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Rahul Shenolikar
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-48 - Experiences of Pts on 1st Line Care (EP1C): Symptoms and Impacts of EGFR TKI Therapy on Real-World Daily Lives of NSCLC Pts (ID 1223)
09:45 - 18:00 | Author(s): Rahul Shenolikar
- Abstract
Background
Approximately one third of patients with NSCLC have tumours harbouring actionable EGFR mutations (Zhang et al. Oncotarget 2016). These patients are routinely treated with EGFR-tyrosine kinase inhibitors (TKIs) that are approved based on their efficacy and safety in clinical trials. Clinical trials do not fully reflect patient experiences as felt and perceived by patients, and in the real world, symptoms related to EGFR-TKIs and impact on patients’ daily lives are not well documented or understood. EP1C assessed patients’ experience with EGFR-TKIs and their impact on patients’ daily lives. Patient insights gained from EP1C can help guide symptom management strategies and improve communication with patients, helping to improve outcomes and quality of life.
Method
This pilot, non-interventional, US-based, real-world study involved individual interviews with adult patients. Eligible patients were those diagnosed with EGFR-mutated metastatic NSCLC, taking one of three US-approved EGFR-TKIs (erlotinib/afatinib/osimertinib) as first-line treatment. Exclusion criteria included: major surgery or radiation therapy three months before treatment, chemotherapy or other therapy as first-line treatment, a second active cancer, or a cognition or sensory issue. Trained qualitative interviewers used a semi-structured interview guide, and conducted all interviews by telephone. Rating questions were included for the severity and degree of bother caused by their symptoms (0–10 point response scale: 0=not at all severe, 10=extremely severe). All interviews were audio recorded, transcribed and coded (ATLAS.ti software) for analysis of similar themes.
Result
A total of 19 patients participated in the interviews. The average age was 54.0 years (range 37–76). The sample was 73.7% female (n=14), and 89.5% (n=17) had an education level of college or above. The most frequently reported symptoms were respiratory and gastrointestinal symptoms (n=18; 94.7% each), skin-related sympoms (n=18; 94.7%), discomfort and pain (n=17; 89.5%), hair and nail-related symptoms (n=17; 89.5% each), fatigue and other energy-related symptoms (n=15; 78.9%).
Ratings of severity and bothersomeness trended toward the mid-range of the scale (4.0 to 6.0) for most of the more commonly reported symptoms. The higher ratings were seen for very specific symptoms reported by only one or two patients, including constipation (8.0 severity/8.0 bother), armpit rash (7.0/8.0), tightness in throat (8.0/8.0), mouth soreness (8.0/9.0) and stinging/burning in the genital area (10.0/10.0).
All 19 patients reported impacts on their daily performance and emotional health. Sleep difficulties were reported by 12 patients (63.2%), and 9 patients (47.4%) reported limitations with inter-personal relationships and social functioning. The impacts on patients’ daily activities (work, chores, daily routine; 7.8) and emotions (anxiety, worry, fear and depression; 7.2) were found to be the most difficult to cope with. Several specific impacts, reported by fewer patients, included decreased independence (n=2; 7.0), economic burden (n=6; 7.7), and childcare difficulties (n=2; 8.5).
Conclusion
In EP1C, real-world interviews allowed patients to express a broader range of symptoms and impacts compared with clinical trials, which mostly focus on symptoms. Some of the traditionally less commonly reported symptoms had a greater impact on patients’ daily lives. Clinicians should also consider these when assisting patients in managing their symptoms.
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-37 - Impact of Brain Metastases on Healthcare Utilisation and Costs in Patients with NSCLC Treated with EGFR-TKIs (ID 1970)
10:15 - 18:15 | Author(s): Rahul Shenolikar
- Abstract
Background
NSCLC with brain metastases is difficult to treat and associated with poor survival. The impact of brain metastases compared with other metastases on healthcare utilisation and costs among patients treated with EGFR-TKIs is not well known.
Method
Newly-diagnosed adult patients with metastatic NSCLC initiating approved first-/second-generation EGFR-TKI treatment (within 90 days of diagnosis) were identified retrospectively from IBM Watson Health MarketScan® healthcare claims databases from 2013–2017. Patients were divided into mutually-exclusive cohorts based on evidence of brain or non-brain metastasis (BM or NBM). Demographics, clinical characteristics and healthcare expenses were captured at baseline. Healthcare utilisation and cost were analysed during the variable-length follow-up period. Costs were standardised to 2017 US$ and reported as per-patient-per-month (PPPM). Generalised linear models were used to assess the impact of brain metastases, adjusting for baseline demographics, comorbidities, healthcare expenses and length of follow-up.
Result
Overall, 222 BM and 280 NBM patients were included. BM patients were, on average, younger than NBM patients (59.9 vs 65.7; p<0.05); both cohorts included mostly female patients and had an average of 14 months follow-up. Among all patients, first EGFR-TKI treatment was 82.3% erlotinib, 16.3% afatinib and 1.4% gefitinib; 10 patients treated with osimertinib were excluded. Seizures (9.0% vs 1.1%), headaches (17.6% vs 10.0%) and altered mental status (11.3% vs 5.7%) were more common in the BM vs NBM cohort (p<0.05). NSCLC-related healthcare utilisation was >2-fold higher in BM patients receiving radiation treatment in the inpatient (15.3% vs 6.8%; p<0.05) and outpatient (87.8% vs 37.5%; p<0.05) settings. PPPM radiation costs were also higher among BM patients in the inpatient ($796 vs $464, p=0.172) and outpatient ($2477 vs $762, p<0.05) settings. All-cause inpatient admissions were more common among the BM vs NBM cohort (67.1% vs 57.1%; p<0.05). While all patients had evidence of outpatient services, the PPPM number of outpatient visits was greater among the BM vs NBM cohort (p<0.05) for both NSCLC-related (5.1 vs 4.2) and all-cause (6.4 vs 5.7) healthcare utilisation. Adjusted NSCLC-related and all-cause PPPM costs were 1.2 times higher among BM patients (+$5674 and +$6393, respectively; p<0.05); age was also a significant predictor in both models (p<0.05).
Conclusion
Healthcare utilisation, hospital admission rates and costs, especially those attributable to radiation treatment, were higher among patients with BM compared with NBM. Future research should assess if central nervous system (CNS)-active EGFR-TKIs have the potential to reduce healthcare utilisation and costs associated with brain metastases.
