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TREATMENT PATTERNS AND OUTCOMES OF BREAST CANCER
PATIENTS IN A PATIENT-CENTERED RETROSPECTIVE
RESEARCH DATABASE
Surasak Saokaew1,2, Beilei Cai1, Kuan-Ling Kuo1, Hillevi Bauer1, Frederick Albright1, Diana I. Brixner1,3, David Stenehjem1,4
1Pharmacotherapy
Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 2Department of Pharmaceutical Care, School of
Pharmaceutical Sciences, University of Phayao, Phayao, Thailand, 3Program in Personalized Health Care, University of Utah, Salt Lake City, UT, USA University of Utah,
4Huntsman Cancer Institute, Salt Lake City, UT, USA.
Results
Background
Although breast cancer is the most common cancer among American women, study
investigating treatment pattern and costs is limited. This study aims to determine breast
cancer treatment patterns and associated health care charges stratified by initial stage at
diagnosis.
Table 1 Study Population Baseline Characteristics
Demographic
Variable
Stage I
N=1310
N
%
Age (Mean, SD)
Objective
This retrospective study aims to determine breast cancer treatment patterns, charges, and
overall survival stratified by initial stage at diagnosis
Stage II
N=1220
N
%
N =3109
Stage III
N=425
N
%
Stage IV
N=154
%
All
N=3109
N
%
N
P-value
59.9
12.9
56.4
13.5
53.7
13.5
56.2
14.5
57.5
13.5
<0.001*
18-30
13
0.99
20
1.64
11
2.59
5
3.25
49
1.58
<0.001**
31-45
159
12.14
247
20.25
115
27.06
34
22.08
555
17.85
-
46-64
644
49.16
624
51.15
204
48.00
73
47.40
1545
49.69
-
65-79
404
30.84
256
20.98
78
18.35
33
21.43
771
24.80
-
≥80
90
6.87
73
5.98
17
4.00
9
5.84
189
6.08
-
Caucasian/ White
856
65.34
824
67.54
285
67.06
96
62.34
2061
66.29
0.039**
Asian
American Indian/
Alaska native
Native Hawaiian
Black/African
American
Other
20
63
4.81
62
5.08
26
6.12
13
8.44
164
5.28
-
Unknown
362
27.63
310
25.41
103
24.24
41
26.62
816
26.39
-
720
54.96
759
58.89
<0.001**
Race
Methods
Data Source
•
•
•
University of Utah Health Sciences Enterprise Data Warehouse (EDW) and the Utah
Population Database (UPDB) served as the primary data sources for this study
All cancer cases across the University of Utah Healthcare (UUHC) and the Huntsman
Cancer Institute (HCI) are integrated into the Enterprise Data Warehouse, which contains
a comprehensive electronic medical record (EMR) for all patients
Death certificate and cause of death information were provided by the UPDB. Patients
were identified between these resources based upon a common master subject index
unique for each patient
Study Population
•
•
•
•
Age ≥18 years on index date (01 Jan 1995 through 01 Jan 2011 )
At least 2 encounters in the EDW, with one encounter at least 30 days from index date
Inclusion in the Huntsman Tumor Registry with ICDO site/histology codes suggestive of
breast cancer
Subjects must have informative stage data contained in the tumor registry
Analysis
•
•
•
•
•
•
Demographic characteristics of the patients were recorded on index date. Descriptive
statistics, including mean, standard deviation, frequency and percentage as appropriate
for continuous and categorical variables, were utilized to describe demographic
characteristics.
The Charlson Comorbidity Index (CCI) was used to assign a comorbidity score based on
the ICD-9 codes. Tests of proportions were used to illustrate the differences in the
demographic characteristics and other categorical variables. We used ANOVA to test
multiple group difference for continuous and categorical variables, respectively
First treatment in breast cancer patients was evaluated as first occurrence of surgery,
radiation, or chemotherapy. We defined the time to first treatment as the number of days
from the date of initial diagnosis to the date of first treatment
Charge and medication data was only available from Jan 2002 to 31 Dec 2010, because
there was inconsistent charge and medication data before 2002 in the EDW
Survival function stratified by stage at diagnosis was assessed using Kaplan-Meier
survival curve
All statistical tests were performed at an a priori significance level of 0.05 using Stata SE v.
10 (StataCorp, College Station, TX) and SAS v. 9 (SAS Institute, Cary, NC)
1.53
7
0.57
4
0.94
1
0.65
32
1.03
-
4
0.31
7
0.57
4
0.94
0
0.00
15
0.48
-
2
0.15
6
0.49
1
0.24
3
1.95
12
0.39
-
3
0.23
4
0.33
2
0.47
0
0.00
9
0.29
-
Plan Type
Commercial
62.21
274
64.47
78
50.65
1831
Medicaid
35
2.67
50
4.10
23
5.41
18
11.69
126
4.05
-
Medicare
425
32.44
289
23.69
88
20.71
37
24.03
839
26.99
-
69
5.27
71
5.82
16
3.76
9
5.84
165
5.31
Self pay and
unfunded
Other government
22
1.68
14
1.15
8
1.88
1
0.65
45
1.45
-
Other/Unknown
39
2.98
37
3.03
16
3.76
11
7.14
103
3.31
-
Utah
1104
84.3
1008
82.6
333
78.3
108
70.1
2553
82.1
Non-Utah
Charlson Scores
(Mean ± SD)
0
17.4
92
21.7
46
2.4
2.3
3.4
3.3
4.4
3.7
6.7
3.7
3.3
3.2
<0.001*
233
17.79
260
21.31
92
21.65
16
10.39
601
19.33
<0.001**
1
290
22.14
217
17.79
59
13.88
575
18.53
-
2
287
21.91
178
14.59
32
7.53
6
3.90
503
16.18
-
>=3
500
38.17
565
46.31
242
56.94
122
79.22
1429
45.96
-
-
Region
206
15.7
212
10
29.9
556
6.49
<0.001**
17.9
-
* ANOVA test, ** Chi square test
Figure 3 Chemotherapy utilization at any time during survival (n = 207), 2002-2010
Results
Figure 1 Flowchart of Patient Selection
Unique Patients in the EDW Database 1995-2010
N=1,240,470
Age ≥18 Years Old
N=965,460
Figure 4 Kaplan-Meier Survival Estimates by Stage at Diagnosis
Kaplan-Meier survival estimates
1.00
Female Patients ≥18 years old
N=495, 523
0.75
Female Patients with Diagnosis of Breast Cancer Using ICD-9 Codes N=8,139
0.50
Patients with Diagnosis of Breast Cancer Cross-linked with Tumor Registry
N=3,999
0.25
Patients with Breast Cancer Staging Information
N=3,497
0.00
Final Sample of Patients Limited to Breast Cancer Stages I, II, III, and IV
N=3,109
0
Stage I
N=1310
Stage II
N=1220
Stage III
N=425
1
2
3
4
Stage IV
N=154
5
6
7
8
9 10
Follow up time (years)
stage = 1
stage = 3
11
12
13
14
15
16
stage = 2
stage = 4
Figure 5 Annualized charges by stage and charge types
Figure 2 Treatment received at anytime during survival (2002-2010)
$80,000
$70,000
$5,680
$60,000
$50,000
$35,753
$40,000
$3,758
$30,000
$2,266
$20,000
$10,000
$1,489
$6,815
$0
$4,008
$2,339
Stage 1 (N=739)
non-cancer inpatient
$22,209
$11,799
$12,765
$4,230
$3,953
Stage 2 (N=666)
non-cancer outpatient
$5,848
$14,995
$6,362
Stage 3 (N=285)
cancer-outpatient
Stage 4 (N=93)
cancer-inpatient
Conclusions
ISPOR 15th Annual European Congress, Berlin, Germany, November 3-7, 2012
This research was supported by an unrestricted research grant from Abbott Laboratories
• Our findings suggest that the treatments and time to treatment in our cohorts
are consistent with NCCN guidelines
• Survival rates decreased by stage and were higher than National Cancer
Data Base statistics
• Health care charges increase by stage at diagnosis
• These results provide unique information on the utilization and treatments in
breast cancer towards the further conduct of oncology outcomes research