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Older patients with NSCLC experience high treatment burden
Medicare beneficiaries diagnosed with early-stage non–small cell lung cancer endure a high treatment burden, which appeared to vary by type of treatment, according to results of a retrospective cohort study.
“These findings highlight a need to improve cancer care coordination,” Carolyn J. Presley, MD, instructor at Yale Cancer Center and a Robert Wood Johnson Clinical Scholar at Yale School of Medicine, said in a press release. “It’s also a call for providers to think about the burden we might be placing on patients.”
Presley and colleagues described treatment burden as an “emerging concept that is distinct from disease burden or symptom burden that describe the work of being a patient and the impact this workload has on a patient’s functioning and well-being.”
It is associated with increasing age, intense therapy and variable prognosis. Efforts to understand treatment burden on older patients newly diagnosed with cancer and its effects has mostly focused on adverse events related to treatment and treatment duration.
Presley and colleagues sought to address knowledge gaps in treatment burden of older patients with NSCLC.
Using the SEER–Medicare database, researchers evaluated data from 8,000 Medicare beneficiaries (mean age, 76 years) diagnosed with stage I NSCLC between 2007 and 2011 who were treated with surgery (76%), stereotactic body radiation therapy (10%) or external beam radiation therapy (13%).
The main objectives of the study were to measure treatment burden, defined as the cumulative number of days a patient was in contact with the health care system, the number of physicians involved in a patient’s care and the number of medications prescribed. A high treatment burden was characterized as having 66 or more encounter days with a physician.
“To our knowledge, this is the first study to characterize treatment burden in terms of touches with the health care system for early-stage lung cancer patients,” Presley told HemOnc Today. “We included ED visits, outpatient visits and hospital-based follow-up in addition to the extra number of physicians seen and medications prescribed.”
Approximately 7,955 patients spent 1 in 3 days interacting with the health care system during the first 60 days of treatment. Within 12 months after treatment initiation, patients experienced a median of 44 encounter days, but this was highly variable (interquartile range [IQR], 29-66).
The median number of physicians involved was 20 (IQR, 14-28) and the median number of medications prescribed was 12 (IQR, 8-17).
“These numbers are very high, and a lot to expect of older patients who often have transportation or mobility issues in addition to other functional limitations,” Presley said, adding that “this could create potential room for errors.”
The researchers also found that treatment burden varied by treatment type. Cancer-related encounter days ranged from a median of 13 (IQR, 2-30) days for patients undergoing stereotactic body radiation therapy, 20 (IQR, 8-38) for patients who underwent surgery, to 42 for patients treated with external beam radiation therapy (IQR, 24-61; P < .001).
Patients treated with external beam radiation therapy had the highest treatment burden (predicted probability = 46.8%; 95% CI, 43.3-50.2) compared with patients treated with surgery (predicted probability = 21.6%; 95% CI, 20.2-23.1) or stereotactic body radiation therapy (predicted probability = 16.1%; 95% CI, 12.9-19.3).
Study researcher Cary P. Gross, MD, co-director of the Robert Wood Johnson Foundation Clinical Scholars Program, and director of the National Clinician Scholars Program at Yale, told HemOnc Today that dealing with cancer is challenging enough without extra burden.
“We found that the complexity of cancer treatment — with numerous doctors involved, and many trips to and from the hospital or ED — is another burden we place on our patients. The medical community needs to figure out how to provide effective treatments, while minimizing the burden we place on patients and their families.” – by Melinda Stevens
For more information:
Cary P. Gross, MD, can be reached at Yale School of Medicine, Internal Medicine, PO Box 208056, 333 Cedar St., New Haven, CT 06520; email: cary.gross@yale.edu.
Carolyn J. Presley, MD, can be reached at Yale School of Medicine, 333 Cedar St., PO Box 208088, New Haven, CT 06520; email: carolyn.presley@yale.edu.
Disclosure : Presley reports research funding for her institution from Celgene. Gross reports research funding from 21st Century Oncology, Johnson & Johnson and Pfizer. Other researchers also report research funding from 21st Century Oncology.