carroll            ...
REACT Project• Part of NCI funded Cancer Research Network (CRN) and  Dana Farber Cancer Institute collaboration• Project T...
Project Team• KPCO                                 •   Dana Farber Cancer  • Deb Ritzwoller, Tom Delate,            Instit...
Background• Platinum-based chemotherapy may prolong survival and improve  symptom control in advanced stage Non Small Cell...
Aim of Study    • Examine comparative effectiveness of patients      with late stage NSCLC in terms of       • Survival   ...
Study Design and Sample • Retrospective cohort identified at 4 HMOs • Inclusion Criteria    • Stage IIIB/IV NSCLC diagnosi...
Methods• Survival Analysis   • Stabilized inverse probability weighted estimators   • Propensity covariates: age group, ge...
ResultsProportion of Stage IIIB/IV NSCLC Patients Receiving Chemotherapy (N = 6614)                   Patients            ...
Results by Age Category    • 3,072 patients receiving chemo identified                   6%                        4%     ...
Results                         Year of Diagnosis    100%     90%     80%     70%     60%                                 ...
Results      Distribution of First Line Therapy         N (% of Total)    Single Agent Therapy                           6...
Unadjusted Survival Results                                   Singlet      Doublet     Triplet/Other Mean Survival Time (S...
Adjusted Hazard Ratios                          HR       95% CI      P-value   Referent                                   ...
Adjusted Survival Curves                           Type of Regimen                                 Singlet                ...
Adjusted ResultsNumber of Hospitalizations                          Rate Ratio     95% CI      P-value   Referent         ...
Adjusted ResultsNumber of Hospital Days                          Rate Ratio     95% CI      P-value   Referent            ...
Findings that inform future studies…     100      90      80                                                     Any Chemo...
Conclusions• Adjusted analysis confirmed that:   • patients on triplet therapy were associated with longer survival than  ...
Next Steps• Additional comparative effectiveness studies  • Examine the factors associated with use of erlotinib and    be...
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Comparative Effectiveness of Chemotherapy Regimens for Advanced Lung Cancer CARROLL

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Transcript of "Comparative Effectiveness of Chemotherapy Regimens for Advanced Lung Cancer CARROLL"

  1. 1. Comparative Effectiveness of Chemotherapy Regimens for Advanced Lung Cancer Nikki Carroll Institute for Health Research Kaiser Permanente Colorado HMO Research Network Conference May 2, 2012
  2. 2. REACT Project• Part of NCI funded Cancer Research Network (CRN) and Dana Farber Cancer Institute collaboration• Project Title • Building CER capacity: Aligning CRN, CMS, and State Resources to Map Cancer Care• Goal • To conduct Research on the Effectiveness of Advanced Cancer Treatment (REACT)
  3. 3. Project Team• KPCO • Dana Farber Cancer • Deb Ritzwoller, Tom Delate, Institute Jared Freml, Kim Bischoff, Nikki • Jane Weeks, Deb Schrag Carroll • GHC• KPNC • Elizabeth Loggers, Arvind • Larry Kushi, Karl Huang, Ramaprasan, Nick Heather Clancy Vanneman• KPNW • Mark Hornbrook, Joanna Bulkley, Stephen Houston
  4. 4. Background• Platinum-based chemotherapy may prolong survival and improve symptom control in advanced stage Non Small Cell Lung Cancer (NSCLC) patients• Newer agents including biologics and targeted agents used as singlet, doublet, or triplet regimens may improve survival• Newer agents are expensive and may produce side effects requiring hospitalization.• Little is known about the comparative effectiveness of various regimens in an HMO-based community setting
  5. 5. Aim of Study • Examine comparative effectiveness of patients with late stage NSCLC in terms of • Survival • Number of hospitalizations • Total hospital days
  6. 6. Study Design and Sample • Retrospective cohort identified at 4 HMOs • Inclusion Criteria • Stage IIIB/IV NSCLC diagnosis in Tumor Registry • First cancer diagnosis • Diagnosed 2000 through 2007 • 21 years or greater at diagnosis • Continuous enrollment from diagnosis until death, disenrollment or end of study (December 2008) • Survival at least 1 month post diagnosis • Patients not on concurrent therapy
  7. 7. Methods• Survival Analysis • Stabilized inverse probability weighted estimators • Propensity covariates: age group, gender, race, median family income, stage at diagnosis, tumor grade, year of diagnosis, modified Charlson comorbidity score and health plan• Number of Hospitalizations/Hospital Days • Poisson regression modeling • Stabilized inverse probability weighted estimators • Propensity covariates: age group, gender, race, median family income, stage at diagnosis, tumor grade, year of diagnosis, modified Charlson comorbidity score, and health plan
  8. 8. ResultsProportion of Stage IIIB/IV NSCLC Patients Receiving Chemotherapy (N = 6614) Patients receiving Doublet Patients not chemo within Regimen receiving 120 days 77% chemo within 55% Singlet 120 days Regimen N = 3,072 45% 18% Triplet Regimen 5%
  9. 9. Results by Age Category • 3,072 patients receiving chemo identified 6% 4% 100% 80% 60% 73% 79% 40% 20% 23% 0% 15% < 65 > 65 Singlet Doublet Triplet/Oth
  10. 10. Results Year of Diagnosis 100% 90% 80% 70% 60% Triplet/Oth 50% 40% Doublet 30% Singlet 20% 10% 0% 2000 2001 2002 2003 2004 2005 2006 2007
  11. 11. Results Distribution of First Line Therapy N (% of Total) Single Agent Therapy 638 (18.5) Platinum (Cisplatin / Carboplatin) 182 (5.3) Taxanes 55 (1.6) Erlotinib 153 (4.4) Other Singlet 248 (7.2) Doublet Therapy 2660 (77.0) Platinums + Taxanes 1930 (55.8) Platinums + Gemcitabine 268 (7.8) Platinums + Other 410 (11.9) Other Doublets 52 (1.5) Triplet Therapy 160 (4.6) Carboplatin + Paclitaxel + Bevacizumab 103 (3.0) Others 57 (1.6)
  12. 12. Unadjusted Survival Results Singlet Doublet Triplet/Other Mean Survival Time (SE) [Days] 339 (18.1) 466 (13.5) 650 (69.5) Median Survival Time [Days] 176 252 354 Percent Censored 8.5% 10.4% 29.7%
  13. 13. Adjusted Hazard Ratios HR 95% CI P-value Referent Group Singlet vs Triplet/Oth 1.78 1.44 – 2.20 < .0001 Triplet Doublet vs Triplet/Oth 1.43 1.17 – 1.75 0.0005 Triplet Singlet vs Doublet 1.29 1.17 – 1.41 < .0001 Doublet
  14. 14. Adjusted Survival Curves Type of Regimen Singlet Doublet Triplet/Oth
  15. 15. Adjusted ResultsNumber of Hospitalizations Rate Ratio 95% CI P-value Referent Group Singlet vs Triplet/Oth 1.42 1.05 – 1.92 0.0229 Triplet Doublet vs Triplet/Oth 1.12 0.84 – 1.49 0.4430 Triplet Singlet vs Doublet 1.25 1.09 – 1.43 0.0013 Doublet
  16. 16. Adjusted ResultsNumber of Hospital Days Rate Ratio 95% CI P-value Referent Group Singlet vs Triplet/Oth 1.98 1.71 – 2.29 < .0001 Triplet Doublet vs Triplet/Oth 1.48 1.29 – 1.71 < .0001 Triplet Singlet vs Doublet 1.32 1.24 – 1.40 < .0001 Doublet
  17. 17. Findings that inform future studies… 100 90 80 Any Chemo + 70 Bevacizumab 60 Doublet/Triplet 50 40 Erlotinib 30 20 Singlet 10 0 2000 2001 2002 2003 2004 2005 2006 2007
  18. 18. Conclusions• Adjusted analysis confirmed that: • patients on triplet therapy were associated with longer survival than those patients on singlet or doublet therapy • patients on triplet therapy were associated with fewer hospitalizations then those patients on singlet or doublet therapy • patients on triplet therapy were associated with fewer hospital days then those patients on singlet or doublet therapy• Secular changes in the distribution of singlet and triplet regimens may have an impact on future findings
  19. 19. Next Steps• Additional comparative effectiveness studies • Examine the factors associated with use of erlotinib and bevacizumab • Conduct separate comparative effectiveness analyses on the impact on survival and hospitalizations by • Receipt of erlotinib • Receipt of carboplatin and paclitaxel with and without bevacizumab
  20. 20. Questions?
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