Chemotherapy treatment patterns, costs, and outcomes of patients with gastric cancer in the United States: a retrospective analysis of electronic medical record (EMR) and administrative claims data

Abstract

BackgroundThe aim of this study was to conduct a retrospective database analysis to describe the chemotherapy treatment patterns and outcomes of patients with gastric cancer.MethodsIndividuals diagnosed with gastric cancer were identified from the IMS Oncology Database, which contains electronic medical record (EMR) data collected from a variety of community practices, and the Truven Health MarketScan® Research database, an administrative claims database. Eligible patients were 18 years of age or older and had an ICD-9 code 151.0–151.9. Patients were excluded if they had evidence of cancer within 6 months of the index diagnosis.ResultsThere were 5257 eligible patients identified in EMR data: 1982 (37.7 %) of these patients also had data regarding chemotherapy treatments. Of the 1982 patients who received first-line therapy, 42.3 %, 18.1 %, and 7.9 % went on to receive a second, third, and fourth line of chemotherapy, respectively. There were 11891 eligible patients identified in the administrative database; 5299 (44.6 %) had data regarding chemotherapy. Of those initiating chemotherapy, 2888 (54.5 %) received a second line and 1598 (30.2 %) received a third line of treatment. The average total cost of care during first-line therapy was $40,811 [standard deviation (SD) = $49,916], which was incurred over an average of 53.5 (SD = 63.4) days. A similar pattern was evident in second-line treatment (mean/SD, $26,588/$33,301) over 41.2 (SD = 55.7) days.ConclusionsCosts and duration of care received vary among gastric cancer patients in the U.S. There is a need to understand which regimens may be associated with better health outcomes and to standardize treatment as appropriate.

Third-Line Chemotherapy with Irinotecan plus 5-Fluorouracil in Caucasian Metastatic Gastric Cancer Patients

“…Evaluated parameters were identified on the basis of previous reports with second-line or third-line CT [5,6,8,10], i.e., ECOG PS, age, response and PFS with first-line and second-line CT, and time interval from the start of first-line to the start of third-line CT. Continuous variables (first-line and second-line PFS and time from first-line to third-line therapy) were dichotomized according to the median values reported in the cohort.…”

“…As the benefit of second-line CT is demonstrated, there is a new window of opportunity for third-line treatments in selected cases, and at present it is estimated that about 20% of mGC patients receive third-line CT [5]. A retrospective analysis suggested that some clinicopathologic factors (PS, serum albumin level, histologic type, and PFS following second-line CT) might be helpful in identifying a subgroup of patients most likely to benefit from third-line treatment [9].…”

“…Considering that many patients still have a good performance status (PS), they may be candidates for further treatment. Recent data showed that about half of the patients who progressed after first-line CT were treated with second-line therapies [5]. Different phase III studies comparing second-line CT with BSC and a recent meta-analysis of randomized trials confirmed that second-line CT results in a significant reduction in the risk of death [hazard ratio 0.64, 95% confidence interval (CI) 0.52-0.79], with no difference between irinotecan and docetaxel [6].…”

“…Different phase III studies comparing second-line CT with BSC and a recent meta-analysis of randomized trials confirmed that second-line CT results in a significant reduction in the risk of death [hazard ratio 0.64, 95% confidence interval (CI) 0.52-0.79], with no difference between irinotecan and docetaxel [6]. Eastern Cooperative Oncology Group (ECOG) PS, the progression-free interval following first-line CT, and platinum-based first-line CT were suggested as prognostic factors to identify patients with the highest chance of benefit from second-line CT [5,6]. …”

Clinical management patterns of advanced and metastatic gastro‐oesophageal carcinoma after fluoropyrimidine/platinum treatment in France, Germany, Spain and the United Kingdom

“…These observations may reflect the lack of standard treatment options during the study period of 2007 to 2013. Studies of advanced GEA, conducted in other geographies, demonstrated similar percentages of patients received second‐line therapy in the United States (Hess et al, ) and South America (de Alencar Camara Vieira et al, ; Novick et al, ), and higher percentages in East Asia (Carter et al, ; Hong et al, ). While treatment with fluoropyrimidine/platinum combinations is a recognised first‐line therapy for advanced GEA, as reflected in the 2016 ESMO guidelines, there are diverse chemotherapy options recommended after discontinuation of first‐line treatment.…”