Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-r... more Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-related quality of life (HRQoL). Comorbidities adversely impact adherence to cancer treatment. Additionally, adherence to medications for comorbidities is positively associated with HRQoL for various diseases. This study used the Center for Disease Control and Prevention's Healthy Days measure of HRQoL to explore the association between HRQoL and adherence to comorbidity medication for elderly patients with cancer and at least one comorbid condition. We conducted a cross-sectional survey combined with retrospective claims data. Patients with metastatic breast, lung or colorectal cancer were surveyed regarding their HRQoL, comorbidity medication adherence and cancer-related symptoms. Patients reported the number of physical, mental and total unhealthy days in the prior month. The Morisky Medication Adherence 8-point scale was differentiated into moderate/high (> 6) and low (≤ 6) com...
Journal of managed care & specialty pharmacy, 2018
Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evide... more Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-m...
Healthcare providers (HCPs) and patient communication are integral to high-quality oncology care.... more Healthcare providers (HCPs) and patient communication are integral to high-quality oncology care. The patient and HCP perspectives are needed to identify gaps in care and develop communication tools. . This study aimed to understand patient- and HCP-perceived elements of and gaps in high-quality care to develop novel communication tools to improve care. . Qualitative interviews were conducted among 16 patients with cancer and 10 HCPs in the United States. Trained interviewers elicited patients' and HCPs' concerns, views, and perceived needs for communication tools. A thematic analysis was used to identify four quality of care domains, depicted in a conceptual model, and two draft communication tools were developed to address identified gaps. . No patients reported previously using a communication tool, and gaps in communication regarding treatment aims and education were evident. Two tools were developed to assess patients' life and treatment goals and the importance of...
150 Background: End-of-Life Care (EOLC) discussions are frequently delayed past the time of usefu... more 150 Background: End-of-Life Care (EOLC) discussions are frequently delayed past the time of usefulness, resulting in cancer patients (pts) receiving aggressive, expensive, non-desired care. The “Living with Cancer” project has developed a 7-item, 5-level Likert scale PRO tool that evaluates, from the pt perspective, their concerns regarding performance status, pain, family/financial burden, and depression during their cancer journey. The instrument was shown to correlate well with the oncologist’s opinion of appropriateness to continue treatment and might be useful as a quality metric in guiding timing of EOLC discussions (J Palliative Med 2016). Methods: The LWC PRO was administered to 1302 pts with advanced malignancies receiving care by Regional Cancer Care Associates (NJ) between Sept 2015 and Aug 2016, with confirmation of life status in Sept 2016. Exploratory factor analysis was conducted on the LWC instrument to identify latent constructs (factors) contributing to the item sc...
189 Background: Previous studies established the link between comorbidities and Health Related Qu... more 189 Background: Previous studies established the link between comorbidities and Health Related Quality of Life (HRQoL) for cancer patients. Adherence to comorbid medications has been found to be predictive of HRQoL in other disease states, but this has not been established for patients with cancer. This study sought to investigate the association between healthy days (HDs) and comorbidity medication adherence (CMA) for cancer patients. Methods: A survey was mailed to 5,098 patients with metastatic breast, lung or colorectal cancer who received treatment in 2014 and had at least one comorbid condition. Survey responses were merged with Humana claims data for analysis. The CDC’s Healthy Days measure was used to identify self-reported overall, physical and mental unhealthy days in the past 30 days and the number of days that poor physical or mental health limited usual activities. The Morisky Medication Adherence 8-point scale was used to differentiate high CMA ( > 6) and low CMA ( ...
99 Background: Patient engagement is essential for high-quality care. This study aimed to develop... more 99 Background: Patient engagement is essential for high-quality care. This study aimed to develop novel communication tools to be used between patients and HCPs to address current gaps in cancer care. Methods: Qualitative interviews were conducted with 16 US patients with various cancers and stage, 6 oncology nurses, and 4 oncologists. Goals were to understand: patients’ changing concerns at diagnosis and during treatment; HCPs views on eliciting patient preferences; and perspectives from both on improving care. A thematic analysis was conducted to identify gaps in care. 8 patients rated their experience and importance of quality care items on a scale of 1 (not experienced/not important) to 5 (experienced/very important). Two draft tools were developed to address identified gaps. Results: None of the 16 patients reported using a communication tool before or during treatment. Gaps in quality care were identified, including communication, patient-centered care, education, and comprehe...
Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-r... more Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-related quality of life (HRQoL). Comorbidities adversely impact adherence to cancer treatment. Additionally, adherence to medications for comorbidities is positively associated with HRQoL for various diseases. This study used the Center for Disease Control and Prevention's Healthy Days measure of HRQoL to explore the association between HRQoL and adherence to comorbidity medication for elderly patients with cancer and at least one comorbid condition. We conducted a cross-sectional survey combined with retrospective claims data. Patients with metastatic breast, lung or colorectal cancer were surveyed regarding their HRQoL, comorbidity medication adherence and cancer-related symptoms. Patients reported the number of physical, mental and total unhealthy days in the prior month. The Morisky Medication Adherence 8-point scale was differentiated into moderate/high (> 6) and low (≤ 6) com...
Journal of managed care & specialty pharmacy, 2018
Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evide... more Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-m...
Healthcare providers (HCPs) and patient communication are integral to high-quality oncology care.... more Healthcare providers (HCPs) and patient communication are integral to high-quality oncology care. The patient and HCP perspectives are needed to identify gaps in care and develop communication tools. . This study aimed to understand patient- and HCP-perceived elements of and gaps in high-quality care to develop novel communication tools to improve care. . Qualitative interviews were conducted among 16 patients with cancer and 10 HCPs in the United States. Trained interviewers elicited patients' and HCPs' concerns, views, and perceived needs for communication tools. A thematic analysis was used to identify four quality of care domains, depicted in a conceptual model, and two draft communication tools were developed to address identified gaps. . No patients reported previously using a communication tool, and gaps in communication regarding treatment aims and education were evident. Two tools were developed to assess patients' life and treatment goals and the importance of...
150 Background: End-of-Life Care (EOLC) discussions are frequently delayed past the time of usefu... more 150 Background: End-of-Life Care (EOLC) discussions are frequently delayed past the time of usefulness, resulting in cancer patients (pts) receiving aggressive, expensive, non-desired care. The “Living with Cancer” project has developed a 7-item, 5-level Likert scale PRO tool that evaluates, from the pt perspective, their concerns regarding performance status, pain, family/financial burden, and depression during their cancer journey. The instrument was shown to correlate well with the oncologist’s opinion of appropriateness to continue treatment and might be useful as a quality metric in guiding timing of EOLC discussions (J Palliative Med 2016). Methods: The LWC PRO was administered to 1302 pts with advanced malignancies receiving care by Regional Cancer Care Associates (NJ) between Sept 2015 and Aug 2016, with confirmation of life status in Sept 2016. Exploratory factor analysis was conducted on the LWC instrument to identify latent constructs (factors) contributing to the item sc...
189 Background: Previous studies established the link between comorbidities and Health Related Qu... more 189 Background: Previous studies established the link between comorbidities and Health Related Quality of Life (HRQoL) for cancer patients. Adherence to comorbid medications has been found to be predictive of HRQoL in other disease states, but this has not been established for patients with cancer. This study sought to investigate the association between healthy days (HDs) and comorbidity medication adherence (CMA) for cancer patients. Methods: A survey was mailed to 5,098 patients with metastatic breast, lung or colorectal cancer who received treatment in 2014 and had at least one comorbid condition. Survey responses were merged with Humana claims data for analysis. The CDC’s Healthy Days measure was used to identify self-reported overall, physical and mental unhealthy days in the past 30 days and the number of days that poor physical or mental health limited usual activities. The Morisky Medication Adherence 8-point scale was used to differentiate high CMA ( > 6) and low CMA ( ...
99 Background: Patient engagement is essential for high-quality care. This study aimed to develop... more 99 Background: Patient engagement is essential for high-quality care. This study aimed to develop novel communication tools to be used between patients and HCPs to address current gaps in cancer care. Methods: Qualitative interviews were conducted with 16 US patients with various cancers and stage, 6 oncology nurses, and 4 oncologists. Goals were to understand: patients’ changing concerns at diagnosis and during treatment; HCPs views on eliciting patient preferences; and perspectives from both on improving care. A thematic analysis was conducted to identify gaps in care. 8 patients rated their experience and importance of quality care items on a scale of 1 (not experienced/not important) to 5 (experienced/very important). Two draft tools were developed to address identified gaps. Results: None of the 16 patients reported using a communication tool before or during treatment. Gaps in quality care were identified, including communication, patient-centered care, education, and comprehe...
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