Search

Objectives: Previous studies have suggested that guideline-recommended therapy improves survival and reduces cost among patients with metastatic non-small cell lung cancer (mNSCLC). The purpose of this study was to explore the relationship between guideline-recommended initiation of therapy (GRI) in patients with mNSCLC and patient-reported outcomes (PROs), such as health-related quality of life (HRQOL) and patient-reported cancer symptoms. Methods: A retrospective cohort of patients with mNSCLC was identified from medical claims and treatment authorization data for 2013-2014 from Humana, Inc, a large health insurance provider. GRI was defined as receipt of >1 cycle of a National Comprehensive Cancer Network-recommended therapy based on age and performance status (PS) or targeted therapies regardless of age and PS. To evaluate PROs, data from a HRQOL survey conducted in 2014 were merged with claims data. HRQOL was measured by the Centers for Disease Control and Prevention's Healthy Days measures of overall, physical, and mental unhealthy days in the past 30 days. Patient-reported presence of cancer- related symptoms (pain, fatigue, shortness of breath, nausea/vomiting, diarrhea/constipation) were also captured by the survey. Data were reported as median (interquartile range), with P values generated from Wilcoxon rank sum and chi-square tests. Results: Of the 1458 patients with mNSCLC, 125 completed the survey. The median age was 72 years, and 44.8% were female. GRI therapy was reported in 82% of patients. There were no differences in age, gender, race/ethnicity, health plan type, comorbidities in the prior 6 months, or Deyo-Charlson Comorbidity Index between patients with GRI and non-GRI therapy. There was no difference in patient-reported pain (50%), fatigue (73%), shortness of breath (62%), nausea/vomiting (20%), or diarrhea/constipation (39%) by GRI. Furthermore, there were no differences in the number of overall (18), physical (10), or mental (4) unhealthy days by GRI, indicating no difference in HRQOL by GRI. Conclusions: This study did not find an association between GRI and patient-reported HRQOL or cancerrelated symptoms in a small cohort of patients with mNSCLC. Future studies should evaluate and consider the relationship between different aspects of guideline recommendations and PROs in a larger cohort. Sponsor: This work was sponsored by Genentech, Inc. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests that medication adherence improves quality of life. This study explored the influence of social support (SS) on the relationship between comorbidity medication adherence (CMA) and health-related quality of life for patients with cancer. Methods: Patients with metastatic breast, colorectal, or lung cancer undergoing cancer treatment in 2015 and at least 1 comorbid condition were mailed surveys to assess SS, CMA, and Healthy Days. The Medical Outcomes Study Social Support Survey Instrument captured patient-perceived SS. The SS scale ranges from 0 to 100 and was collapsed into 2 categories: poor/fair (<60-80) and good (>80). CMA was assessed using the 8-point Morisky Medication Adherence Scale and was collapsed into 2 categories: low (<6) and high (≥6). The Centers for Disease Control and Prevention's Healthy Days Measure assessed self-reported health-related quality of life as the number of unhealthy days (unHD) in the past 30 days. Results were reported as mean (standard deviation); statistical significance was assessed by t test. Negative-binomial regression was used to assess the relationship between CMA and SS on unHD. Results were presented as rate ratios (95% CIs). Results: Of 7432 patients surveyed, 25% (n = 1847) responded. Respondents were 67% female, and 88% were Medicare beneficiaries, with a mean age of 69.2 ± 9.2 years. Good SS was reported by 63% of patients; fair/ poor SS by 37% of patients. High CMA was reported in 70% of the cohort, and low CMA in 30%. The average number of unHD was 14.0 ± 11.9. Regression analysis revealed the association between CMA and unHD was moderated by SS. In a main effects regression model, low CMA (1.18 [1.03, 1.35]; P = .0155), but not low SS (1.12 [0.99, 1.27]; P = .0694), was associated with unHD. When tested for a moderator effect, unHD was regressed on CMA/SS interaction along with main effects. Evidence of moderation was observed in the interaction between SS and CMA (P = .0393) and no association with unHD by SS (P = .6819) or CMA (P = .5895). With low SS, low CMA increased unHD by 33% (1.33 [1.01-1.74]), whereas with high SS, low CMA increased unHD by only 5% (1.05 [0.88, 1.2]). Conclusions: Patients with low CMA experienced more unHD than those with high CMA. The increase in unHD attributed to low CMA is further amplified by low SS. This finding suggests that a greater importance should be placed on patients' social and caregiver resources. Note: This work was supported by Genentech, Inc. [ABSTRACT FROM AUTHOR]