Alex Rider

The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study

PurposeDisease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.MethodsPatients with advanced (stage IIIB/IV) NSCLC (Nu2009=u2009450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy—Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.ResultsA high proportion of patients experienced lung cancer symptoms: fatigue (100xa0%), loss of appetite (97xa0%), shortness of breath (95xa0%), cough (93xa0%), pain (92xa0%), and blood in sputum (63xa0%). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (βu2009=u2009−0.204; pu2009<u20090.001), cough (βu2009=u2009−0.145; pu2009<u20090.01), pain (βu2009=u2009−0.265; pu2009<u20090.001), and shortness of breath (βu2009=u2009−0.145; pu2009<u20090.01) were found to be significant predictors of the quality of life.ConclusionsSymptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.

Treatment patterns and characteristics of European patients with castration-resistant prostate cancer

BackgroundEuropean treatment guidelines recommend the use of hormonal therapy for the treatment of advanced prostate cancer, including castration-resistant prostate cancer (CRPC), but there is little understanding of how common practices in prostate cancer treatment compare across Europe. The aim of this analysis was to evaluate the management of CRPC patients across five European countries (France, Germany, Italy, Spain and the UK).MethodsData were drawn from the Adelphi Real World Prostate Cancer Disease Specific Programme (DSP), a cross-sectional survey of patients undertaken between December 2009 and May 2010. The study is based on physician interviews, physician-completed detailed patient record forms, and a patient-completed questionnaire.ResultsA total of 348 physicians (191 urologists and 157 oncologists) reported on 3477 patients with prostate cancer. Of the 3477 patients, 1405 (40%) were categorised as having CRPC, and 1119 of these had metastatic CRPC. Bone metastases were the most common (78%), followed by liver (37%) and lung (30%). The mean age of CRPC patients was 71xa0years, 35% were current or ex-smokers and 10% had a family history of prostate cancer. CRPC patients had a mean of 1.8 comorbidities; 66% had hypertension and 32% had diabetes. Most physicians estimated their patients would stop responding to initial hormone therapy after 19–24xa0months. Overall, addition of an anti-androgen to a luteinising-hormone-releasing hormone (LHRH) agonist was the most commonly prescribed therapy when patients failed initial LHRH agonist therapy, although there were considerable variations between countries. While 72% of physicians in Europe would choose chemotherapy as the next treatment option after diagnosis of CRPC, 31% of this group would initially prescribe this without an LHRH agonist.ConclusionsResults from this analysis highlight inconsistencies in common hormonal therapy treatment patterns for CRPC and hormonal therapy across the EU.

Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries

Background Bone metastases (BMs) are common in patients with breast cancer and can lead to skeletal-related events (SREs), which are associated with increased pain and reduced quality of life (QoL). Bone-targeted agents (BTAs), like zoledronic acid and denosumab, reduce the incidence of SREs and delay progression of bone pain. Materials and methods We evaluated the management of BMs and pain in six European countries (Belgium, France, Germany, Italy, Spain, and UK) using the Adelphi Breast Cancer Disease Specific Programme, which included a physician survey and patient-reported outcomes (PROs) to assess the impact of BMs on pain and QoL. Results 301 physicians completed patient record forms for 2984 patients with advanced breast cancer; 1408 with BMs and 1136 with metastases at sites other than bone (non-BMs). Most patients with BMs (88%) received a BTA, with 81% receiving treatment during 3 months following BM diagnosis. For those who did not receive a BTA, the main reasons given were: very recent BM diagnosis, perceived low risk of bone complications, and short life expectancy. Most patients with BMs (68%) were experiencing bone pain and, of these, 97% were taking analgesics (including 28% receiving strong opioids). Despite this, moderate to severe pain was reported in 20% of patients who were experiencing pain. PROs were assessed in 766 patients with advanced breast cancer (392 with BMs, 374 with non-BMs). Overall, patients with BMs reported worse pain and QoL outcomes than those with non-BMs, those not receiving a BTA reported worse pain. Conclusion Despite the large proportion of patients receiving BTAs in this study, some patients with BMs are still not receiving early treatment to prevent SREs or to manage pain. Improving physicians’ understanding of the role of BTAs and the importance of early treatment following BM diagnosis has the potential to improve patient care.

Bone targeting agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in the US.

93 Background: Bone is the most common site of distant metastasis in patients with advanced breast cancer. Bone metastases (BMs) often lead to skeletal-related events (SREs) and may result in debilitating bone pain which impacts a patients quality of life. Bone targeting agents (BTAs) reduce the incidence of SREs and progression of pain due to BMs. This study aims to understand real world patients experience of bone pain and to assess BTAs treatment patterns.nnnMETHODSnData were extracted from the Adelphi Breast Cancer Disease-Specific Programme (DSP), a cross-sectional survey of 98 US oncologists conducted from February to May 2015 in the USA. Each physician completed comprehensive record forms capturing the following information about the next 12 patients being treated for advanced breast cancer: Presence of BMs, patients pain state at diagnosis of BMs, current pain state, time since diagnosis of BMs, current analgesic use and reasons for prescribing BTAs.nnnRESULTSnBone pain was more prevalent (p < 0.001) in patients with BMs (67% of 485) than those without BM (7% of 791). Mean time for pain assessment was 6.2 months after BM diagnosis. Among breast cancer patients with BMs and bone pain (n = 323), 98% required analgesic medications to manage the pain, including 40% (n = 130) who were treated with strong opioids (e.g., morphine, oxycodone, hydromorphone, or methadone). Of these patients, 100 (77%) had moderate/severe bone pain. Of the patients with BMs, 69% (n = 337) were treated with a BTA and treatment was initiated within 3 months of BMs diagnosis in 91% (n = 306) of them. The reasons for prescribing a BTA within 3 months of BM diagnosis were bone pain (32%), high risk of bone complications (25%), prior history of bone complications(18%), number of BMs (11%) and location of BMs (4%).nnnCONCLUSIONSnAdvanced breast cancer patients with BMs are more likely to experience bone pain, and three-fourths of the patients treated with strong opioids experienced moderate/severe bone pain.The majority of patients with BMs receive a BTA prescription for the reduction of bone pain and risk of bone complications.

International Differences in the Role of Payer and Administrative Controls in Prescribing Decisions

Presented at ISPOR 18th Annual European Congress, Milan, 7th – 11th November 2015, Milan UPDATE ● The major 5 European markets all operate socialised healthcare systems. In each there are different structures and organisations in place to assess the value of medical interventions, and a number of different decision makers who act on the basis of these assessments to ensure efficient use of healthcare resources. Collectively these decision makers are commonly referred to as payers. ● One of the key objectives of the payer is to influence prescribing behaviour, to ensure effective use of healthcare resources in order to contain healthcare costs while simultaneously allowing an acceptable minimum quality of care. To achieve this they use a number of administrative approaches. These vary according to the care setting. ● Less clear is the extent to which these administrative controls are effective tools to influence prescribing behaviour; the extent to which prescribers feel that these are implemented appropriately or how this varies between countries or therapy areas. ● Oncology is an interesting setting in which to explore this topic for two key reasons: There is a mix of locally active payers (located within the organisations where care is given), national decision makers and in some cases regional or quasi regional payers who are further removed from the prescriber. It is a highly emotive therapy area, in which innovative drugs are often costly – providing the possibility for tension between the payers’ incentive to attempt to contain use of new medications, and the prescribers’ desires to use new treatments to improve outcomes in terminal conditions. ● The objective of the analysis was to assess the extent to which prescribing decisions are influenced by payer implemented controls.

Bone Pain And Bone Targeting Agent (Bta) Treatment Pattern In Patients With Bone Metastases (Bms) From Prostate Cancer (Pc) In Real World Setting In Europe.

Objectives: To examine bone pain and BTA utilization in patients with BMs from PC in real-world setting in Europe. nMethods: This study was conducted using the Adelphi Prostate Cancer Disease Specific Programme (DSP) 2015 database, a multi-country cross-sectional survey of 241 oncologists and 103 urologists in 6 European countries (UK, Germany, France, Italy, Spain, and Belgium). Patients’ current pain state, current analgesic use, BTA treatment, and reasons for BTA treatment data were extracted from the patient record forms (PRFs) completed by the physicians. nResults: A total of 3608 PRFs were collected including 1931 on PC patients with BMs. At the time of survey (an average of 15.2 months from BMs diagnosis), 41% patients experienced mild pain; and 29% had moderate/severe bone pain. The majority of the patients (96%) with pain took analgesics to manage pain, including 29% (n=387) patients who were treated with strong opioids (e.g. morphine, oxycodone etc.). Of these patients, 73% (284/387) still had moderate/severe pain. Among the patients with BMs, 74% (n=1437) were treated with a BTA, and BTA treatment occurred within 3 months of BMs diagnosis in 72% (n=1036) of them. Reasons for BTA treatment initiation within 3 months of BMs were “bone pain” (40%), “high risk of bone complications” (29%), “number of BMs” (11%), “location of BMs” (8%) and “prior history of bone complications” (5%). Reasons for not treating patients with BTA were “recent diagnosis” (36%), “low bone complication risk” (22%), and “focus on treating primary tumor” (8%). nConclusions: Bone pain is the major symptom encountered by patients with BMs from PC. The majority of these patients treated with strong opioids still experienced moderate/severe bone pain. Approximately three quarters of patients with BMs received BTAs; primary treatment goals were reductions of the risk of bone complications and associated bone pain.