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Purpose In older patients with metastatic cancer, hospitalization for treatment toxicity may reduce the quality of an already limited life expectancy. We evaluated the association between chemotherapy for metastatic cancer and risk of hospitalization. Methods In the population-based SEER-Medicare dataset, we identified patients 66 years or older diagnosed with metastatic cancer of the bladder, breast, prostate, colon or rectum, esophagus, pancreas, stomach, ovaries, or lung in 2001 to 2009 who died by December 31, 2010. Chemotherapy recipients were matched to nonrecipients by age, sex, race, geographic region, comorbidity, and survival duration. We identified hospitalizations for any cause and for likely chemotherapy-related toxicity, comparing chemotherapy recipients with their matched peers. Results Of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity. The corresponding rates among matched nonrecipients were 83% and 34%. Chemotherapy was associated with a significantly increased risk of likely toxicity-related hospitalization in nearly all cancers, controlling for sociodemographic characteristics and other treatment. The association was greatest in patients with metastatic esophageal cancer (adjusted hazard ratio, 2.00; 95% CI, 1.11 to 3.60) and smallest in patients with metastatic prostate cancer (adjusted hazard ratio, 1.22; 95% CI, 1.01 to 1.47). Conclusion Hospitalizations are common in patients with incurable advanced malignancies and more likely among those who receive chemotherapy. Understanding common reasons for these events may help reduce adverse effects of chemotherapy for metastatic cancer and help patients and their families make informed treatment decisions. [ABSTRACT FROM AUTHOR]

The article reports on a 2015 study on the variation in use of long-term central venous catheters (CVC) in insured women with breast cancer and on its complication risks. Results show that two-thirds of cohorts had a long-term CVC, with varied rates across regions, health plans, and insurance coverage. The article states that the benefits of long-term CVCs is offset by its association with increased morbidity, and that some of their use are provider- or institution-driven.

Purpose: The use of anticancer drugs (chemotherapies) is an important determinant of national spending trends. Recent policies have aimed to accelerate generic entry among chemotherapies to generate cost savings. Methods: We examined the effects of generic entry on the choice of chemotherapy for the treatment of metastatic colorectal cancer (MCRC) between 2006 and 2009 using autoregressive-moving average modeling with case control. A nationally representative sample of oncologists and patients with cancer (age ≥ 65 years) was employed to estimate the magnitude and significance of the impact of the generic entry of irinotecan in February 2008 on the number of administrations of irinotecan compared with oxaliplatin. Results: The generic entry of irinotecan resulted in a 17% to 19% decrease (P < .001) in use among elderly patients with MCRC compared with oxaliplatin. The results were robust to multiple sensitivity checks. Conclusion: This study provides novel and robust estimates of the decline in use of a chemotherapy to treat a common cancer in the elderly after patent expiration. The results suggest estimates from a previous Office of the Inspector General report of the potential savings derived from the generic entry of irinotecan for public payers are an overestimate, likely confounded by oncologists' response to financial incentives, changes in scientific evidence, and promotional activities. As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types. [ABSTRACT FROM AUTHOR]