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Gastric Cancer

, Volume 21, Issue 5, pp 738–744 | Cite as

Predictors of heterogeneity in the first-line treatment of patients with advanced/metastatic gastric cancer in the U.S.

  • Thomas Abrams
  • Lisa M. Hess
  • Yajun Emily Zhu
  • William Schelman
  • Astra M. Liepa
  • Charles Fuchs
Original Article

Abstract

Background

Patients with metastatic gastric cancer have a poor prognosis (5-year survival of less than 10%). This study was designed to describe the treatment patterns of patients with gastric cancer and to understand the factors associated with treatment choices to inform evidence-based care.

Methods

A retrospective observational study was conducted using two real-world databases to describe treatment trends and to quantify variability in treatment patterns of patients diagnosed with advanced/metastatic gastric cancer between 1/1/2007 and 9/30/2014 in the U.S. Heterogeneity was measured by the Herfindahl–Hirschman Index (HHI). Predictors (baseline clinical, treatment, and demographic variables) of treatment regimen choice were evaluated using logistic regression.

Results

A total of 5772 patients with advanced/metastatic gastric cancer were included in this study [5044 from claims data and 728 from electronic medical records (EMR)]. Of the 5044 from claims data, 2457 had evidence of metastatic disease at diagnosis. Only the fluorouracil + oxaliplatin regimen exceeded 10% utilization in the first-line setting [claims metastatic (12.1%), claims advanced (8.2%), and EMR metastatic (16.6%) cohorts]. The HHI demonstrated extreme heterogeneity (0.14 for first-line therapy and 0.13 for second-line therapy). Patient age and geographic region of residence were significantly associated with treatment choice across all three cohorts in the first-line setting (p < 0.05).

Conclusion

Treatment of patients with gastric cancer was highly variable. Despite the availability of treatment guidelines, there is a lack of consistent treatment patterns. There is a need to improve evidence-based care for patients with gastric cancer.

Keywords

Population characteristics Stomach neoplasms Drug therapy Antineoplastic agents 

Notes

Funding

This study was an unfunded research project conducted with the material support in the form of employee time and data resources by Eli Lilly and Company.

Compliance with ethical standards

Conflict of interest

LMH, YEZ, WS, and AML are employees of Eli Lilly and Company.

Ethical standards

This study was deemed exempt from Institutional Review Board review in accordance with the US Code of Federal Regulations [45CFR46.101(b)] as these data do not contain any variables that could identify an individual subject either directly or indirectly.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMedGoogle Scholar
  3. 3.
    Cancer stat facts: stomach cancer, SEER 18 2007–2013. https://seer.cancer.gov/statfacts/html/stomach.html.
  4. 4.
    NCCN Clinical practice guidelines in oncology, Gastric cancer version 4.2017 https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf.
  5. 5.
    Barzi A, Hess LM, Zhu YE, Liepa AM, Fang Y, Kuder C, Beyrer J, Chao J. Treatment and outcomes of patients with advanced gastric, esophageal, or gastroesophageal junction adenocarcinoma in the United States. Ann Oncol 2017;28(Suppl 3):35.Google Scholar
  6. 6.
    Hess LM, Cui ZL, Wu Y, Li X, Liepa AM, Abraham SM, Schelman W. Patient experience after receiving a diagnosis of gastric cancer in the USA. J Gastrointest Cancer. 2016.  https://doi.org/10.1007/s12029-016-9904-7.Google Scholar
  7. 7.
    Hess LM, Michael D, Mytelka DS, Beyrer J, Liepa AM, Nicol S. Chemotherapy treatment patterns, costs, and outcomes of patients with gastric cancer in the United States: a retrospective analysis of electronic medical record (EMR) and administrative claims data. Gastric Cancer. 2016;19(2):607–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Weinstock DS. Using the Herfindahl Index to measure concentration. Antitrust Bull. 1982;27:285.Google Scholar
  9. 9.
    Calkins S. The new merger guidelines and the Herfindahl-Hirschman index. Cal L Rev. 1983;71:402.CrossRefGoogle Scholar
  10. 10.
    Dave CV, Kesselheim AS, Fox ER, Qiu P, Hartzema A. High generic drug prices and market competition: a retrospective cohort study. Ann Intern Med. 2017;167:145–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Cutler DM, Scott Morton F. Hospitals, market share, and consolidation. JAMA. 2013;310(18):1964–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Schelman WR, Paulson AP, Aguilar K, Clark J, Cui ZL, Liepa AM, Hess LM. Predictive factors associated with ramucirumab monotherapy or combination therapy among patients with gastric/gastroesophageal junction cancer in the community oncology setting. Ann Oncol 2017;28(Suppl 3):77.Google Scholar
  13. 13.
    Nordstrom BL, Simeone JC, Malley KG, Fraeman KH, Klippel Z, Durst M, Page JH, Xu H. Validation of claims algorithms for progression to metastatic cancer in patients with breast, non-small cell lung, and colorectal cancer. Front Oncol. 2016;6:18.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Nekhlyudov L, Levit L, Hurria A, Ganz PA. Patient-centered, evidence-based, and cost-conscious cancer care across the continuum: translating the Institute of Medicine report into clinical practice. CA Cancer J Clin. 2014;64(6):408–21.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Thomas Abrams
    • 1
  • Lisa M. Hess
    • 2
  • Yajun Emily Zhu
    • 2
  • William Schelman
    • 3
  • Astra M. Liepa
    • 2
  • Charles Fuchs
    • 4
  1. 1.Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  2. 2.Eli Lilly and Company, Global Patient Outcomes and Real World EvidenceCorporate CenterIndianapolisUSA
  3. 3.Eli Lilly and CompanyUS Medical AffairsIndianapolisUSA
  4. 4.Yale Cancer CenterNew HavenUSA

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