Reports From JCO and JOP


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Staying up-to-date with peer-reviewed oncology literature is a daunting task. To assist readers, The ASCO Post has summarized a number of studies recently published in the Journal of Oncology Practice (JOP) and the Journal of Clinical Oncology (JCO).

Survival as Quality Metric in Cancer Care

In a National Cancer Data Base study reported in the Journal of Oncology Practice, Shulman et al found little difference in risk-adjusted cancer mortality among individual hospitals, suggesting survival may not be an ideal quality metric at the individual hospital level. However, survival was better among National Cancer Institute (NCI)-designated comprehensive cancer centers compared with academic and community hospitals.

Study Details

The study included an analysis of risk-adjusted hazards for survival among patients with stage III breast cancer (n = 116,787) and stage IIIB or IV non–small cell lung cancer (n = 252,392) at 1,593 hospitals included in the National Cancer Data Base.

Among the 1,593 hospitals, risk-adjusted hazard ratios for survival were statistically better for 8 and statistically worse for 6 for breast cancer patients and statistically better for 15 and statistically worse for 5 for lung cancer patients.

Compared with academic hospitals, risk-adjusted survival for breast cancer patients was significantly better for NCI-designated comprehensive cancer centers (hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.81–0.95) and significantly worse for comprehensive community hospitals (HR = 1.09, 95% CI = 1.04–1.14) and community hospitals (HR = 1.17, 95% CI = 1.11–1.23). Compared with academic hospitals, risk-adjusted survival for lung cancer patients was significantly better for NCI-designated comprehensive cancer centers (HR = 0.83, 95% confidence interval [CI] = 0.80–0.86) and significantly worse for comprehensive community hospitals (HR = 1.07, 95% CI = 1.05–1.09) and community hospitals (HR = 1.14, 95% CI = 1.11–1.17).

The investigators concluded: “Using the [National Cancer Data Base] as the data source, survival rates for patients with stage III breast cancer and stage IIIB or IV non–small-cell lung cancer were statistically better at NCI–designated comprehensive cancer centers when compared with other hospital types. Compared with academic hospitals, risk-adjusted survival was lower in community hospitals. At the individual hospital level, after risk adjustment, few hospitals were shown to have statistically better or worse survival, suggesting that, using [National Cancer Data Base] data, survival may not be a good metric to determine relative quality of cancer care at this level.”

Schulman L, et al: J Oncol Pract. November 1, 2017 (early release online).

Event-Free Survival at 24 Months and Overall Survival in PTCL

In a study reported in the Journal of Clinical Oncology, Maurer et al found that event-free survival at 24 months (EFS24) was associated with prolonged subsequent overall survival among patients with peripheral T-cell lymphoma (PTCL).

The study involved patients with systemic PTCL newly diagnosed from 2000 to 2012 from the United States (n = 138), Sweden (n = 422; initial cohorts), and Canada (n = 215; replication cohort) who were treated with curative intent. Event-free survival was defined as the time from the date of diagnosis to disease progression after primary treatment, retreatment, or death. Subsequent overall survival was measured after achieving EFS24 or from the time of disease progression if disease progression occurred within 24 months.

EFS24 and Overall Survival

Among the total of 775 patients, the median age at diagnosis was 64 years, and 63% were men. Since results were similar in the initial and replication cohorts, a combined analysis was performed. Overall, 64% of patients had disease progression within the first 24 months; these patients had a median overall survival of 4.9 months and a 5-year overall survival of 11%. Among patients who were event-free at 24 months, relapse occurred in 23% of patients within the following 5 years; median overall survival was not reached, and 5-year overall survival was 78%. Among patients aged ≤ 60 years at diagnosis who were event-free at 24 months, 5-year overall survival was 91%.

The investigators concluded: “EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent [overall survival], especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.”

The study was supported by grants from the National Cancer Institute, the Terry Fox Research Institute, and the British Columbia Cancer Foundation.

Andrew L. Feldman, MD, of the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, is the corresponding author of the -Journal of Clinical Oncology article.

Maurer MJ, et al: J Clin Oncol. October 26, 2017 (early release online). 

Predictors of Posthospital Care Transitions in Advanced Cancer

In a study reported in the Journal of Clinical Oncology, Lage and colleagues found that among patients with advanced cancer who had an unplanned hospital admission, those discharged to hospice or post–acute care facilities had a worse symptom burden and physical function and worse survival than did those discharged home without hospice.

Study Details

The prospective study included 932 patients with advanced cancer (those not being treated with curative intent) who had an unplanned admission to Massachusetts General Hospital between September 2014 and March 2016. Upon admission, patients’ physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4) were assessed. The primary outcome was discharge location, consisting of home without hospice, post–acute care facility, or hospice in any setting.

Of the 932 patients, 726 (77.9%) were discharged home without hospice; 118 (12.7%), to a post–acute care facility; and 88 (9.4%), to hospice. Compared with patients discharged home without hospice, those discharged to a post–acute care facility and to hospice reported high rates of severe symptoms, including dyspnea (19% vs 28% and 34%, P < .001), constipation (24% vs 31% and 36%, P < .017), low appetite (41% vs 56% and 60%, P < .001), fatigue (60% vs 70% and 72%, P < .013), depression (25% vs 42% and 49%, P < .001), and anxiety (24% vs 38% and 38%, P < .003).

On regression analysis, patients discharged to a post–acute care facility or hospice vs home without hospice were more likely to be older (odds ratio [OR] = 1.03, P < .001), live alone (OR = 1.95, P < .003), have impaired mobility (OR = 5.08, P < .001), longer hospital stays (OR = 1.15, P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR = 1.02, P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR = 1.13, P < .027). Patients discharged to hospice vs a post–acute care facility were more likely to receive palliative care consultation (OR = 4.44, P < .001) and have shorter hospital stays (OR = 0.84, P < .001). Patients discharged to a post–acute care facility vs home without hospice had poorer survival (hazard ratio = 1.53, P < .001).

The investigators concluded: “Patients with advanced cancer who were discharged to [post–acute care] facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.”

The study was supported by the Scullen Family Center for Cancer Data Analysis, Conquer Cancer Foundation, Ghiso Fellowship in Compassionate Care, and a grant from the National Institutes of Health.

Areej El-Jawahri, MD, of Massachusetts General Hospital Cancer Center, is the corresponding author of the Journal of Clinical Oncology article. Daniel E. Lage, MD, and Ryan D. Nipp, MD, MPH, contributed equally to the work.

Lage DE, et al: J Clin Oncol. October 25, 2017 (early release online). ■


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