Innovation takes time, especially when it comes to cancer research. Unfortunately, delays in the adoption of novel oncology treatments can have a significant effect on patient health.
Geographic analysis of claims data has shown that patients in regions with more rapid uptake of novel cancer therapies have longer overall survival. According to a recent study of 6 landmark therapies, median overall survival among eligible patients gaining access to these treatments increased by an average of 14.7 months.
“We know ex post that these were successful treatments,” said Jason Shafrin, Director of Healthcare Quality and Value-Based Research Methods and Senior Research Economist at Precision Health Economics, Los Angeles, CA. “We want to make sure that cancer drugs are safe and effective, of course, but faster adoption can provide an important survival benefit to patients.”
As Mr Shafrin reported at the 2017 Cancer Survivorship Symposium, despite the potential of new oncology treatments to improve patient outcomes, it can take up to 17 years for treatments identified as beneficial in randomized clinical trials to enter real-world practice. Using Surveillance, Epidemiology, and End Results Program–Medicare linked data from 1991 to 2013, Mr Shafrin and colleagues retrospectively analyzed the variability of adoption of 6 new cancer treatments across 50 aggregated metropolitan statistical areas (MSAs). After determining the percentage of patients who were eligible to receive treatment in a given MSA, the researchers looked at treatment history and survival outcomes.
“We wanted to see whether regions that had access to treatments earlier saw significant advances in survival, so we assigned treatments randomly across patients, depending entirely on where they lived,” Mr Shafrin explained. This approach was applied to 6 oncology therapeutic case studies: trastuzumab for breast cancer, bevacizumab for colorectal cancer, bevacizumab for lung cancer, erlotinib for lung cancer, bortezomib for multiple myeloma, and lenalidomide for multiple myeloma.
Mr Shafrin and colleagues included 92,496 patients (mean age, 76.9 years) in the baseline cohort. Three-year survival rates were highest for patients with multiple myeloma (36.5%) and lowest for patients with lung cancer (7.5%). As expected, the researchers observed variability in adoption rates across the 50 MSAs included in the study. The difference between adoption rates among eligible patients for MSAs at the 90th percentile and those at the 10th percentile, for example, was 20.1 percentage points. According to Mr Shafrin, the largest difference was seen with bevacizumab in patients with colorectal cancer (51.2% at the 90th percentile vs 20.9% at the 10th percentile), whereas the smallest difference in adoption was seen with erlotinib (10.3% at the 90th percentile vs 2.8% at the 10th percentile).
The researchers also identified survival improvements due to faster treatment adoption. Among eligible patients gaining access to these landmark therapies, median overall survival increased by an average of 14.7 months compared with patients who did not receive the therapy. Improvement in overall survival was greatest for patients receiving lenalidomide and smallest for those receiving bortezomib, at 33.4 months and 2.9 months, respectively.
Based on these data, said Mr Shafrin, increasing the speed of adoption of novel agents has the potential to improve real-world survival for cancer patients. Access to novel treatments could be improved by faster regulatory review, better physician education, or fewer payer-imposed barriers to access, the authors noted.
