“Data from this [CanCORS] study will hopefully shed more light on factors which influence treatment-related decision making for lung and colorectal cancers,” he said.
Q&A with Dr. Zafar
Q: Given the current emphasis on cost reduction in healthcare, how much influence do you think reimbursement rates had on oncologists and their treatment decisions in your study?
Dr. Zafar: Differences in reimbursement probably did not play a significant role in why one regimen was chosen over another because the differences are probably small. As far as drug costs are concerned, both regimens have similar overall costs. However, the issue of cost of care remains important, particularly in terms of out-of-pocket expenses that are borne by patients and not third-party payers. I am designing a study that aims to identify the extent of out-of-pocket expenses related to cancer care and how those expenses impact quality of care delivered.
Vantage Point
A challenging area with few data available
The analysis by Dr. Zafar's group confirms the tendency of physicians to make treatment decisions based on their familiarity with a particular therapy, wrote Dr. Eng and Dr. Kopetz in an accompanying JOP editorial. Dr. Eng, an associate professor, and Dr Kopetz, an assistant professor, are based at Houston’s M.D. Anderson Cancer Center (J Oncol Pract 5:233-235, 2009).
On the basis of these study results, there was a preference for FOLFOX even though European phase II trials have shown that FOLFOX and FOLFIRI are equivalent as first-line therapy, they said. In addition, FOLFOX was combined with bevacizumab, although the latter was approved by the FDA based on a phase III trial in combination with irinotecan rather than oxaliplatin (J Clin Oncol 23:4866-4875, 2005; J Clin Oncol 22:229-237, 2004).
“Familiarity with the drug of interest appears to have precedence in practice patterns over recent evidenced-based literature,” Drs. Eng and Kopetz wrote.
With regard to age, the commentators said that the study did not state the median age and the percentage of patients older than 70 years. They recommended that stratifying patients on the basis of biologic age (comorbidities, functional status) would be necessary for defining optimal chemotherapy utilization. Dr. Eng and Dr. Kopetz pointed out that the nine community practices analyzed in this study were all affiliated with Duke University, which may have influenced their practice patterns.
However, the study “emphasizes the importance and value of observational analyses...in improving quality measures for any practicing physician,” they wrote. This is “a challenging subject on which, to our knowledge, few data have been published.”
