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Tsz Chan



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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.15-05 - Prescribing Patterns of Physicians and Financial Implications for Lung Cancer Treatment at the End of Life (ID 12176)

      16:45 - 18:00  |  Author(s): Tsz Chan

      • Abstract

      Background

      Rates of systemic chemotherapy use at the end of life are estimated to be above 44%. Limited information exists on prescribing patterns of intravenous and oral treatments (immunotherapy, chemotherapy, and tyrosine kinase inhibitors) at the end of life. Use of systemic therapy in the last month of life may have a significant clinical and financial impact. This study aimed to evaluate prescribing patterns and costs associated with lung cancer treatments in the last month of life in two large academic institutions.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients (n=184) deceased between July 2016 and June 2017 who received lung cancer treatment were included in this analysis. The primary objective was characterization of prescribing patterns associated with end of life care. Patient, disease, and treatment related factors were recorded. Patient characteristics were compared between those who did and did not receive treatment in the final month of life using Wilcoxon and chi-square tests, respectively.

      4c3880bb027f159e801041b1021e88e8 Result

      Forty-three (23%) patients received treatment in the last 28 days of life. Patient-related factors were similar between patients who did and did not receive therapy at the end of life. Patients who did not receive therapy at the end of life were more likely to be enrolled in hospice (72% vs 40%; p =0.0035, chi-square test). Of therapies given within the last month of life, 47% were oral therapies, 35% were intravenous chemotherapy, and 16% were immunotherapy (p = <0.0001, chi-square test). Using average wholesale price, overall drug costs given in the last month of life were $422,454, of which oral agents accounted for $326,400. There were no statistical differences in patient factors, including age, creatinine, albumin, hemoglobin, Charlson Index, and ECOG performance status between patients who received therapy at the end of life and those that did not (all p-values >0.05).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Oral therapies are the most commonly prescribed modality of treatment at the end of life compared to intravenous chemotherapy or intravenous immunotherapy. Oral therapies pose a significant financial burden to patients at the end of life. Using patient factors to determine candidates for therapy at the end of life continues to be an area of exploration. Further studies are warranted to identify when therapies should be discontinued or to identify patients who may not benefit from systemic therapy.

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