NE Oncology Issue – September 2011

Reyes C, et al. ASCO 2011: Abstract 8565

Background

Frequently, the treatment of metastatic melanoma with currently available therapies provides limited clinical benefit, with infrequent durable responses and relatively low rates of survival. Few studies have examined healthcare utilization, costs, and treatment patterns of the disease.

At ASCO 2011, Reyes and colleagues presented their findings of a study on the burden of metastatic melanoma, including treatment patterns, healthcare utilization, and costs.1

Study design

  • From January 1, 2007 to March 31, 2010, a claimsbased analysis was conducted using data from a national commercial health insurer.
  • Eligible patients were 18 years or older, and had two or more claims for metastatic disease (at least 30 days apart, and two or more claims for melanoma at least 30 days apart, or one or more claim for cancer-related treatment with a diagnosis of melanoma. Patients with a second primary cancer were excluded.
  • Patients were continuously enrolled for six months prior to the index date (baseline) and more than three months post-index date (follow-up).
  • The index date was the first metastatic melanoma diagnosis date.
  • During the observation period, patients were examined from the index date to the end of the observation period (that being death, disenrollment, or end of the study period).
  • First-line or second-line therapy began at the date of the first receipt of chemotherapy and ended at the earlier of either the start of subsequent-line therapy, start of best supportive care, or end of the observation period.
  • Outcome measures included treatment patterns, total healthcare usage, average per-patient per-month costs, best supportive care (defined as hospice after the end of systemic therapy), and mortality.

Key findings

  • The study enrolled 829 metastatic melanoma patients with a mean age of 58.8 years with a mean baseline comorbidity index of 3.42.
  • A significantly higher percentage of patients received testing, imaging, and treatment during the follow-up compared with the six-month baseline period.
  • Throughout the study period, 71% and 10% of patients had evidence of immunohistochemistry and molecular testing, respectively.
  • 431 (52%) and 103 (12%) patients had evidence of starting first-line and second-line treatment, respectively.
  • Temozolomide, interferon alfa 2b, and interleukin 2 were the most common systemic therapies.
  • The rate of healthcare utilization (defined as events per person, per year) increased 1.5–5-fold from baseline to follow-up (p <0.001). (Table 1)
    • 0.28 versus 1.40 for inpatient, 19.11 versus 29.64 for office visits, 12.03 versus 26.87 for outpatient visits, and 0.96 versus 1.45 for emergency room (ER) visits.
  • The mean per-patient per-month healthcare costs increased five-fold from $1,855 at baseline to $9,495 during follow-up (p <0.001). (Figure 1)
  • All components of medical costs were significantly higher (p <0.001) during the follow-up period compared with the baseline period. (Figure 2)
  • 21% of patients (n = 173) had evidence of best supportive care (BSC) with a mean time to BSC of 261 days (Figure 3).
  • 35% of patients died during the study period and among those who died, the mean survival time was 285 days.

Key conclusions

  • Resource utilization and cost increase considerably after the development of metastases in patients with melanoma.
  • The low proportion of patients with first- or second-line treatment suggests frequent enrolment in clinical trials as an early or intervening treatment.
  • More effective treatments, such as those targeting relevant biomarkers, are needed to improve outcomes and reduce the burden of metastatic melanoma.

Reference: 1. Reyes C, DaCosta Byfield S, Satram-Hoang S, et al. The burden of metastatic melanoma (mM): Treatment patterns, healthcare use, and costs. J Clin Oncol (ASCO Annual Meeting Abstracts) 2011;29:8565.

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Canadian Perspectives

dr-lachance
Silvy Lachance, MD, FRCPC, CSPQ
Dr. Silvy Lachance is currently a hematologist, clinical researcher, and Director of the Stem Cell Transplant Program at the MaisonneuveRosement Hospital in Montreal, Quebec, and Professor of Medicine and Director of the Fellowship Program in Stem Cell Transplantation at the University of Montreal. In 1995, Dr. Lachance established the first Stem Cell Transplant Unit at the University Health Centre (CUSE) in Sherbrooke, Quebec. She joined the Hematology and Oncology Division of the Montreal General Hospital as a transplant physician in 1997 and became an Associate Professor of Medicine at McGill University in 2005, holding both positions until 2006. Dr. Lachance has served as chair of the Continuing Medical Education Committee of the Quebec Association of Hematologists and Oncologists, and is currently treasurer of the executive committee. She has also served as chair of the jury for the hematology specialty exam board of the Collège des Médecins du Québec (CMQ). Her research interests include stem cell transplant, graft-versus-host-disease, and lymphoproliferative disorders.

dr-petrella
Teresa Petrella, BSc, MD, MSc, FRCPC
Teresa Petrella is a Medical Oncologist at the Odette Cancer Centre (OCC) in Toronto, Canada and an Assistant Professor at the University of Toronto. Dr. Petrella has a BSc in Molecular Biology from the University of Western Ontario and she completed her MD at Queen’s University. Her Internal Medicine and Medical Oncology training was at McMaster University. She subsequently completed a fellowship in Melanoma and Breast Cancer at the Toronto Sunnybrook Regional Cancer Centre along with a Masters degree in Health Research Methodology at McMaster University. She was the recipient of a CIHR/CAMO award for her research in vaccine therapy in combination with interferon for melanoma patients. Dr. Petrella joined the staff at OCC in 2002 and became the head of the Melanoma Site Group. She also chairs the Provincial Guidelines Melanoma Disease Site Group Program in Evidence Based Care the National Cancer Institute of Canada (NCIC) Melanoma Clinical Trials Group. Her research interests are in melanoma and breast cancer and she is currently the Principal Investigator for several multicentre trials investigating novel therapies in melanoma.