Health resource utilization associated with skeletal-related events in patients with advanced breast cancer: results from a prospective, multinational observational study

Abstract

Patients with breast cancer and bone metastases often experience skeletal complications (skeletal-related events [SREs]: pathologic fracture, radiation to bone, surgery to bone or spinal cord compression). Prospective data on the health resource burden of SREs are needed for planning healthcare requirements and estimating the value of new treatments, but limited data are available. This prospective, observational study collected health resource utilization (HRU) data independently attributed to SREs by investigators. Eligible patients had bone metastases secondary to breast cancer, life expectancy ≥6 months, Eastern Cooperative Oncology Group (ECOG) performance status ≤2, and at least one SRE in the 97 days before enrollment. Data, collected retrospectively for 97 days before enrollment and prospectively for 18–21 months, included number and duration of inpatient stays, outpatient visits, emergency room visits and procedures. Altogether, 223 patients were enrolled from Germany, Italy, Spain and the UK. Of the 457 SREs, 118 (25.8%) were associated with inpatient stays. The mean duration of stay was 19.5 (standard deviation [SD] 19.2) days per SRE (based on 117 SREs). Surgery to bone and spinal cord compression were the SREs most likely to require inpatient stays (77.8% and 57.9% of SREs, respectively), while radiation to bone was the least likely (9.7%). Spinal cord compression required the longest inpatient stay per event (34.2 [SD 30.2] days) and radiation to bone the shortest (14.3 [SD 10.2] days). Overall, 342 SREs (74.8%) required an outpatient visit, with radiation to bone the most likely (85.7%), and surgery to bone the least likely (42.6%). Radiation to bone was also associated with the greatest number of outpatient visits per event (6.8 [SD 6.7] visits). All SREs were associated with substantial HRU therefore, preventing SREs in patients with breast cancer may reduce the burden imposed on healthcare systems.

Health resource utilisation associated with skeletal-related events in European patients with lung cancer: Α subgroup analysis from a prospective multinational study

“…Therefore, HRU was recorded only when the treating physician considered it to be a direct result of a SRE, as opposed to the underlying disease. In line with other previous studies (22,23), all the SREs resulting from bone metastases secondary to lung cancer were associated with substantial HRU.…”

Healthcare resource utilisation associated with skeletal‐related events in European patients with multiple myeloma: Results from a prospective, multinational, observational study

“…This is a smaller proportion than in patients with other cancer types (lung cancer, 80%; prostate cancer, 74%; breast cancer, 58%). [14][15][16] The reasons for this difference are unclear and are beyond the scope of this study, but a speculative explanation could be that the threshold to initiate imag- Outpatient visits were necessary for the majority of SREs (63.7%) and were most frequently required for radiation to bone (74.8%) and vertebral fracture (73.3%). In the UK, the mean number of outpatient visits required per SRE was less than one-third of that of the overall mean.…”

“…SREs determined to be secondary to a primary SRE were excluded from the analysis, as reported previously. 16…”

“…Data on the HRU associated with SREs in breast cancer, lung cancer and prostate cancer in the four European countries (Germany, Italy, Spain and the UK) have been previously reported. [14][15][16] Here, we report the European data for patients with MM.…”

Rethinking end-points for bone-targeted therapy in advanced cancer

“…They also differ significantly in impact; palliative radiation to a painful rib metastasis is considered equivalent to spinal cord compression despite substantially less morbidity. Both clinical trials and population-based observation studies show that the most common type of SRE is the receipt of radiation to bone [21,22]. The need for radiation to bone can be subjective and recommendations for such therapy may be based on identification of asymptomatic imaging findings rather than symptomatic deterioration.…”