Martin Marciniak

Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small cell lung cancer in the United States

PURPOSE This study assessed first-line chemotherapy treatment patterns over time and identified predictors of chemotherapy use and treatment selection among elderly patients with newly diagnosed Stage IIIB/IV non-small cell lung cancer (NSCLC) in the United States. METHODS Patients aged 65 years and older newly diagnosed with Stage IIIB/IV NSCLC between 1997 and 2002 were identified and followed through 2003 using the Surveillance, Epidemiology and End Results (SEER)-Medicare database to evaluate temporal trends in chemotherapy treatment. Multivariate logistic regression models were estimated to identify predictors of chemotherapy treatment and factors associated with use of cisplatin/carboplatin (platinum) and either a taxane or gemcitabine versus other treatments. RESULTS Chemotherapy use increased from approximately 28% of Stage IIIB/IV NSCLC patients diagnosed in 1997 to 36% of patients diagnosed in 2002. Doublet therapy was most commonly used as first-line therapy, received by 74% of chemotherapy-treated patients across all study years. Use of doublet therapy with platinum and either a taxane or gemcitabine also increased over time (with the largest increase for gemcitabine combinations from 0.3% in 1997 to 11.8% in 2002). Males were more likely than females to be treated with chemotherapy (odds ratios [95% CI]: 1.14 [1.06-1.22]), as were patients in the Northeast and South relative to patients in the West (1.24 [1.13-1.36] and 1.33 [1.20-1.47], respectively). CONCLUSION Use of first-line chemotherapy treatment among elderly Stage IIIB/IV NSCLC patients is low, but appears to be increasing, with potential regional and gender differences in treatment. These findings are likely to be of interest to clinicians and policymakers.

A Randomized Phase II Study of Paclitaxel and Bevacizumab With and Without Gemcitabine as First-Line Treatment for Metastatic Breast Cancer

BACKGROUND The addition of bevacizumab to paclitaxel improved progression-free survival (PFS) of patients with metastatic breast cancer (MBC). We examined the efficacy and safety of adding gemcitabine to paclitaxel/bevacizumab (PB). PATIENTS AND METHODS In this multicenter, open-label, randomized phase II trial, women with locally advanced or MBC were randomly assigned to receive paclitaxel 90 mg/m(2) (days 1, 8, 15) and bevacizumab 10 mg/kg (days 1, 15) with or without gemcitabine 1500 mg/m(2) (days 1, 15) in 28-day cycles. Patients with prior cytotoxic therapy for MBC were ineligible. The primary endpoint was investigator-assessed overall response rate (ORR); secondary endpoints were PFS, overall survival (OS), safety, and quality of life. RESULTS Ninety-four patients received PB, and 93 received paclitaxel/bevacizumab/gemcitabine (PB+G). The ORRs were 48.9% (95% confidence interval [CI], 38.5%-59.5%) and 58.7% (95% CI, 47.9%-68.9%; P = .117) with PB and PB+G, respectively. The median PFS was 8.8 months (95% CI, 8.1-10.4 months) and 11.3 months (95% CI, 9.7-12.7 months; P = .247; hazard ratio, 0.82); the median OS was 25.0 months (95% CI, 18.8-not assessable [N/A] months) and 24.3 months (95% CI, 20.3-N/A months; P = .475; hazard ratio, 0.84), with PB and PB+G, respectively. There was significantly more grade 3-4 neutropenia (P = .001) and dyspnea (P = .014) with PB+G. Patients treated with PB experienced more improvement in total FACT-B (Functional Assessment of Cancer Therapy-Breast) (P = .021), FACT-B Social/Family Well-being (P = .041), and Breast Cancer-Additional Concerns (P = .008) scores than patients treated with PB+G. CONCLUSION The addition of gemcitabine to PB was not associated with a statistically significant improvement in ORR. Treatment with PB+G increased the incidence of severe neutropenia and dyspnea, although the regimen generally was well tolerated.

The cost of comorbid depression and pain for individuals diagnosed with generalized anxiety disorder.

Patients with generalized anxiety disorder (GAD) often have comorbid medical and psychiatric disorders and may incur higher costs. In this study, a total of 36,435 GAD patients aged 18 to 64 were identified from a claims database. Patients total health care and component costs were compared between GAD patients with and without comorbid depression and pain using general linear models. The average total annual cost for all the GAD patients in the study was

Cigarette consumption and sales of nicotine replacement products

7451. Compared with patients with GAD-only, the estimated total cost was

Rational addiction and smoking cessation: An empirical study

762 higher for GAD with depression (p < 0.001),

Does Type of Tumor Histology Impact Survival among Patients with Stage IIIB/IV Non-Small Cell Lung Cancer Treated with First-Line Doublet Chemotherapy?

2989 higher for GAD with pain (p < 0.001), and

Promising therapies, prohibitive costs: a qualitative assessment of the effects of the Medicare Part D doughnut hole on access to costly cancer medications

6073 higher for GAD with both depression and pain (p < 0.001). Comorbid depression and pain had significant impact on costs, especially those with pain or with both depression and pain. This suggests that an optimal strategy for GAD should take into account comorbid pain and depression.

Prospective observational comparison of clinical outcomes between african-american and caucasian patients receiving second-line treatment with pemetrexed for advanced non-small-cell lung cancer.

BACKGROUND The first nicotine replacement product, Nicorette Gum, was marketed in 1984 as an adjuvant to help smokers quit smoking. In 1992, sales of nicotine patches were begun. Before 1996, nicotine gums and nicotine patches were prescribed by physicians and supplemented with behavioural counselling. Since 1996, nicotine gums and patches became available over the counter. OBJECTIVES To examine the effect of sales of nicotine replacement products on national cigarette consumption. DESIGN National time series quarterly cigarette consumption, sales of nicotine gums and patches data between 1976 and 1998 are used to estimate a time series autoregressive moving average intervention model. PARTICIPANTS National reported statistics. MAIN OUTCOME MEASURES Per capita cigarette sales. RESULTS A 10% increase in sales of nicotine replacement products will lead to a 0.04% reduction in cigarette sales. The model indicates that a 0.076% reduction in cigarette consumption is associated with the availability of nicotine patches after 1992. The over the counter dummy variable (after 1996) has a negative sign, but is not significant, perhaps due to only a few quarters of data in the study period. CONCLUSIONS Nicotine replacement products (nicotine gums and nicotine patches) play a significant role in reducing cigarette consumption, in addition to the negative effect of increasing cigarette price and the overall trend of declining cigarette consumption (as reflected by the time trend variable). The findings of this study suggest that additional efforts for promoting sales of nicotine replacement products will be another effective alternative to discouraging cigarette consumption.

PCN43 THE ASSOCIATION OF TUMOR HISTOLOGY WITH FIRST-LINE TREATMENT AND LIFETIME MEDICAL-CARE COSTS AMONG ELDERLY STAGE IIIB/IV NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS TREATED WITH COMMONLY USED DOUBLET THERAPIES AMONG

Abstract The theory of rational addictive behavior has important implications concerning the impact of a smoker’s socioeconomic status on his or her incentive to quit. The research reported on here extends the previously developed theory of addictive behavior to show its implications for both successful and unsuccessful quitting. Further, it develops hypotheses as to how successful and unsuccessful smoking cessation should relate to an individual’s socioeconomic status if the theory is correct. The hypotheses are then tested empirically, using multinomial logit analysis for a sample of more than 24,000 Californians. The results support the theory of rational addictive behavior.

Neutropenia-Related Costs in Patients Treated with First-Line Chemotherapy for Advanced Non-Small Cell Lung Cancer

Chemotherapy regimens may have differential efficacy by histology in nonsmall cell lung cancer (NSCLC). We examined the impact of histology on survival of patients (N = 2,644) with stage IIIB/IV NSCLC who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G) and cisplatin/carboplatin plus a taxane (C/C+T) identified retrospectively in the SEER cancer registry (1997–2002). Patients with squamous and nonsquamous cell carcinoma survived 8.5 months and 8.1 months, respectively (P = .018). No statistically significant difference was observed in survival between C/C+G and C/C+T in both histologies. Adjusting for clinical and demographic characteristics, the effect of treatment regimen on survival did not differ by histology (P for interaction = .257). There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC.