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  • American Society of Clinical Oncology (ASCO)  (69)
  • 1
    Online Resource
    Online Resource
    Use, misuse, and overuse of white cell growth factors (GF) in community oncology practices in southeastern United States.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 15_suppl ( 2014-05-20), p. 9654-9654
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 15_suppl ( 2014-05-20), p. 9654-9654
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.15_suppl.9654
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
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    Ensuring evidence-based cancer medicine by influencing prescribing behavior.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 31_suppl ( 2013-11-01), p. 212-212
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 31_suppl ( 2013-11-01), p. 212-212
    Abstract: 212 Background: Oncology Analytics, Inc. (OA) promotes evidence-based, guidelines-compliant cancer therapeutic decision-making on behalf of healthcare payers. The OA web-based 1,300 protocol treatment request system screens several hundred applications each month. Evidence-based requests are automatically approvable within seconds (Auto); those needing medical director (MD) review, within hours (Non-Auto). Some 10% of all requests require real-time consultation between OA board-certified medical oncologists/hematologists and the prescribing cancer specialist. Three-quarters of these non-compliant residual requests are rescinded by the treating oncologist. The remainder are either approved because of additional information while about 1% are recommended for an adverse determination. Methods: We hypothesize that OA’s presence in a cancer market gradually improves the likelihood of evidence-based oncologist prescribing behavior. We tested this over 44 consecutive months of rapid growth, from May 2009 through December 2012, within a single southeastern US market. Since Auto requests are evidence- and guidelines-based, and Non-Auto requests are either not supported by evidence or have evidence support but with less toxic or less costly alternatives available, we reasoned that any sustained directional change in the ratio of Auto to Non-Auto represents a characteristic change in cancer specialist behavior over that span. The monthly ratios of Auto to Non-Auto were analyzed for trends by least squares and the slopes of each were contrasted by ANCOVA. Results: During the first six months, Auto-processed requests approximately equaled Non-Auto-processed request numbers, for a baseline ratio of one. Over the next 38 months, this ratio rose to approximately 1.4, meaning that 40% more requests were eventually approved automatically each month than those requiring MD review. The slopes of this relationship between Auto and Non-Auto approvals are statistically distinct (F = 43.34; p 〈 0.001). Conclusions: This progressive quality improvement reflects malleability of cancer doctor prescribing behavior, results in substantial savings, occurs quickly, persists and grows over time.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.31_suppl.212
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 3
    Online Resource
    Online Resource
    Trends in the use of bone agents in metastatic cancer.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e20672-e20672
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e20672-e20672
    Abstract: e20672 Background: Bone modifying agents have been shown to delay and/or prevent skeletal-related events for a range of cancers metastatic to the bone. Various studies have identified pamidronate, zoledronic acid, and denosumab as bone modifying agents, each of which confers clinical benefit. The convenience of administration and costs of these agents differ greatly. Administration spans vary from roughly 2 hours for IV pamidronate, 15 minutes for IV zoledronic acid, and minimal time for subcutaneous denosumab. The estimated cost for a single dose of pamidronate, zoledronic acid, and denosumab are $29, $890, and $1,712, respectively. Methods: All requests for pamidronate, zoledronic acid, and denosumab authorization submitted by practicing oncologists within southeast Florida were tabulated for 2010, 2011, and 2012. Comparisons for both frequency of use and cost over time were made using ANOVA and Chi Square; p 〈 0.05 for significance. Trends were assessed by linear regression. Results: 895 requests for pamidronate, zoledronic acid, or denosumab were examined over this three year span. The use of bone modifying agents for metastatic cancer is increasing rapidly, as treatment request totaled 171, 269, and 455 for all three agents, pamidronate, zoledronic acid, or denosumab, in 2010, 2011, and 2012, respectively. Zoledronic acid requests significantly increased (p 〈 0.001) per year between 2010 and 2011, as with 2011 and 2012. Denosumab requests are also increasing steadily and sharply in 2012. Conclusions: Each of these three agents has demonstrated clear efficacy in delaying or preventing second skeletal events among patients with metastatic cancer already involving bone. Toxicities among these three agents are comparable in the vast majority of eligible cancer patients. Relative costs should be carefully considered when choosing which agent to use as the use of these agents in general is increasing rapidly and will have a major impact upon overall cancer care costs. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e20672
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 4
    Online Resource
    Online Resource
    Improving QOL and safety while reducing costs: Evidence-based adjuvant chemotherapy of colorectal cancer (CRC).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e14646-e14646
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e14646-e14646
    Abstract: e14646 Background: The addition of oxaliplatin in adjuvant chemotherapy for stage II CRC and for elderly (≥ 70) patients with stage II or III CRC requires careful consideration. Most patients with stage II or III CRC receive oxaliplatin-based adjuvant regimens (Abrams. J Clin Oncol 2011). Mature results of the adjuvant MOSAIC and C-07 trials, however, failed to show improvement in OS or DFS among the elderly (≥ 70 years) and those with stage II CRC (Tournigand. J Clin Oncol 2012). Oxaliplatin causes neuropathy, increases the incidence and severity of febrile neutropenia, and adds substantial cost for both oxaliplatin and WBC growth factors. Methods: All chemotherapy requests submitted to Oncology Analytics for stage II and III CRC from 2009 through 2012 were analyzed. Utilization of oxaliplatin was retrospectively analyzed, with special attention to its use in those who were elderly (≥ 70 years), and for those of any age with stage II. Results: Our review showed a total of 242 adjuvant chemotherapy requests in stage II/III CRC. The majority of them, 57% (138/242), were elderly (≥ 70 years) with Stage II/III, and 24% (58/242) of any age had stage II. Thirty-four (14%) were both elderly and stage II. Overall, more than two thirds, 71% (171/242), received oxaliplatin containing regimens. More than two thirds of the elderly, regardless of stage, and more than half of all stage II patients, regardless of age, were treated with oxaliplatin containing regimens. Conclusions: The historical predominance of oxaliplatin use in the adjuvant setting, among patients over seventy years of age and/or those with stage II CRC, needs to be addressed as a priority. With mature data from the MOSAIC and C-07 trials, oncologists need to change prescribing behavior to provide less toxic therapies, thereby diminishing the incidence of neuropathy and reducing the risk of febrile neutropenia. The elimination of oxaliplatin in these subsets will also diminish costs for the Medicare population by a quarter billion dollars each year, without an adverse impact on outcome. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e14646
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 5
    Online Resource
    Online Resource
    Adjuvant chemotherapy selection for stage I NSCLC 2011 through 2014 in the southeastern United States.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 30_suppl ( 2014-10-20), p. 248-248
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 30_suppl ( 2014-10-20), p. 248-248
    Abstract: 248 Background: Among patients with early stage non-small cell lung cancer (NSCLC), appropriate use of adjuvant chemotherapy is an important determinant of survival. Existing level 1 data, which includes analysis of five cisplatin-based phase III trials (IALT, BLT, ALPI, ANITA, NCIC-CTG-JBR.10), two carboplatin-based phase III trials (CALGB 9633 and NATCH Trial), and two meta-analyses (LACE, MRC), demonstrate only cisplatin-based adjuvant chemotherapy regimens enhance overall patient survival. Most importantly, these studies also reveal that survival advantage from adjuvant chemotherapy does not extend to stage I patients, but only to stage II-IIIA patient subgroups. Unplanned a posteriori subset analyses indicate the possibility that certain stage I NSCLC with one or more "high risk" characteristics may benefit from cisplatin-based adjuvant chemotherapy. This hypothesis must be properly tested before it can be adopted. We, herein, hypothesize that many US stage I NSCLC patients are routinely treated in the adjuvant setting with regimens that have not demonstrated level one overall survival benefit. Methods: We examined chemotherapy request data for stage I & II NSCLC, submitted to a private health insurer by oncologists for the adjuvant treatment of NSCLC patients in the southeast US from January 2011 through May 2014. Results: Overall, 25% (67/264) of adjuvant chemotherapy requests were for stage I NSCLC patients (potential overuse). The frequency of these requests has increased over time: 17% in 2011, 20% in 2012, 30% in 2013, 34% in 2014. Four out of five of patients with stage I NSCLC (52/67) were given carboplatin-based regimens, while only one in five (19%, 13/67) received cisplatin-based regimens, and 3% (3/67) were pemetrexed-based regimens (potential misuse). Conclusions: High misuse and overuse rates of adjuvant chemotherapy for stage I NSCLC are observed among the privately insured populations of Florida, Texas and Georgia. Quality improvement initiatives in this patient population may be indicated to prevent potential harm from treatments advised against by ASCO, ESMO, NCIC, NCCN and UK guidelines.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.30_suppl.248
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 6
    Online Resource
    Online Resource
    Effect of pretreatment clinical consultation on oncologist prescribing behavior in the initial treatment of NSCLC.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e19130-e19130
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e19130-e19130
    Abstract: e19130 Background: Oncology Analytics (OA) promotes evidence-based treatments, based upon objective assessments of efficacy and safety. ASCO guidelines and FDA approval recommend bevacizumab only in combination with carboplatin/paclitaxel, based on E4599 which showed improved OS. NCCN guidelines allow bevacizumab with virtually any approved 1st line chemotherapy (2A). Board certified OA oncologists perform real-time clinical consultations if bevacizumab usage in 1st line is not per level 1 evidence. More recently, those conversations include the Phase III Pointbreak Trial’s failure to show OS advantage with carboplatin/pemetrexed/bevacizumab. Methods: All bevacizumab requests with doublet chemotherapy were tabulated, from 2010 through 2012, and the outcome of pre-treatment clinical consultations were retrospectively analyzed. Results: Bevacizumab with a platinum doublet was requested in 91 patients with non-squamous NSCLC. Of these, 53% (48/91) of requests were for carboplatin/paclitaxel/bevacizumab, consistent with level one evidence, FDA approval and ASCO guidelines. All were approved after confirmation of histology and absence of relative contraindications. Approximately half (47%; 43/91) of the requests were not consistent with level 1 evidence, though compliant with non-evidence-based NCCN guidelines. After clinical consultation, 20 of 43 requests (46%) were revised to evidence-based protocols. Conclusions: These data suggest that nearly half of bevacizumab requests in NSCLC are not in accordance with published level 1 evidence. Pre-treatment clinical consultations can promote evidence based care while reducing costs. National guidelines should be evidence based, especially in common cancers where level 1 evidence is available, since practicing physicians may rely on these guidelines when planning treatment. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e19130
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 7
    Online Resource
    Online Resource
    Community use of anthracyclines for adjuvant HER2-positive breast cancer (BC).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e11609-e11609
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e11609-e11609
    Abstract: e11609 Background: Anthracyclines remain among the most active agents for the treatment of BC. NSABP B-31, NCCTG N9831 and HERA, each employing anthracyclines followed by trastuzumab in adjuvant HER2+ BC, demonstrated significant reduction in the risk of recurrence and improvement in survival . A fourth study, BCIRG-006, compared a non-anthracycline containing regimen, TCH, to an anthracycline based regimen, AC-TH . Both arms had similar overall survival, but there was a higher incidence of cardiac events in patients who received anthracycline. HER2-analyses in randomized adjuvant trials, in the pre-trastuzumab era, comparing anthracycline with non-anthracycline chemotherapy regimens, show that HER2+ BC derives greater benefit from anthracycline use . TOP2A coamplification, which occurs in 35% of HER2-positive patients, has shown a direct association with anthracycline benefit in several studies. We investigate and report, herein, the ways in which community oncologists are currently treating these patients. Methods: All treatment requests for adjuvant trastuzumab were examined, from 2009 through 2012. Chi-square analysis at 0.05α was used to test for interaction of age group to type of treatment. Results: During this span, oncologists requested adjuvant trastuzumab for 121 patients. In 10% (12/121) of patients, adjuvant trastuzumab alone, without chemotherapy and with or without hormonal therapy, was requested. Among patients who also received adjuvant chemotherapy (109), 35% (38/109), received anthracyclines. There was no relationship of anthracycline-usage with BC stage (data not shown) or patient age (Chi Sq p = 0.73). Adjuvant trastuzumab, without chemotherapy, was requested more often for the elderly (20% versus 4%; Chi Sq p = 0.003). Conclusions: Anthracyclines are utilized in adjuvant HER2+ BC in only about a third of patients, regardless of BC stage or patient age. The availability of a reliable, inexpensive, and convenient test to predict which patients are most likely to benefit from anthracyclines, over other options, would be useful. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e11609
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 8
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    Online Resource
    Annual rhythm in filgrastim use in southeast Florida.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e20697-e20697
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e20697-e20697
    Abstract: e20697 Background: Circadian, seasonal and annual temporal organization characterizes earth-evolved life forms. Cellular proliferation in human bone marrow shares this temporal organization. Careful clinical trials have documented that bone marrow damage from a range of cytotoxic anti-cancer drugs is predictably greater and lesser when these drugs are given at specific times of day and seasons of the year to human beings with cancer. Filgrastim is a human growth factor, which is given to stimulate the production of neutrophils that have been depressed to low levels by cancer chemotherapy, in order to prevent infectious complications. We hypothesized that administration of filgrastim, stimulated by dangerously low neutrophil counts, would be initiated non-randomly with reproducible seasonality and annual rhythmicity. Methods: All claims from contracted healthplans submitted by oncologists in southeast Florida were tabulated by month of service date, during the calendar years of 2010, 2011, and 2012 (n=2,506). These numbers were de-trended, tested by linear regression, ANOVA and multi-component least squares cosine curve fitting for annual rhythmicity. Results: Similar stable annual time structures characterize filgrastim use in this population for each of these three years. An overall increasing trend (p 0.004) was present in its use during this three year span. Time of year effects were present (ANOVA p 〈 0.058), demonstrating a prominent annual rhythm (p 0.006). The annual use pattern peaks during late winter and early spring and is lower in summer and fall. Conclusions: A large literature documents expected annual rhythmicity of cytotoxic drug bone marrow damage as reflected in circulating neutrophil count. Substantial annual rhythms characterize the clinical use of filgrastim in southeast Florida for this indication. The relative contributions of “snowbird” migration and the temporal organization of hematopoiesis remain to be fully elucidated. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e20697
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 9
    Online Resource
    Online Resource
    Adjuvant colon cancer care compliance with level I data and NCCN guidelines in the elderly population.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 15_suppl ( 2014-05-20), p. e14520-e14520
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 15_suppl ( 2014-05-20), p. e14520-e14520
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.15_suppl.e14520
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 10
    Online Resource
    Online Resource
    Community use of anthracyclines in metastatic breast cancer (MBC).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. 1080-1080
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. 1080-1080
    Abstract: 1080 Background: For decades, anthracyclines have been among the most useful treatments for women with MBC. Though recent publications have confirmed an overall decline in the use of anthracyclines in BC, most of that decline was felt to be due to its diminished utilization in the adjuvant management of BC. Current community anthracycline usage pattern in MBC is not known. We investigate and report, herein, how community oncologists in the southeast USA are currently utilizing anthracyclines for MBC. Methods: All chemotherapy treatment requests for HER2+ and HER2- Stage 4 BC were examined, from 2009 through 2012. Chi-Square test was performed for interaction between age and anthracycline utilization, with p-value less than 0.05 considered significant. The proportion of women who had been treated previously in the adjuvant setting with low cumulative doses of anthracyclines, which would have some effect upon subsequent use, was not retrievable. Results: During this span, 420 unique chemotherapy requests were initiated for 247 patients. These included 54 anthracycline requests for 50 MBC patients. The use of anthracyclines for metastatic HER2+ BC was virtually absent (one in 63 requests among 42 patients). The remaining 357 chemotherapy requests were for treatment of 205 HER2- MBC patients. Anthracyclines were employed in 22% of women under 65 years of age and in 25% of those older than 65 (p = 0.77). Approximately 83% (45/54) of anthracycline-requests were for conventional doxorubicin, either alone or in combination with other agents. The rest were for liposomal doxorubicin (6/54) or epirubicin (3/54). Conclusions: Data from the southeast USA identifies that anthracyclines are virtually never used in HER2+ MBC. Even in HER2- MBC, anthracyclines are used in only one out of 4 patients suffering from this disease. The effect of this unheralded alteration in oncology practice must be carefully considered when trends in metastatic breast cancer control are examined. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.1080
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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