The economic burden of brain metastasis among lung cancer patients in the United States

Guérin, Annie; Sasané, Medha; Dea, Katherine; J, Zhang; Culver, Kenneth W.; Nitulescu, Roy; Wu, Eric Q.; Macalalad, Alexander R.

doi:10.3111/13696998.2016.1138962

Cited by 34 publications

(36 citation statements)

References 34 publications

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“…The search identified 3945 unique citations (PubMed (n = 2891), Web of Science (n = 775), CINAHL (n = 180), and PsycINFO (n = 99)) with 31 studies meeting our inclusion criteria (Table 2) [8, 18, 20, 21, 26, 29-33, 36-38, 40, 41, 43], 5 studies focused on breast cancer [19,25,28,35,42,44] and 2 included multiple myeloma patients [22,45]. The other studies focused on bladder [39], prostate [23], colorectal [24], lung [27], head and neck cancer [34], and bone marrow transplant patients [17]. Time since diagnosis ranged from a mean of 8.4 months before diagnosis [27] until a mean of 13 years after diagnosis [19] often had a broad range, and sometimes was not reported at all.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The other studies focused on bladder [39], prostate [23], colorectal [24], lung [27], head and neck cancer [34], and bone marrow transplant patients [17]. Time since diagnosis ranged from a mean of 8.4 months before diagnosis [27] until a mean of 13 years after diagnosis [19] often had a broad range, and sometimes was not reported at all. Sample sizes ranged from 129 [19] to 16,771 [30] participants.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Sample sizes ranged from 129 [19] to 16,771 [30] participants. Eight studies had a longitudinal design [19,24,25,27,32,35,42,44]. Both definitions and measures of financial toxicity varied strongly, and most measures were not validated making comparison between studies difficult.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Financial toxicity and employment status in cancer survivors. A systematic literature review

Mols

Tomalin

Pearce

et al. 2020

Support Care Cancer

129

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Background Financial toxicity has traditionally been attributed to the rising costs of cancer care. As ability to work impacts one's financial situation, limited employment and reduced income may also contribute to financial toxicity. We examined evidence of the association between financial toxicity and employment status in cancer survivors. Methods A systematic literature review was performed via PubMed, Web of Science, CINAHL, and PsycINFO with search terms including "Cancer," "Financial toxicity," and "Employment" on September 25, 2019. Results Thirty-one papers met eligibility criteria. Thirteen studies were rated as having high quality, 16 as adequate, and two as low. Being actively treated for cancer had serious negative consequences on employment and medical expenditures. Unemployment, changed or reduced employment, lost days at work, poor work ability, and changes to employment were associated with a higher risk of financial toxicity. Patients who were younger, non-white, unmarried, of low education, living with dependents, residing in non-metropolitan service areas, with lower income, and of low socioeconomic status were more at risk of financial toxicity. Other variables associated with financial toxicity included having a mortgage/personal loan, higher out of pocket costs and household bills, limited health insurance, more severely ill, on active treatment, and lower functioning or quality of life. Conclusion Cancer negatively affects employment, and these changes are significant contributors to financial toxicity. Researchers, healthcare professionals, and patients themselves should all cooperate to tackle these complex issues.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Financial toxicity and employment status in cancer survivors. A systematic literature review

Mols

Tomalin

Pearce

et al. 2020

Support Care Cancer

129

View full text Add to dashboard Cite

show abstract

“…Retrospective studies of North American insurance claims databases have evaluated the economic burden of brain metastases in patients with primary lung cancer and have shown that direct health costs increase around fourfold following diagnosis of brain metastases. 8 9 In particular, use of stereotactic brain surgery may markedly increase the cost of treatment. 10 However, since the cost of management of lung cancer rises substantially following evolution to the metastatic stage, regardless of the site of metastasis, 11 it is not clear how much of the extra cost determined in these studies is inherent to management of metastases specifically arising in the central nervous system.…”

Section: Introductionmentioning

confidence: 99%

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Girard

Cozzone

Léotoing³

et al. 2018

ESMO Open

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PurposeTo assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases at the time of diagnosis.MethodsData were extracted from the French Hospital medical information database (Programme de Médicalisation des Systèmes d’Information (PMSI)). Patients with non-squamous NSCLC were identified through a diagnosis of lung cancer and a prescription of bevacizumab or pemetrexed. All such patients hospitalised with lung cancer for the first time in 2013 and with metastases identified at the first hospitalisation were eligible. Two cohorts were identified, one with brain metastases (group B: n=971) and one with metastases at other sites (group A: n=1529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 euros.ResultsThe mean number of hospitalisations per patient in the 24-moth follow-up period was 17 in group A and 21 in group B. >99% of patients in both groups received chemotherapy. 58% of patients in group B and 13% in group A were managed by radiotherapy. 37% in group B and 24% in group A received palliative care. The associated cost was €2979 per patient-month for patients in group B and €2426 for patients in group A, representing a differential cost of €553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost.ConclusionsThe presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.

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“…In these molecular subgroups where the incidence of brain metastases is high, further clarification of response to ICIs will be important. When brain metastases develop, the cost of patient care rises significantly (84). It is unlikely that use of ICIs without better patient selection will be cost effective in treating an overall poor prognostic cohort of patients.…”

Section: N I V O L U M a B H A S A L S O D E M O N S T R A T E D A C mentioning

confidence: 99%

Are immune checkpoint blockade monoclonal antibodies active against CNS metastases from NSCLC?—current evidence and future perspectives

O’Kane

2016

Transl. Lung Cancer Res.

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Brain metastases occur in approximately half of patients with non-small cell lung cancer (NSCLC) and are associated with a poor prognosis and an inferior quality of life. Historically systemic therapy has had a limited role in CNS disease with a reliance placed on local treatments. The emergence of targeted therapies and immune checkpoint inhibitors (ICIs) in recent years has dramatically changed the treatment landscape of NSCLC. Programmed cell death-1 (PD-1) inhibitors have demonstrated efficacy in three randomized trials and now represent standard second line therapy after platinum failure. Trials have largely excluded patients with symptomatic or untreated CNS disease as the brain has been considered an 'immune-privileged' organ. We review the evidence and future prospects of ICIs in treating brain metastases in NSCLC.

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The economic burden of brain metastasis among lung cancer patients in the United States

Abstract: Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.

Cited by 34 publications

References 34 publications

Financial toxicity and employment status in cancer survivors. A systematic literature review

Financial toxicity and employment status in cancer survivors. A systematic literature review

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Are immune checkpoint blockade monoclonal antibodies active against CNS metastases from NSCLC?—current evidence and future perspectives

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