Pub Date : 2025-03-01Epub Date: 2024-08-05DOI: 10.1200/OP.23.00688
Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje
Purpose: Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).
Methods: Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.
Results: In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.
Conclusion: The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.
{"title":"Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records.","authors":"Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje","doi":"10.1200/OP.23.00688","DOIUrl":"10.1200/OP.23.00688","url":null,"abstract":"<p><strong>Purpose: </strong>Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).</p><p><strong>Methods: </strong>Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.</p><p><strong>Results: </strong>In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.</p><p><strong>Conclusion: </strong>The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"400-407"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-10-15DOI: 10.1200/OP.24.00434
Inimfon Jackson, Qian Lu, Debasish Tripathy
Purpose: We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization.
Methods: Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use.
Results: Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility.
Conclusion: Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.
{"title":"Racial/Ethnic Disparities in Hospitalization Outcomes by Palliative Care Utilization and Trends Among Women With Metastatic Breast Cancer in the United States.","authors":"Inimfon Jackson, Qian Lu, Debasish Tripathy","doi":"10.1200/OP.24.00434","DOIUrl":"10.1200/OP.24.00434","url":null,"abstract":"<p><strong>Purpose: </strong>We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization.</p><p><strong>Methods: </strong>Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use.</p><p><strong>Results: </strong>Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility.</p><p><strong>Conclusion: </strong>Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"418-426"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-07-25DOI: 10.1200/OP.24.00208
Niamh Walsh, Rosalie Stephens, Alvin Tan, Vanessa Durandt, Jennifer McLachlan, Jody Jordan, Kate Gregory, Sean Sutton, Catherine Barrow, Annie N M Wong
Purpose: Melanoma brain metastases (BMs) are associated with poor survival. Combination immune checkpoint inhibitors (ICIs) with anti-PD1 and anti-CTLA-4 are the international standard-of-care treatment. Most landmark clinical trials excluded real-world patients with symptomatic disease, poor performance status (PS), and steroid use. Despite the high incidence of melanoma in New Zealand (NZ), the only publicly funded systemic treatment is anti-PD1 monotherapy. The real-world outcomes for BMs after ICIs in NZ are unknown.
Methodology: Medical records of patients with melanoma BMs in seven cancer centers across NZ between September 1, 2016, and September 1, 2020, were evaluated. Clinicopathologic characteristics, treatment, intracranial (IC) tumor response rates, IC progression-free survival, and overall survival (OS) are reported.
Results: One hundred and forty-four patients received at least one dose of ICI. One hundred and thirty-three (93%) patients received anti-PD1 monotherapy. Almost a quarter of patients had poor baseline PS, 56% were symptomatic, and 33% had corticosteroids. Patients also received local therapies: 61 (42%) patients underwent surgery, 42 (29%) received whole brain radiation, and 47 (33%) received stereotactic radiation. The median OS was 15 months, and a third of patients were alive at 2 years. The toxicity of ICIs was at 28% and 15% for Common Terminology Criteria for Adverse Events grade 1-2 and 3-4 events, respectively. Of the patients who are still alive, 76% of patients remained symptomatic neurologically at last follow-up.
Conclusion: Most patients in this NZ real-world study were symptomatic and received anti-PD1 monotherapy. Approximately one-third of treated patients are alive at 2 years, but most patients remained symptomatic. This highlights the need for more effective treatment and prospective management of their neurologic rehabilitation needs.
{"title":"Real-World Outcomes of Immunotherapy for Melanoma Brain Metastases in New Zealand.","authors":"Niamh Walsh, Rosalie Stephens, Alvin Tan, Vanessa Durandt, Jennifer McLachlan, Jody Jordan, Kate Gregory, Sean Sutton, Catherine Barrow, Annie N M Wong","doi":"10.1200/OP.24.00208","DOIUrl":"10.1200/OP.24.00208","url":null,"abstract":"<p><strong>Purpose: </strong>Melanoma brain metastases (BMs) are associated with poor survival. Combination immune checkpoint inhibitors (ICIs) with anti-PD1 and anti-CTLA-4 are the international standard-of-care treatment. Most landmark clinical trials excluded real-world patients with symptomatic disease, poor performance status (PS), and steroid use. Despite the high incidence of melanoma in New Zealand (NZ), the only publicly funded systemic treatment is anti-PD1 monotherapy. The real-world outcomes for BMs after ICIs in NZ are unknown.</p><p><strong>Methodology: </strong>Medical records of patients with melanoma BMs in seven cancer centers across NZ between September 1, 2016, and September 1, 2020, were evaluated. Clinicopathologic characteristics, treatment, intracranial (IC) tumor response rates, IC progression-free survival, and overall survival (OS) are reported.</p><p><strong>Results: </strong>One hundred and forty-four patients received at least one dose of ICI. One hundred and thirty-three (93%) patients received anti-PD1 monotherapy. Almost a quarter of patients had poor baseline PS, 56% were symptomatic, and 33% had corticosteroids. Patients also received local therapies: 61 (42%) patients underwent surgery, 42 (29%) received whole brain radiation, and 47 (33%) received stereotactic radiation. The median OS was 15 months, and a third of patients were alive at 2 years. The toxicity of ICIs was at 28% and 15% for Common Terminology Criteria for Adverse Events grade 1-2 and 3-4 events, respectively. Of the patients who are still alive, 76% of patients remained symptomatic neurologically at last follow-up.</p><p><strong>Conclusion: </strong>Most patients in this NZ real-world study were symptomatic and received anti-PD1 monotherapy. Approximately one-third of treated patients are alive at 2 years, but most patients remained symptomatic. This highlights the need for more effective treatment and prospective management of their neurologic rehabilitation needs.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"358-364"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-10-09DOI: 10.1200/OP-24-00492
Tharani Krishnan, Emily Leung, Joao Paulo Solar Vasconcelos, Howard Lim, Jonathan M Loree, Janine Davies, Karamjit Gill, Sharlene Gill
Purpose: Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada.
Methods: The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared.
Results: Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (P = .039), well/moderately differentiated (P = .005), and low-risk disease (P < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 v 36%, P < .0001) and to stop oxaliplatin early (54 v 31%, P < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (P < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 v 19 days, P = .007).
Conclusion: In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.
{"title":"Three Versus Six Months of Adjuvant Oxaliplatin-Containing Chemotherapy for Patients With Stage III Colorectal Cancer: A Contemporary Real-World Analysis.","authors":"Tharani Krishnan, Emily Leung, Joao Paulo Solar Vasconcelos, Howard Lim, Jonathan M Loree, Janine Davies, Karamjit Gill, Sharlene Gill","doi":"10.1200/OP-24-00492","DOIUrl":"10.1200/OP-24-00492","url":null,"abstract":"<p><strong>Purpose: </strong>Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada.</p><p><strong>Methods: </strong>The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared.</p><p><strong>Results: </strong>Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (<i>P</i> = .039), well/moderately differentiated (<i>P</i> = .005), and low-risk disease (<i>P</i> < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 <i>v</i> 36%, <i>P</i> < .0001) and to stop oxaliplatin early (54 <i>v</i> 31%, <i>P</i> < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (<i>P</i> < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 <i>v</i> 19 days, <i>P</i> = .007).</p><p><strong>Conclusion: </strong>In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"365-372"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-07-24DOI: 10.1200/OP.24.00159
Jacob B Leary, Junxiao Hu, Alexis Leal, S Lindsey Davis, Sunnie Kim, Robert Lentz, Tyler Friedrich, Whitney Herter, Wells A Messersmith, Christopher H Lieu
Purpose: Rising rates of early-onset colon cancer (EOCC) present challenges in deciding how to optimally treat patients. Although standard of care for stage II CC is surgical resection, adding chemotherapy for high-risk disease, evidence suggests treatment selection may differ by age. We investigated whether adjuvant chemotherapy (AC) administration rates differ between patients with early- and later-onset stage II CC.
Methods: Data originated from the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database spanning January 1, 2003, to August 1, 2021. Adults with stage II CC were grouped as age 18-49 years (EOCC) and those age 50 years or older (later-onset colon cancer [LOCC]). Demographics, Eastern Cooperative Oncology Group score, tumor stage and site, and chemotherapy were included. Primary outcomes included rates of AC administration by age and ethnicity; secondary outcomes included overall survival (OS) and time to metastatic disease (TTMD). Univariate and multivariable logistic regression models evaluated relationships between chemotherapy administration, age, and ethnicity, adjusting for significant covariates.
Results: One thousand sixty-five patients were included. Median age of patients with EOCC was 45.0 years versus 69.0 years for patients with LOCC. Adjusted multivariate analysis showed patients with EOCC received AC significantly more often than patients with LOCC. Non-Hispanic patients received AC at significantly lower rates than Hispanic patients in both cohorts. Subanalysis of stage IIA patients showed that patients with EOCC were more likely to receive AC than patients with LOCC. No significant differences in OS or TTMD were observed by age regardless of AC administration in stage II overall; however, patients with stage IIA EOCC receiving AC had significantly longer TTMD than those not receiving AC.
Conclusion: AC was given preferentially in stage II EOCC, even in stage IIA, despite deviation from guidelines. This may expose low-risk patients to unnecessary toxicities and suggests bias toward treating younger patients more aggressively, despite unclear evidence for better outcomes.
目的:早发性结肠癌(EOCC)发病率的上升给决定如何对患者进行最佳治疗带来了挑战。虽然II期结肠癌的标准治疗方法是手术切除,并对高风险疾病进行化疗,但有证据表明,不同年龄段的患者选择的治疗方法可能不同。我们研究了早期和晚期II期CC患者的辅助化疗(AC)使用率是否存在差异:数据来源于全国性的 Flatiron Health 电子健康记录(EHR)衍生的去标识数据库,时间跨度为 2003 年 1 月 1 日至 2021 年 8 月 1 日。II期结肠癌患者分为18-49岁(EOCC)和50岁或以上(晚发结肠癌[LOCC])两组。研究对象包括人口统计学、东部合作肿瘤学组评分、肿瘤分期和部位以及化疗。主要结果包括不同年龄和种族的 AC 使用率;次要结果包括总生存期 (OS) 和转移性疾病发生时间 (TTMD)。单变量和多变量逻辑回归模型评估了化疗用药、年龄和种族之间的关系,并对重要的协变量进行了调整:共纳入 165 名患者。EOCC患者的中位年龄为45.0岁,而LOCC患者的中位年龄为69.0岁。调整后的多变量分析显示,EOCC 患者接受 AC 治疗的频率明显高于 LOCC 患者。在两个队列中,非西班牙裔患者接受 AC 治疗的比例明显低于西班牙裔患者。对 IIA 期患者进行的子分析显示,EOCC 患者比 LOCC 患者更有可能接受 AC 治疗。在II期患者中,无论是否接受AC治疗,按年龄划分的OS或TTMD均无明显差异;但接受AC治疗的IIA期EOCC患者的TTMD明显长于未接受AC治疗的患者:结论:尽管偏离了指南,但在 II 期 EOCC 中,即使是 IIA 期,也优先给予 AC。这可能会使低风险患者遭受不必要的毒副作用,并表明对年轻患者的治疗偏向于更积极,尽管没有明确的证据表明这样做能获得更好的疗效。
{"title":"Risk Without Reward: Differing Patterns of Chemotherapy Use Do Not Improve Outcomes in Stage II Early-Onset Colon Cancer.","authors":"Jacob B Leary, Junxiao Hu, Alexis Leal, S Lindsey Davis, Sunnie Kim, Robert Lentz, Tyler Friedrich, Whitney Herter, Wells A Messersmith, Christopher H Lieu","doi":"10.1200/OP.24.00159","DOIUrl":"10.1200/OP.24.00159","url":null,"abstract":"<p><strong>Purpose: </strong>Rising rates of early-onset colon cancer (EOCC) present challenges in deciding how to optimally treat patients. Although standard of care for stage II CC is surgical resection, adding chemotherapy for high-risk disease, evidence suggests treatment selection may differ by age. We investigated whether adjuvant chemotherapy (AC) administration rates differ between patients with early- and later-onset stage II CC.</p><p><strong>Methods: </strong>Data originated from the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database spanning January 1, 2003, to August 1, 2021. Adults with stage II CC were grouped as age 18-49 years (EOCC) and those age 50 years or older (later-onset colon cancer [LOCC]). Demographics, Eastern Cooperative Oncology Group score, tumor stage and site, and chemotherapy were included. Primary outcomes included rates of AC administration by age and ethnicity; secondary outcomes included overall survival (OS) and time to metastatic disease (TTMD). Univariate and multivariable logistic regression models evaluated relationships between chemotherapy administration, age, and ethnicity, adjusting for significant covariates.</p><p><strong>Results: </strong>One thousand sixty-five patients were included. Median age of patients with EOCC was 45.0 years versus 69.0 years for patients with LOCC. Adjusted multivariate analysis showed patients with EOCC received AC significantly more often than patients with LOCC. Non-Hispanic patients received AC at significantly lower rates than Hispanic patients in both cohorts. Subanalysis of stage IIA patients showed that patients with EOCC were more likely to receive AC than patients with LOCC. No significant differences in OS or TTMD were observed by age regardless of AC administration in stage II overall; however, patients with stage IIA EOCC receiving AC had significantly longer TTMD than those not receiving AC.</p><p><strong>Conclusion: </strong>AC was given preferentially in stage II EOCC, even in stage IIA, despite deviation from guidelines. This may expose low-risk patients to unnecessary toxicities and suggests bias toward treating younger patients more aggressively, despite unclear evidence for better outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"333-340"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-10-16DOI: 10.1200/OP-24-00609
Al-Hafis Adegun, Reid Schalet, Ivan Berezowski, Marie L Borum
{"title":"Importance of Identifying Physical Manifestations That Are Associated With Hereditary Cancer Predisposition: AXIN2 Mutation in an African American Patient.","authors":"Al-Hafis Adegun, Reid Schalet, Ivan Berezowski, Marie L Borum","doi":"10.1200/OP-24-00609","DOIUrl":"10.1200/OP-24-00609","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"440-441"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-07-19DOI: 10.1200/OP.24.00021
Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney
Purpose: The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).
Methods: We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV v SC).
Results: Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 v 84.3 minutes; P < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 v 177.8 minutes; P < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 v 119.2 minutes; P < .0001).
Conclusion: SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.
{"title":"Subcutaneous vs Intravenous Trastuzumab/Pertuzumab: A Time and Motion Substudy of a Phase II Trial of Adjuvant Trastuzumab/Pertuzumab for Stage I HER2+ Breast Cancer (ADEPT trial).","authors":"Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney","doi":"10.1200/OP.24.00021","DOIUrl":"10.1200/OP.24.00021","url":null,"abstract":"<p><strong>Purpose: </strong>The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).</p><p><strong>Methods: </strong>We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV <i>v</i> SC).</p><p><strong>Results: </strong>Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 <i>v</i> 84.3 minutes; <i>P</i> < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 <i>v</i> 177.8 minutes; <i>P</i> < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 <i>v</i> 119.2 minutes; <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"351-357"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-09-13DOI: 10.1200/OP-24-00611
Frank A Sinicrope
Rates of adjuvant chemotherapy in patients with early-onset versus later-onset stage II colon cancer.
早期与晚期 II 期结肠癌患者的辅助化疗率。
{"title":"Adjuvant Chemotherapy for Early-Onset Stage II Colon Cancer.","authors":"Frank A Sinicrope","doi":"10.1200/OP-24-00611","DOIUrl":"10.1200/OP-24-00611","url":null,"abstract":"<p><p>Rates of adjuvant chemotherapy in patients with early-onset versus later-onset stage II colon cancer.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"273-274"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-09-30DOI: 10.1200/OP.24.00268
Xin Hu, Sharon M Castellino, Anne C Kirchhoff, Rebecca S Williamson Lewis, Nicholas P DeGroote, Patricia Cornwell, Ann C Mertens, Joseph Lipscomb, Xu Ji
Purpose: Many patients with cancer do not gain Medicaid coverage until a cancer diagnosis, which can reduce access to early cancer detection and timely treatment, potentially driving inferior survival. Little is known about whether continuous Medicaid coverage prediagnosis through postdiagnosis (v gaining Medicaid at/after diagnosis) provides survival benefits for pediatric/adolescent oncology patients.
Materials and methods: We identified patients newly diagnosed with cancer at age 21 years or younger in a large pediatric health system between 2007 and 2016. Electronic medical records (EMRs) were linked to Medicaid administrative data to differentiate insurance continuity patterns during the 6 months preceding through the 6 months after cancer diagnosis (assessment window): continuous Medicaid, newly gained Medicaid (at or after diagnosis), and other Medicaid enrollment patterns. For patients not linked to Medicaid data, we used EMR-reported insurance types at diagnosis. We followed patients from 6 months postdiagnosis up to 5 years, death, or December 2020, whichever came first. Multivariable regressions estimated all-cause and cancer-specific survival, controlling for sociodemographic and cancer-related factors.
Results: Among 1,800 patients included in the analysis, 1,293 (71.8%) had some Medicaid enrollment during the assessment window; among them, 47.6% had continuous Medicaid and 36.3% had newly gained Medicaid. Patients not linked with Medicaid data had private (26.9%) or other/no insurance (1.2%) at diagnosis. Compared with patients with continuous Medicaid, those with newly gained Medicaid had higher risks of all-cause death (hazard ratio [HR], 1.41 [95% CI, 1.10 to 1.81]; P = .008) and cancer-specific death (HR, 1.46 [95% CI, 1.12 to 1.90]; P = .005).
Conclusion: Continuous Medicaid coverage throughout cancer diagnosis is associated with survival benefits for pediatric/adolescent patients. This finding has critical implications as millions of American individuals have been losing coverage since the unwinding of the Medicaid Continuous Enrollment Provision.
{"title":"Association Between Medicaid Coverage Continuity and Survival in Patients With Newly Diagnosed Pediatric and Adolescent Cancers.","authors":"Xin Hu, Sharon M Castellino, Anne C Kirchhoff, Rebecca S Williamson Lewis, Nicholas P DeGroote, Patricia Cornwell, Ann C Mertens, Joseph Lipscomb, Xu Ji","doi":"10.1200/OP.24.00268","DOIUrl":"10.1200/OP.24.00268","url":null,"abstract":"<p><strong>Purpose: </strong>Many patients with cancer do not gain Medicaid coverage until a cancer diagnosis, which can reduce access to early cancer detection and timely treatment, potentially driving inferior survival. Little is known about whether continuous Medicaid coverage prediagnosis through postdiagnosis (<i>v</i> gaining Medicaid at/after diagnosis) provides survival benefits for pediatric/adolescent oncology patients.</p><p><strong>Materials and methods: </strong>We identified patients newly diagnosed with cancer at age 21 years or younger in a large pediatric health system between 2007 and 2016. Electronic medical records (EMRs) were linked to Medicaid administrative data to differentiate insurance continuity patterns during the 6 months preceding through the 6 months after cancer diagnosis (assessment window): continuous Medicaid, newly gained Medicaid (at or after diagnosis), and other Medicaid enrollment patterns. For patients not linked to Medicaid data, we used EMR-reported insurance types at diagnosis. We followed patients from 6 months postdiagnosis up to 5 years, death, or December 2020, whichever came first. Multivariable regressions estimated all-cause and cancer-specific survival, controlling for sociodemographic and cancer-related factors.</p><p><strong>Results: </strong>Among 1,800 patients included in the analysis, 1,293 (71.8%) had some Medicaid enrollment during the assessment window; among them, 47.6% had continuous Medicaid and 36.3% had newly gained Medicaid. Patients not linked with Medicaid data had private (26.9%) or other/no insurance (1.2%) at diagnosis. Compared with patients with continuous Medicaid, those with newly gained Medicaid had higher risks of all-cause death (hazard ratio [HR], 1.41 [95% CI, 1.10 to 1.81]; <i>P</i> = .008) and cancer-specific death (HR, 1.46 [95% CI, 1.12 to 1.90]; <i>P</i> = .005).</p><p><strong>Conclusion: </strong>Continuous Medicaid coverage throughout cancer diagnosis is associated with survival benefits for pediatric/adolescent patients. This finding has critical implications as millions of American individuals have been losing coverage since the unwinding of the Medicaid Continuous Enrollment Provision.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"380-390"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}