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Treatment and Outcomes in Patients With Metastatic Colorectal Cancer in Washington State and Canada


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In a study reported in JCO Oncology Practice, Todd A. Yezefski, MD, and colleagues found that the cost of first-line systemic therapy for metastatic colorectal cancer was higher in Western Washington state compared with British Columbia and that survival outcomes were similar.

Todd A. Yezefski, MD

Todd A. Yezefski, MD

A stated by the investigators, the aim of the study was to identify differences in treatment, cost, and outcomes in the two geographically and culturally similar populations with different health-care systems—ie, the U.S. multipayer health system and the Canadian single-payer system.

Study Details

The study involved data from 1,592 patients in British Columbia and 901 in Western Washington state diagnosed with metastatic colorectal cancer. Data were identified from the BC Cancer database and a regional database linking the Western Washington state Surveillance, Epidemiology, and End Results registry to claims from Medicare and two large commercial insurers.

Dates of diagnosis were January 2010 to December 2012 for the British Columbia cohort and January 2010 to December 2016 for the Western Washington state cohort. Cost data obtained from the BC Cancer Pharmacy Database were converted to U.S. dollars using the Purchasing Power Parity for Health for 2009 (1.33 U.S. dollars/Canadian dollars).

Key Findings

Median age at diagnosis was similar in British Columbia (66 years) and Western Washington state (63 years). Patients in British Columbia were more likely to be male (57.1% vs 51.2%, P ≤ .01) and to have de novo metastatic disease (61.0% vs 38.3%, P ≤ .01).

The rate of use of radiation therapy was similar in British Columbia and Western Washington state (31.2% vs 33.9%, P = .18). Patients in British Columbia were more likely to have primary tumor resection (74.1% vs 66.3%, P ≤ .01) and hepatic metastasectomy (12.4% vs 2.3%, P ≤ .01).

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The rate of receipt of systemic therapy was similar in British Columbia and Western Washington state (68.8% vs 67.1%, P = .40). The cost of first-line systemic therapy in Western Washington state was significantly higher than that in British Columbia (mean cost of $15,792 vs $6,226 USD per patient per month, P ≤ .01).  

Median overall survival was similar in patients in British Columbia and those in in Western Washington state—16.9 months vs 18 months—including median survival durations of 22.1 months vs 23 months among patients who received systemic therapy and 6.3 months vs 7 months in those who did not.

The investigators concluded, “Cost of systemic therapy for metastatic colorectal cancer was significantly higher for patients in in Western Washington state than in British Columbia, but this did not translate to a difference in overall survival.”

Dr. Yezefski, of the Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by internal funding at University of Washington/Fred Hutchinson Cancer Research Center and British Columbia Cancer Agency. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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