Second-line treatments recommended by the National Cancer Center Network to manage advanced-stage gastrointestinal stromal tumours (GIST) were evaluated to determine the cost and cost-effectiveness of each intervention in the Mexican insurance system, the Instituto Mexicano del Seguro Social (IMSS). Treatments examined over a 5-year temporal horizon to estimate long-term costs included 800 mg day À1 of imatinib mesylate, 50 mg day À1 of sunitinib malate (administered in a 4 week on/2 week rest schedule), and palliative care. The mean cost (MC), cost-effectiveness, and benefit of each intervention were compared to determine the best GIST treatment from the institutional perspective of the IMSS. As sunitinib was not reimbursed at the time of the study, a Markov model and sensitivity analysis were conducted to predict the MC and likelihood of reimbursement. Patients taking 800 mg day À1 of imatinib had the highest MC ( ± s.d.) of treatment at $35 225.61 USD ( ± 1253.65 USD); while sunitinib incurred a median MC of $17 805.87 USD (±694.83 USD); and palliative care had the least MC over treatment duration as the cost was $2071.86 USD (±472.88 USD). In comparison to palliative care, sunitinib is cost-effective for 38.9% of patients; however, sunitinib delivered the greatest survival benefit as 5.64 progression-free months (PFM) and 1.4 life-years gained (LYG) were obtained in the economic model. Conversely, patients on imatinib and palliative care saw a lower PFM of 5.28 months and 2.58 months and also fewer LYG (only 1.31 and 1.08 years, respectively). Therefore, economic modeling predicts that reimbursing sunitinib over high dose imatinib in the second-line GIST indication would deliver cost savings to the IMSS and greater survival benefits to patients.
#3107 Purpose: To examine factors associated with seeking second opinions, patient satisfaction, and education among a recently diagnosed internet-based breast cancer population. Methods: In 2007, 6970 of the 90,426 internet-registered female breast cancer patients completed an internet-based survey, developed jointly by members of the Department of Surgical Oncology at Emory University and the educational staff at the Healthcare business of Thomson Reuters, formerly Nexcura. After excluding caregivers (n=205), those not within 5 years of diagnosis (n=962) or for whom treatment information was missing (n=40), we analyzed 5763 patients. Chi-square tests were used to assess system characteristics and patient demographics by their second opinion, satisfaction, and informed status. Patient satisfaction was collapsed as low (1-3), moderate (4-6), or high (7-10). How informed patients considered themselves was combined into 3 categories: well-informed (well or very well informed), somewhat informed and uninformed (somewhat or very uninformed). Results: The majority of the 5763 patients were between ages 40 and 59 when diagnosed (75.43%), Caucasian (92.96%), currently married (76.33%), had a household income ≥ $50,000 (60.92%) and at least a 4-year college education (55.78%). Stage I and II cancers comprised 36.61 and 35.71% respectively. Over one-third (n=2039) sought a second opinion. Factors significantly associated with seeking a second opinion were higher socioeconomic or education status, feeling informed, receiving the initial diagnosis from a primary care physician or private community hospital, close proximity to the biopsy location, and less satisfaction with the initial biopsy experience. Patients highly satisfied with their second opinion (87.35%) were more likely to refer others (96.52%), use the second opinion facility for the next treatment (63.90%), and to not seek additional opinions (75.29%). Facility options and initially being treated with surgery or systemic therapy predicted high satisfaction with initial treatment. Medical oncologists were the most frequently cited primary source of breast cancer education (37.81%), followed by surgeons (30.57%), and the internet (12.77%). About 20% who cited these sources considered themselves somewhat or very uninformed. Conclusions: Women who seek information via the internet rely primarily on medical professionals for their breast cancer education. Factors related to the initial biopsy affect the likelihood of patients seeking a second opinion, satisfaction with second opinions can influence choices regarding the ensuing treatment steps, and factors associated with initial treatment influence patient satisfaction. Probing the issues underlying these findings could improve care for all. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3107.
Background: Most early-stage breast cancer (EBC) patients (pts) do not experience signs or symptoms of disease; approximately 90% of women diagnosed in breast screening are asymptomatic in the US (Ryerson et al. 2015). Rather, side effects of cancer therapy have the greatest impact and can be burdensome to pts on and after treatment. Bother and impact have not been thoroughly assessed from the patient perspective in trials. Qualitative research with 56 pts undergoing or completing (after 3 and within 24 mos of) systemic treatment were conducted to assess the need for EBC-focused patient-reported outcome (PRO) measures. Methods: Semi-structured interviews were conducted to better understand the treatment experience; the interview guide was developed in consultation with breast cancer advocates who were former pts. The interview sample was determined to capture findings across EBC therapies (HER2-targeted [HER2], hormone/endocrine [H/E], and/or chemotherapy [CT]). Treatment experience, including treatment-related symptoms and treatment impact (e.g. on activities of daily living, emotional aspects) were discussed in each 90-minute session. Pts rated level of bother of symptoms and impacts on an 11-point scale. Disease stage, treatment received, surgery, and other health information was collected from medical charts. Qualitative analysis was conducted with ATLAS.ti software. Symptom data was reviewed to appropriately analyze therapy subgroups. Results: Stage Ia (17.9%), Ib (14.3%), IIa (32.1%), IIb (25.0%), or IIIa (7.1%) pts that received adjuvant (75%) or neoadjuvant (25%) therapy participated; 106 unique treatment-related symptoms were reported. Symptoms most frequently reported included hair loss (86.7%), change in taste (73.3%), and tiredness/fatigue (71.1%) on CT (n=45); tiredness/fatigue (34.8%), runny nose (26.1%), and watery eyes (21.7%) on HER2 (n=23); and hot flashes (50.0%), joint pain (37.5%), and weight gain (20.1%) on H/E (n=24). The most common symptoms reported after therapy completion included memory loss (63.6%), symptoms of neuropathy (numbness, tingling, and pain in fingers, 63.6%), and tiredness/fatigue (45.5%) (n=11). CT symptoms rated by ≥ 25% of pts that were most bothersome included tiredness/fatigue (x -=8.2, n=18**), hair loss (x -=8.2, n=32**), and memory loss (x -=7.7, n=15**). HER2 and H/E ratings of bother were less frequent. EBC treatment was associated with significant impact on pts' lives; categories described are below: Impact category Average bother rating* (n**)Concerns with treatment9.5 (2)Physical/functional7.7 (36)Work or school7.5 (37)Sleep7.5 (21)Daily tasks and activities7.4 (95)Emotional7.4 (62)Sexual behavior7.1 (22)Cognitive function6.8 (6)Social6.7 (54)Appearance6.5 (32)* Rating on 11-pt scale; 0=none to 10=extremely bothersome ** n=number of patients rating the level of bother Conclusion: Treatment-related symptoms and associated degree of bother differed by treatment group. Pts' descriptions of treatment impact provided additional insight into the burden of EBC. EBC-specific PROs included in trials that gain pts' perspective on experience with treatment would further inform pts and may also inform therapy choice. Citation Format: Petersen JA, Gauthier MA, Piault E, DeBusk KPA, Buzaglo JS, Eng-Wong J, Glazer JR, Green MC, Johnson JM, Spears PA, Evans CJ. Importance of the patient voice in drug development: Early-stage breast cancer and measurement gaps concerning the treatment experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-20.
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