Understanding disease progression and treatment patterns in metastatic breast, colorectal, and lung cancer: Implications for evaluating value and quality of care.

24 Background: Impact of strategies for evaluating value and quality of cancer care may vary for patients with metastatic tumors, particularly for strategies considering lines of treatment therapy as distinct events. To aid in evaluating the value and quality of care in patients' overall trajectory of disease, this study examined disease progression, mortality, hospice, and treatment patterns in patients (pts) with metastatic breast (mBC), lung (mLC), and colorectal cancers (mCRC).

METHODS: Included were commercially insured and Medicare Advantage adults from a large US health plan administrative claims database (2007-2014); pts had ≥ 2 claims for BC, CRC, or LC, and ≥ 2 claims for metastases. Index date was defined as the first post-metastatic systemic anti-cancer therapy (TX). Health plan enrollment for 6 mo pre- and post-index date was required; pts with < 6 mo of follow-up due to death were included. Pts with other primary cancers were excluded. A line of therapy (LOT) algorithm was developed and outcomes assessed over a variable follow-up. Progressive disease (PD) was defined as: start of a new LOT, where 1) previous LOT duration > 60 days, and 2) ≥ 1 imaging/lab test occurred between previous LOT and new LOT; receipt of hospice care; or death.

RESULTS: Among 7070 mBC, 4767 mCRC and 6994 mLC patients, 73%, 72%, and 84% respectively progressed during the study period (incidence rates: 7, 7, and 13 per 10-pt-years). Mean (median) time in months to PD was 9.5 (6.5) for mBC, 9.0 (7.0) for mCRC and 6.3 (5.0) for mLC. For all cancers, median number of LOT over 1 year was 2, with means of 1.8 (mBC), 1.7 (mCRC), and 1.7 (mLC). Compared to patients without PD, patients with PD had shorter LOT1. Mortality was highest among mLC patients (50%) compared to mCRC (27%) and mBC (22%), with rates per 100-pt-years of 50, 16, and 11 respectively. Hospice rates varied by tumor type.

CONCLUSIONS: The high level of progression and use of multiple lines of therapy in the metastatic setting suggests a need to delay progression with effective treatments for breast, lung, and colorectal cancers. The value and quality of cancer care should be evaluated across the entire span of patients' disease.