From a managed care perspective, it is important to promote utilization of resources toward the most cost-effective option.
—Edward Li, PharmD
The 19th Annual Conference of the National Comprehensive Cancer Network (NCCN), recently held in Hollywood, Florida, featured a number of scientific posters by member organizations and meeting sponsors. The ASCO Post captured some of the most interesting findings for our readers, including these news briefs. The results of these studies support the use of NCCN Guidelines in patient care.
Cisplatin in Bladder Cancer
For muscle-invasive bladder cancer patients opting for radical cystectomy, current guidelines strongly recommend neoadjuvant cisplatin-based chemotherapy, and eligibility for this treatment is based on creatinine clearance as estimated by the Cockcroft-Gault equation. In 2009, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) proposed a more precise equation.
Sumanta K. Pal, MD, and colleagues at City of Hope Comprehensive Cancer Center, Los Angeles, evaluated eligibility for the receipt of cisplatin on the basis of the CKD-EPI equation, vs the Cockcroft-Gault equation and other conventional methods and found the two approaches identified the same proportion of patients, approximately 70%.1 In the subset of patients ≥ 80 years old, the CKD-EPI equation found that a much smaller percentage were eligible—25% compared to 50% by the Cockcroft-Gault equation. Of 126 patients, only 34 (27%) received neoadjuvant cisplatin-based chemotherapy, and of the 92 who did not, 64% had a creatinine clearance > 60 mL/min by Cockcroft-Gault.
“In contrast to previous reports, the CKD-EPI equation does not appear to characterize a broader span of patients as cisplatin-eligible,” the authors concluded. “The discordance between actual rates of neoadjuvant chemotherapy use and rates of cisplatin eligibility suggest that other factors may guide clinical decision-making.”
Gaps in Survivorship Care
Most colorectal cancer and non–small cell lung cancer (NSCLC) patients receive surveillance care and coordinated care as per NCCN Guidelines. However, only a minority receive a comprehensive assessment of treatment-associated effects, preventive cancer screening, or healthy behavior counseling, according to a study led by Crystal S. Denlinger, MD, of Fox Chase Cancer Center, Philadelphia.2
“NCCN Guidelines for Non-Small Cell Lung Cancer, Colon Cancer, and Rectal Cancer have included survivorship care guidelines since 2009, but it is unclear whether survivorship guidelines are used in follow-up care of survivors. Evaluating adherence may improve survivorship care by raising oncology providers’ awareness of appropriate survivorship care,” Dr. Denlinger suggested.
The study involved a review of 374 patient charts at 10 sites encompassing 19 oncology practices affiliated with Fox Chase. The main finding was that patients are receiving appropriate cancer surveillance care and coordinated care with primary physicians, but survivors are not likely to receive comprehensive preventive care, and comprehensive intervention for the effects of cancer is uncommon.
The researchers reported:
The researchers will assess the impact of an educational initiative for the providers in future analyses.
Palonosetron (Aloxi) is an effective antiemetic for chemotherapy-induced nausea and vomiting (CINV), but it may not be the most cost-effective option for regimens with low emetogenic potential, considering that other lower-cost 5HT3 antagonists are available. This was the conclusion of pharmacists from New Century Health, a health-care management organization, who reported results from a quality management program.4
“From a managed care perspective, it is important to promote utilization of resources toward the most cost-effective option, and thus it is important to understand the patterns of inappropriate use of palonosetron,” said lead author Edward Li, PharmD. “Other treatment options may be equally efficacious and more cost-effective in low-emetogenic regimens.”
The study examined a cohort of denied chemotherapy treatment authorization requests containing palonosetron to determine trends in demographics, authorization request patterns, and cost. The information was reviewed by the oncology quality management program at New Century Health from January 2013 to October 2013.
A total of 378 cases of denied authorization requests were identified; most involved single-agent chemotherapy. The reasons for denial included lack of compendia support (81%), availability of a therapeutic alternative (42%), clinical criteria not met (15%), and dosing/frequency errors (10%).
The program prompted chemotherapy regimen changes in 156 cases and supportive care treatment changes in 222 cases. Palonosetron was removed in 82% of all final, approved chemotherapy treatment authorization requests and retained in just 18% of cases.
The total net cost savings based on all the changes within the cohort was $1,087,073. Evidence-based changes in therapy that resulted in enhanced care quality but increased cost totaled $757,473, according to Dr. Li and colleagues. ■
Disclosure: Drs. Pal and Saam reported no potential conflicts of interest. Dr. Li is on the advisory board of Amgen and Hospira and is on the speakers bureau for Pfizer.
1. Chang M, Ruel N, Villegas S, et al: Chronic kidney disease epidemiology and Cockcroft-Gault equations identify similar candidates for neoadjuvant chemotherapy in muscle-invasive bladder cancer. 19th NCCN Annual Conference. Abstract AB2014-11. Presented March 13, 2014.
2. Denlinger CS, Filchner K, O’Grady M, et al: Adherence to NCCN survivorship care guidelines in lung and colorectal cancer patients. 19th NCCN Annual Conference. Presented March 13, 2014.
3. Saam J, Arnell C, Moyes K, et al: Evaluating the personal and family history overlap between hereditary cancer syndromes. 19th NCCN Annual Conference. Abstract AB2014-29. Presented March 13, 2014.
4. Li E, Tran C, Peterson B, et al: Palonosetron for chemotherapy-induced nausea and vomiting: Description and report of a quality management program. 19th NCCN Annual Conference. Abstract AB2014-17. Presented March 13, 2014.