Open AccessImpact of High Cost Anticancer Drugs´ Indications Throughout Time in Noncurative Advanced (Stage IV) Cancer Patients With Solid Tumors
Author(s) -
J. Lacava,
Volker Geist,
Desiree Ortiz
Publication year - 2018
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.18.33200
Subject(s) - medicine , discontinuation , cancer , population , quality of life (healthcare) , stage (stratigraphy) , palliative care , gastroenterology , nursing , environmental health , paleontology , biology
Background: Most high cost anticancer drugs (HCAD) are indicated in noncurative advanced (stage IV) cancer patients (NCP) for palliative reasons with variable impacts on quality of life and survival. HCAD challenge health care systems because of their high prices specially in nonhigh income countries. Aim: To evaluate the proportional impact (HDCA indications/overall survival) in NCP throughout years. To analyze causes of HDCA discontinuation. To calculate time elapsed from end of HCDA treatment to end of life (ETEL index). Methods: We reviewed charts of 268 NCP treated in a Patagonian cancer institution between 2009 to 2017 with an HCDA (either alone or in combinations) according to standard of care. Mean age was 58 y (26-84), sex (m/f) 126/142, primary tumor: GI 106 (40%), GU 27 (10%), GYN 20 (7%), BR 58 (22%), LG 43 (16%), others 14 (5%). 29 different HCAD were indicated in 402 treatments (small targets therapies 35%, Moabs 60%, others 5%): 1st line 268 (100%), 2nd line 89 (33%), 3rd line 34 (13%), thereafter 11 (4%). Results: Median OS for the entire population was 26 m (1-120), while it was: GI 20 m, GU 28 m, GYN 27 m, BR 47 m, LG 18 m, Others 21 m. Proportion of OS with HCAD indications: 50% (1-100) in the whole population, while it was: GI 49% (25-100), GU 62% (5-100), GYN 39% (6-93), BR 50% (3-100), LU 45% (6-93), others 61% (25-100). HDAC indications increased over time: 26% (2009-11), 33% (2012-14), 40% (2015-17), with a more than 2% of new NCP increment per year. Additionally proportion (HCAD/OS) was: 43% (2009-11), 47% (2012-14), 52% (2015-17). Median time of HCAD according to line of therapy was: 1st line 6 m, 2nd line 4 m, 3rd line 6 m, 4th+ lines 4.5 m. Causes of discontinuation of HCAD were: disease progression in 87% of cases and 13% for toxicity/others. Median ETEL index (days) was 80 d (1-340). Conclusion: 1) HCAD are indicated during a significant proportion of life (50%) in stage IV NCP with many solid tumors. 2) Its use is increasing over years with a rate of 2% of NCP per year and for more proportion of time. 3) A great number of HCAD treatments are discontinued due to failure reasons, while it is expected more than 10% of adverse events causes. 4) ETEL index is proposed as a measurement indicator of GCP. 5) Impact of HCAD treatments is a major issue in health care policies.