Comprehensive Geriatric Assessment guided treatment versus usual care for older adults aged 60 years and above with cancer

Ng, Zhi Xuan; Zheng, Huili; Chen, Matthew; Soon, Yu Yang; Ho, Francis

doi:10.1002/14651858.cd014875

Cited by 1 publication

(2 citation statements)

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“…Given that many older adults are excluded from clinical trials, geriatric oncology research has shown that value-based assessments often lead to deviations from standards of care. 18 Other studies have found that pathway adherence can range from 53% to 70% depending on disease site, and tends to decrease with increasing pathway complexity. 7 , 8 We would be remiss not to mention the impact of the COVID-19 pandemic on treatment modifications and pathway deviations, particularly in the early, prevaccine days of the pandemic.…”

Section: Discussionmentioning

confidence: 96%

“…In at least 1 notable study looking at uptake of guideline-directed care, the most important variance in drug prescribing was associated with physician characteristics, not patient or disease characteristics. Given that many older adults are excluded from clinical trials, geriatric oncology research has shown that value-based assessments often lead to deviations from standards of care . Other studies have found that pathway adherence can range from 53% to 70% depending on disease site, and tends to decrease with increasing pathway complexity .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Patient, Physician, and Practice-Level Factors with Uptake of Payer-Led Oncology Clinical Pathways

Mullangi

Chen²,

Pham³

et al. 2023

JAMA Netw Open

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ImportancePayers use oncology clinical pathways programs to increase evidence-based drug prescribing and control drug spending. However, compliance with these programs has been low, which may decrease their efficacy, and factors associated with pathway compliance are unknown.ObjectiveTo determine extent of pathway compliance and identify factors associated with pathway compliance using characteristics of patients, practices, and the companies that develop cancer treatment pathways.Design, Setting, and ParticipantsThis cohort study comprised patients with claims and administrative data from a national insurer and a pathways health care professional between July 1, 2018, and October 31, 2021. Adult patients with metastatic breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, and uterine cancer being treated in the first line were included. Six months of continuous insurance coverage prior to the date of treatment initiation was required for determination of baseline characteristics. Stepwise logistic regression was used to identify factors associated with pathway compliance.Main Outcomes and MeasuresUse of a pathway program–endorsed treatment regimen in the first-line setting for metastatic cancer.ResultsAmong 17 293 patients (mean [SD] age, 60.7 [11.2] years; 9183 [53.1%] women; mean [SD] Black patients per census block, 0.10 [0.20]), 11 071 patients (64.0%) were on-pathway, and 6222 (36.0%) were off-pathway. Factors associated with increased pathway compliance were higher health care utilization during the 6-month baseline period (measured in inpatient visits and emergency department visits) (5220 on-pathway inpatient visits [47.2%] vs 2797 off-pathway [45.0%]; emergency department visits, 3304 [27.1%] vs 1503 [24.2%]; adjusted odds ratio [aOR] for inpatient visits, 1.32; 95% CI, 1.22-1.43; P &lt; .001), volume of patients with this insurance provider per physician (mean [SD] visits: on-pathway, 128.0 [258.3] vs off-pathway, 121.8 [161.4]; aOR, 1.12; 95% CI, 1.04-1.20; P = .002), and practice participation in the Oncology Care Model (on-pathway participation, 2601 [23.5%] vs 1305 [21.0%]; aOR, 1.13; 95% CI, 1.04-1.23; P = .004). Higher total medical cost during the 6-month baseline period were associated with decreased pathway compliance (mean [SD] costs: on-pathway, $55 990 [$69 706] vs $65 955 [$74 678]; aOR, 0.86; 95% CI, 0.83-0.88; P &lt; .001). There was heterogeneity in odds of pathway compliance between different malignancies. Pathway compliance rates trended down from the reference year of 2018.Conclusions and RelevanceIn this cohort study, despite generous financial incentives, compliance with payer-led pathways remained at historically reported low rates. Factors such as increasing exposure to the program due to the number of patients impacted and participation in other value-based payment programs, such as the Oncology Care Model, were positively associated with compliance; factors such as the type of cancer and patient complexity may have played a role, but the directionality of potential effects was unclear.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%