The Journal of Community and Supportive Oncology

In his December podcast for The Journal of Community and Supportive Oncology, Dr David Henry takes a look at filgrastim-sndz, the first biosimilar to be approved in United States. He also highlights two Original Reports that focus on cancer patients from racially diverse or underserved communities – one study looks at the patients’ enrollment in clinical trials; the other, at racial disparities in breast cancer diagnosis – as well as articles on the implementation of distress screening in an oncology setting and on oncology nurses’ perceptions of and practices and perceived barriers in regard to sexual health assessment and counseling among patients with cancer. The podcast rounds off with a discussion about a new era of combination therapy in cancer.

In his December podcast for The Journal of Community and Supportive Oncology, Dr David Henry takes a look at filgrastim-sndz, the first biosimilar to be approved in United States. He also highlights two Original Reports that focus on cancer patients from racially diverse or underserved communities – one study looks at the patients’ enrollment in clinical trials; the other, at racial disparities in breast cancer diagnosis – as well as articles on the implementation of distress screening in an oncology setting and on oncology nurses’ perceptions of and practices and perceived barriers in regard to sexual health assessment and counseling among patients with cancer. The podcast rounds off with a discussion about a new era of combination therapy in cancer.

In his December podcast for The Journal of Community and Supportive Oncology, Dr David Henry takes a look at filgrastim-sndz, the first biosimilar to be approved in United States. He also highlights two Original Reports that focus on cancer patients from racially diverse or underserved communities – one study looks at the patients’ enrollment in clinical trials; the other, at racial disparities in breast cancer diagnosis – as well as articles on the implementation of distress screening in an oncology setting and on oncology nurses’ perceptions of and practices and perceived barriers in regard to sexual health assessment and counseling among patients with cancer. The podcast rounds off with a discussion about a new era of combination therapy in cancer.

The past year has been an exciting one for new oncology and hematology drug approvals and the continued evolution of our oncology delivery system toward high quality and value. In all, at press time in mid-November, the US Food and Drug Administration (FDA) had approved or granted expanded indications for 24 drugs, compared with 19 in the 2 preceding years. Of those 24 approvals, 7 were accelerated and 6 were expanded approvals, and 3 alone were for the immunotherapeutic drug, nivolumab – 2 for non-small-cell lung cancer (NSCLC) and 1 for metastatic melanoma.

Click on the PDF icon at the top of this introduction to read the full article.

The past year has been an exciting one for new oncology and hematology drug approvals and the continued evolution of our oncology delivery system toward high quality and value. In all, at press time in mid-November, the US Food and Drug Administration (FDA) had approved or granted expanded indications for 24 drugs, compared with 19 in the 2 preceding years. Of those 24 approvals, 7 were accelerated and 6 were expanded approvals, and 3 alone were for the immunotherapeutic drug, nivolumab – 2 for non-small-cell lung cancer (NSCLC) and 1 for metastatic melanoma.

Click on the PDF icon at the top of this introduction to read the full article.

The past year has been an exciting one for new oncology and hematology drug approvals and the continued evolution of our oncology delivery system toward high quality and value. In all, at press time in mid-November, the US Food and Drug Administration (FDA) had approved or granted expanded indications for 24 drugs, compared with 19 in the 2 preceding years. Of those 24 approvals, 7 were accelerated and 6 were expanded approvals, and 3 alone were for the immunotherapeutic drug, nivolumab – 2 for non-small-cell lung cancer (NSCLC) and 1 for metastatic melanoma.

Click on the PDF icon at the top of this introduction to read the full article.

Background Health care costs are rising. Identifying areas for health care utilization savings may reduce costs.

Objective To identify oncology patients receiving inpatient radiotherapy with the purpose of measuring length of stay (LoS) and hospital charges.

Methods During July 2013 the oncology service physicians at Mount Sinai Medical Center in New York City were surveyed daily to identify patients receiving inpatient radiation. Actual LoS, acuity LoS were determined from the chart review. Expected LoS was calculated using the University Healthsystem Consortium database. Charges associated with actual LoS, acuity LoS, and expected LoS were then reported. Actual and expected LoS were compared for inpatient radiotherapy and nonradiotherapy groups.

Results 7 patients were identified as having remained in the hospital to receive radiation treatment. In that cohort, the average actual LoS and charges per patient were 40.1 and $48,724, compared with acuity LoS and charges of 25.6 days and $34,089 and expected LoS and charges of 7.7 days and $10,028. Mean LoS and charges attributed to radiation alone amounted to 11 days and $12,514. The mean actual LoS of oncology patients admitted during the same time period who did not receive radiation was 6.7 days, compared with 40.1 days for patients who received radiation (P < .0001).

Limitations Inability to access actual reimbursement data prevented exact cost calculations, small sample size, and single-institution focus.

Conclusion Delivery of radiation therapy during inpatient hospitalization extends LoS and contributes to higher health care costs. Methods to facilitate the delivery of outpatient radiotherapy may result in cost savings.

Click on the PDF icon at the top of this introduction to read the full article.

Background Health care costs are rising. Identifying areas for health care utilization savings may reduce costs.

Objective To identify oncology patients receiving inpatient radiotherapy with the purpose of measuring length of stay (LoS) and hospital charges.

Methods During July 2013 the oncology service physicians at Mount Sinai Medical Center in New York City were surveyed daily to identify patients receiving inpatient radiation. Actual LoS, acuity LoS were determined from the chart review. Expected LoS was calculated using the University Healthsystem Consortium database. Charges associated with actual LoS, acuity LoS, and expected LoS were then reported. Actual and expected LoS were compared for inpatient radiotherapy and nonradiotherapy groups.

Results 7 patients were identified as having remained in the hospital to receive radiation treatment. In that cohort, the average actual LoS and charges per patient were 40.1 and $48,724, compared with acuity LoS and charges of 25.6 days and $34,089 and expected LoS and charges of 7.7 days and $10,028. Mean LoS and charges attributed to radiation alone amounted to 11 days and $12,514. The mean actual LoS of oncology patients admitted during the same time period who did not receive radiation was 6.7 days, compared with 40.1 days for patients who received radiation (P < .0001).

Limitations Inability to access actual reimbursement data prevented exact cost calculations, small sample size, and single-institution focus.

Conclusion Delivery of radiation therapy during inpatient hospitalization extends LoS and contributes to higher health care costs. Methods to facilitate the delivery of outpatient radiotherapy may result in cost savings.

Click on the PDF icon at the top of this introduction to read the full article.

Background Health care costs are rising. Identifying areas for health care utilization savings may reduce costs.

Objective To identify oncology patients receiving inpatient radiotherapy with the purpose of measuring length of stay (LoS) and hospital charges.

Methods During July 2013 the oncology service physicians at Mount Sinai Medical Center in New York City were surveyed daily to identify patients receiving inpatient radiation. Actual LoS, acuity LoS were determined from the chart review. Expected LoS was calculated using the University Healthsystem Consortium database. Charges associated with actual LoS, acuity LoS, and expected LoS were then reported. Actual and expected LoS were compared for inpatient radiotherapy and nonradiotherapy groups.

Results 7 patients were identified as having remained in the hospital to receive radiation treatment. In that cohort, the average actual LoS and charges per patient were 40.1 and $48,724, compared with acuity LoS and charges of 25.6 days and $34,089 and expected LoS and charges of 7.7 days and $10,028. Mean LoS and charges attributed to radiation alone amounted to 11 days and $12,514. The mean actual LoS of oncology patients admitted during the same time period who did not receive radiation was 6.7 days, compared with 40.1 days for patients who received radiation (P < .0001).

Limitations Inability to access actual reimbursement data prevented exact cost calculations, small sample size, and single-institution focus.

Conclusion Delivery of radiation therapy during inpatient hospitalization extends LoS and contributes to higher health care costs. Methods to facilitate the delivery of outpatient radiotherapy may result in cost savings.

Click on the PDF icon at the top of this introduction to read the full article.

Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

Click on the PDF icon at the top of this introduction to read the full article.

Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

Click on the PDF icon at the top of this introduction to read the full article.

Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

Click on the PDF icon at the top of this introduction to read the full article.

It seems it was  just yesterday that we did our first “mutation analysis” to help guide us in our treatment of patients with a drug that was more likely to work than not. Of course, I am referring to estrogen-receptor/progesterone receptor (ER/PR) blocking therapy, and “yesterday” actually goes all the way back to the 1970s! When tamoxifen was first given to unselected metastatic breast cancer patients, the response rate was low, but when the study population was “enriched” with breast cancer patients who were ER/ PR-positive, the response rates improved and the outcomes were more favorable. So began the era of tumor markers and enriching patient populations, and the process now referred to as mutation analysis, which is becoming more broadly applicable to other tumors as well.

Click on the PDF icon at the top of this introduction to read the full article.

It seems it was  just yesterday that we did our first “mutation analysis” to help guide us in our treatment of patients with a drug that was more likely to work than not. Of course, I am referring to estrogen-receptor/progesterone receptor (ER/PR) blocking therapy, and “yesterday” actually goes all the way back to the 1970s! When tamoxifen was first given to unselected metastatic breast cancer patients, the response rate was low, but when the study population was “enriched” with breast cancer patients who were ER/ PR-positive, the response rates improved and the outcomes were more favorable. So began the era of tumor markers and enriching patient populations, and the process now referred to as mutation analysis, which is becoming more broadly applicable to other tumors as well.

Click on the PDF icon at the top of this introduction to read the full article.

It seems it was  just yesterday that we did our first “mutation analysis” to help guide us in our treatment of patients with a drug that was more likely to work than not. Of course, I am referring to estrogen-receptor/progesterone receptor (ER/PR) blocking therapy, and “yesterday” actually goes all the way back to the 1970s! When tamoxifen was first given to unselected metastatic breast cancer patients, the response rate was low, but when the study population was “enriched” with breast cancer patients who were ER/ PR-positive, the response rates improved and the outcomes were more favorable. So began the era of tumor markers and enriching patient populations, and the process now referred to as mutation analysis, which is becoming more broadly applicable to other tumors as well.

Click on the PDF icon at the top of this introduction to read the full article.

In his November podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an article and accompanying commentary on the US Food and Drug Administration’s re-approval of gefitinib for the treatment of patients with EGFR-mutated lung cancer. (The drug’s original 2003 approval had been withdrawn in 2011 after subsequent findings failed to show a survival advantage.) He also comments on a line-up of clinical and supportive oncology articles reporting on a modified olanzapine regimen for the prevention of chemotherapy-induced nausea and vomiting; caregivers’ attitudes about their roles in promoting exercise among patients with late-stage lung cancer; the impact of inpatient radiation on length of stay and health care costs; and a study of patients with incurable cancer by Japanese investigators who examined differences in the timing of palliative chemotherapy cessation between patients in a local hospital and patients who transitioned to a local hospital from a tertiary medical center. The final item details a case of treatment-related MDS/AML in a patient after receiving therapy for large-cell neuroendocrine lung cancer.

Click on the download icon at the top of this introduction to listen to the podcast.

In his November podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an article and accompanying commentary on the US Food and Drug Administration’s re-approval of gefitinib for the treatment of patients with EGFR-mutated lung cancer. (The drug’s original 2003 approval had been withdrawn in 2011 after subsequent findings failed to show a survival advantage.) He also comments on a line-up of clinical and supportive oncology articles reporting on a modified olanzapine regimen for the prevention of chemotherapy-induced nausea and vomiting; caregivers’ attitudes about their roles in promoting exercise among patients with late-stage lung cancer; the impact of inpatient radiation on length of stay and health care costs; and a study of patients with incurable cancer by Japanese investigators who examined differences in the timing of palliative chemotherapy cessation between patients in a local hospital and patients who transitioned to a local hospital from a tertiary medical center. The final item details a case of treatment-related MDS/AML in a patient after receiving therapy for large-cell neuroendocrine lung cancer.

Click on the download icon at the top of this introduction to listen to the podcast.

In his November podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an article and accompanying commentary on the US Food and Drug Administration’s re-approval of gefitinib for the treatment of patients with EGFR-mutated lung cancer. (The drug’s original 2003 approval had been withdrawn in 2011 after subsequent findings failed to show a survival advantage.) He also comments on a line-up of clinical and supportive oncology articles reporting on a modified olanzapine regimen for the prevention of chemotherapy-induced nausea and vomiting; caregivers’ attitudes about their roles in promoting exercise among patients with late-stage lung cancer; the impact of inpatient radiation on length of stay and health care costs; and a study of patients with incurable cancer by Japanese investigators who examined differences in the timing of palliative chemotherapy cessation between patients in a local hospital and patients who transitioned to a local hospital from a tertiary medical center. The final item details a case of treatment-related MDS/AML in a patient after receiving therapy for large-cell neuroendocrine lung cancer.

Click on the download icon at the top of this introduction to listen to the podcast.