Use of bevacizumab in community settings

Toxicity profile and risk of hospitalization in patients with advanced non-small-cell lung cancer

Nikki M. Carroll, Thomas Delate, Alex Menter, Mark C. Hornbrook, Lawrence Kushi, Erin J Aiello Bowles, Elizabeth T. Loggers, Debra P. Ritzwoller

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Little is known regarding toxicities and hospitalizations in community-based settings for patients with advanced non-small-cell lung cancer (NSCLC) who received commonly prescribed carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) chemotherapy. Methods: Patients with stages IIIB-IV NSCLC age ≥ 21 years diagnosed between 2005 and 2010 who received first-line CP or CPB were identified at four health maintenance organizations (N=1, 109). Using patient and tumor characteristics and hospital and ambulatory encounters from automated data in the 180 days after chemotherapy initiation, the association between CP and CPB and toxicities and hospitalizations were evaluated with Χ2 tests and propensity score-adjusted regression models. Results: Patients who received CPB were significantly younger and had significantly more bleeding, proteinuria, and GI perforation events (all P <.05). For these patients, the unadjusted odds ratio associated with the likelihood of having a hospitalization was 0.46 (95%CI, 0.32 to 0.67). As shown by multivariable and propensity score-adjusted models, patients who received CPB were less likely to have been hospitalized (odds ratio, 0.48; 95%CI, 0.32 to 0.71) and had fewer total hospitalizations (rate ratio, 0.62; 95%CI, 0.47 to 0.82) and hospital days (rate ratio, 0.53; 95%CI, 0.47 to 0.60) than patients who received CP. Conclusion: Consistent with earlier randomized clinical trials, significantly more toxicity events were identified in patients treated with CPB. However, both unadjusted and adjusted models showed that patients who received CPB were less likely than patients who received CP to experience a hospital-related event after the initiation of chemotherapy. Findings here confirm the need for adherence to clinical recommendations for judicious use of CPB, but provide reassurance regarding the relative risk for hospitalizations.

Original languageEnglish (US)
Pages (from-to)356-362
Number of pages7
JournalJournal of Oncology Practice
Volume11
Issue number5
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

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Carboplatin
Paclitaxel
Non-Small Cell Lung Carcinoma
Hospitalization
Propensity Score
Drug Therapy
Bevacizumab
Odds Ratio
Health Maintenance Organizations
Proteinuria
Randomized Controlled Trials

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Use of bevacizumab in community settings : Toxicity profile and risk of hospitalization in patients with advanced non-small-cell lung cancer. / Carroll, Nikki M.; Delate, Thomas; Menter, Alex; Hornbrook, Mark C.; Kushi, Lawrence; Bowles, Erin J Aiello; Loggers, Elizabeth T.; Ritzwoller, Debra P.

In: Journal of Oncology Practice, Vol. 11, No. 5, 01.09.2015, p. 356-362.

Research output: Contribution to journalArticle

Carroll, NM, Delate, T, Menter, A, Hornbrook, MC, Kushi, L, Bowles, EJA, Loggers, ET & Ritzwoller, DP 2015, 'Use of bevacizumab in community settings: Toxicity profile and risk of hospitalization in patients with advanced non-small-cell lung cancer', Journal of Oncology Practice, vol. 11, no. 5, pp. 356-362. https://doi.org/10.1200/JOP.2014.002980
Carroll, Nikki M. ; Delate, Thomas ; Menter, Alex ; Hornbrook, Mark C. ; Kushi, Lawrence ; Bowles, Erin J Aiello ; Loggers, Elizabeth T. ; Ritzwoller, Debra P. / Use of bevacizumab in community settings : Toxicity profile and risk of hospitalization in patients with advanced non-small-cell lung cancer. In: Journal of Oncology Practice. 2015 ; Vol. 11, No. 5. pp. 356-362.
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abstract = "Purpose: Little is known regarding toxicities and hospitalizations in community-based settings for patients with advanced non-small-cell lung cancer (NSCLC) who received commonly prescribed carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) chemotherapy. Methods: Patients with stages IIIB-IV NSCLC age ≥ 21 years diagnosed between 2005 and 2010 who received first-line CP or CPB were identified at four health maintenance organizations (N=1, 109). Using patient and tumor characteristics and hospital and ambulatory encounters from automated data in the 180 days after chemotherapy initiation, the association between CP and CPB and toxicities and hospitalizations were evaluated with Χ2 tests and propensity score-adjusted regression models. Results: Patients who received CPB were significantly younger and had significantly more bleeding, proteinuria, and GI perforation events (all P <.05). For these patients, the unadjusted odds ratio associated with the likelihood of having a hospitalization was 0.46 (95{\%}CI, 0.32 to 0.67). As shown by multivariable and propensity score-adjusted models, patients who received CPB were less likely to have been hospitalized (odds ratio, 0.48; 95{\%}CI, 0.32 to 0.71) and had fewer total hospitalizations (rate ratio, 0.62; 95{\%}CI, 0.47 to 0.82) and hospital days (rate ratio, 0.53; 95{\%}CI, 0.47 to 0.60) than patients who received CP. Conclusion: Consistent with earlier randomized clinical trials, significantly more toxicity events were identified in patients treated with CPB. However, both unadjusted and adjusted models showed that patients who received CPB were less likely than patients who received CP to experience a hospital-related event after the initiation of chemotherapy. Findings here confirm the need for adherence to clinical recommendations for judicious use of CPB, but provide reassurance regarding the relative risk for hospitalizations.",
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AU - Kushi, Lawrence

AU - Bowles, Erin J Aiello

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