MANY CANCER PATIENTS GET INEFFECTIVE TREATMENTS
5:20 PM
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A study of more than 1,000 cancer patients with colon cancer that had spread to distant sites found that one in eight was treated with at least one drug regimen that was not recommended. Those patients were exposed to significant risk without proven benefits, at an estimated cost–just for the drugs–of more than $2 million.
The study focused on three chemotherapy regimens that were not supported by evidence from prior clinical studies or clinical practice guidelines. One treatment was rated “insufficient data to support,” one had been “shown to be ineffective,” and one was supported by “no data, nor is there a compelling rationale.”
“Cancer patients with advanced cancers that do not respond to standard therapies should either be looking for clinical trials, where there is a chance for a benefit, or should have been thinking about shifting toward palliative care,” said study author Jonas De Souza. “Cancer patients should not face the risks, discomforts and costs of aggressive and often quite toxic chemotherapy with treatment regimens that did not provide a benefit in previous studies.”
Under an agreement with UnitedHealthcare, a health benefits business, the researchers used de-identified medical and pharmaceutical claims data in the collaborative project. They examined claims from 7,642 colon cancer cases treated between January 2007 and June 2010, including 1,041 who developed metastatic disease. Of those 1,041 cancer patients, 140 (13%) received treatments that were not supported by the evidence from clinical studies. Many of them received multiple cycles of non-beneficial chemotherapy.
The researchers focused on three chemotherapy regimens with specific recommendations against their use in the National Comprehensive Cancer Network (NCCN) guidelines. The regimen with insufficient data involved bevacizumab (trade name Avastin) used after the patient had progressed on a combination of that drug and chemotherapy. The treatment shown to be “ineffective” was capecitabine (trade name Xeloda) after progression on the same class of drugs. The regimen with no compelling rationale was panitumumab or cetuximab (trade name Erbitux) after progression on similar drugs.
The 140 patients received 869 cycles of chemotherapy. Some received two or more unproven treatments.
“DeSouza’s research highlights the importance of evidence-based treatment for cancer patients,” said Lee Newcomer, UnitedHealthcare’s senior vice president, oncology. “Expert oncology opinions tell us that the extra therapies that these cancer patients received potentially exposed these patients to unnecessary side effects. We should be relieving symptoms and not causing new ones, even as we try to address the underlying disease.”
The study focused on three chemotherapy regimens that were not supported by evidence from prior clinical studies or clinical practice guidelines. One treatment was rated “insufficient data to support,” one had been “shown to be ineffective,” and one was supported by “no data, nor is there a compelling rationale.”
“Cancer patients with advanced cancers that do not respond to standard therapies should either be looking for clinical trials, where there is a chance for a benefit, or should have been thinking about shifting toward palliative care,” said study author Jonas De Souza. “Cancer patients should not face the risks, discomforts and costs of aggressive and often quite toxic chemotherapy with treatment regimens that did not provide a benefit in previous studies.”
Under an agreement with UnitedHealthcare, a health benefits business, the researchers used de-identified medical and pharmaceutical claims data in the collaborative project. They examined claims from 7,642 colon cancer cases treated between January 2007 and June 2010, including 1,041 who developed metastatic disease. Of those 1,041 cancer patients, 140 (13%) received treatments that were not supported by the evidence from clinical studies. Many of them received multiple cycles of non-beneficial chemotherapy.
The researchers focused on three chemotherapy regimens with specific recommendations against their use in the National Comprehensive Cancer Network (NCCN) guidelines. The regimen with insufficient data involved bevacizumab (trade name Avastin) used after the patient had progressed on a combination of that drug and chemotherapy. The treatment shown to be “ineffective” was capecitabine (trade name Xeloda) after progression on the same class of drugs. The regimen with no compelling rationale was panitumumab or cetuximab (trade name Erbitux) after progression on similar drugs.
The 140 patients received 869 cycles of chemotherapy. Some received two or more unproven treatments.
- Ninety-one of those patients went through 632 intravenous cycles of bevacizumab, at an estimated cost of $1.3 million. Potential side effects include hypertension, heightened risk of bleeding and bowel perforation.
- Fifty-nine cancer patients received 218 non-evidence-based cycles of capecitabine, at a cost of more than $600,000. This drug, taken orally, can cause diarrhea, nausea, vomiting, fatigue, rash and swelling of the hands or feet.
- Six patients underwent 19 cycles of panitumumab, at a cost of almost $70,000. This drug can trigger itching, dermatitis and rash.
“DeSouza’s research highlights the importance of evidence-based treatment for cancer patients,” said Lee Newcomer, UnitedHealthcare’s senior vice president, oncology. “Expert oncology opinions tell us that the extra therapies that these cancer patients received potentially exposed these patients to unnecessary side effects. We should be relieving symptoms and not causing new ones, even as we try to address the underlying disease.”