Taxanes for Ovarian Cancer: Progress Report
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Transcript of Taxanes for Ovarian Cancer: Progress Report
Taxanes for Ovarian Cancer:Progress Report
Rosemary Tate
Information Projects Team
December 2000
Background Issues
• Recent research evidence has shown improved survival times with paclitaxel (Taxol) for ovarian cancer patients
• High cost • Variation in HA funding• Yorks Network (Aug 98), Northern (May 99)• National Cancer Guidance (July 99)• NICE (May 00)
Aims and Objectives (1)
• To quantify proportion of patients with a newly diagnosed, histologically confirmed ovarian cancer who received chemotherapy in 1998 compared with 2000
• To determine the proportion of patients who received taxane-based chemotherapy as first/second/third line chemotherapy
Aims and Objectives (2)
• To describe the patterns of yearly taxane prescribing across the different Health Authorities of N & Y
• To identify the circumstances under which taxanes were given, e.g. in a cancer centre/unit, as part of a trial/protocol
• To investigate reasons for any variation in the use of taxanes
Data Required
• Complete regional coverage• Diagnosis • Patient-based• Chemotherapeutic agents prescribed• Chemotherapeutic line (1st, 2nd, 3rd)• Clinical trial, name, arm
Data Sources Investigated
• Registry data• Regional Pharmacy
– Medicare Audit UK database
• Northern Gynaecological Oncology Group (NGOG) database
• Clinician’s own data• Trust/hospital Pharmacy data
Registry Ovarian Cancer Data(September 2000, excluding certain paths., private & ER hospitals))
HistologicallyConfirmed
1998 1999 2000 TOTAL
Complete 438 154 8 600
All 459 535 534 1528
% ofComplete/All
95% 29% 2% 39%
All withChemo “Yes”
221 108 11 340
% of All withChemo “Yes”
48% 20% 2% 22%
N.B. Chemotherapeutic agents, trials and line data not recorded
Medicare Audit Data
• 95% UK coverage of overall prescribing patterns
• Covers several high-cost drugs, listed by specialty, Trust
• May be made up at one hospital, but prescribed at another
• Trials and line data not recorded
Paclitaxel Average Monthly Cost by Trust
£0
£20,000
£40,000
£60,000
£80,000
£100,000
£120,000
LE
EDS TEACHIN
G
GATESHEAD
RO
YAL HULL
NEW
CASTLE C
ITY
SOUTH T
EES
BRADFO
RD
HUDDERSFIE
LD
CARLIS
LE
HARRO
GATE
NO
RTH TEES
NO
RTHALLERTON
PIN
DERFIELD
S & P
ONTE
SCARBO
RO & N
E YORKS
SOUTH D
URHAM
SOUTH T
YNESIDE
W
EST CUM
BRIA
2000
1999
1998
MEDICARE AUDIT DATA
Medicare Data - Missing TrustsAiredale )
Calderdale )
Dewsbury )
Newcastle upon Tyne Hospitals ) do not
North Durham ) prescribe
North Lakeland ) taxanes?
Northumbria )
Priority Healthcare Wearside )
Sunderland )
Tees and North East Yorks )
York )
North East Lincs ) not in our
Scunthorpe and Goole ) region?
NGOG Database
• 16 larger Northern hospitals submit data• 11 smaller hospitals and NCCT have not• Patient-based data from Jan 1997• Diagnostic, FIGO staging, Trials data
included• Chemotherapy type unreliably recorded• Clinician compliance disappointing• Changing to data entry at clinical interface
Clinicians’ patients receiving Taxol 1998-2000
• List of 11 Northern clinicians’ named patients with dates prescribed and costs
• 30/53 patients identified on Registry database as having ovarian cancer diagnosis
• Cost per patient varied from £1,026 to £11,437 (Mean £5690, SD £2960)
• Administered for mean of 67 days and up to 121 days
Treatment pathway of patients receiving Taxol 1998-2000 as recorded
by Registry • 9/30 (30%) patients had surgery immediately
after diagnosis• 6/30 (20%) had chemotherapy 1 to 7 months
after surgery• 5/30 (17%) had Taxol 5 months to 3.5 years
after first chemotherapy• 1/30 (3%) had post-op radiotherapy• 21/30 (70%) had no treatment
Clinicians’ patients receiving Taxol 1998-2000
• Patients prescribed Taxol 7 months to 12.5 years after diagnosis, mean 3.5 years
• 12/30 (40%) who received Taxol 1998 - 2000 were diagnosed 1998 - 2000
• 1/30 (3%) chemotherapy date = Taxol date (7 months after diagnosis)
• 15/30 (50%) patients now dead, given Taxol in year preceding death
Trust/Hospital Pharmacy Data Held
• 30/31 (97%) Pharmacies returned completed questionnaires
• 18/30 (60%) reported that they prescribed taxanes 1998 - 2000– 8 (44%) had paper records only– 3 (17%) had electronic records only– 6 (33%) had paper and electronic records– 1 (6%) had no records of taxane prescribing
Trust/Hospital Pharmacy Data Items (N = 18)
• 87% Patient name• 76% Chemotherapy type• 74% Clinician name• 36% Trials details• 31% NHS No• 28% Patient diagnosis• 20% Chemotherapy line no.• 6% Clinical stage
Hospital Type of SoftwareAiredale General Ascribe program for
asepticsCumberland Infirmary Filemaker Pro (can be
converted to Access)North Tees Ascribe after Oct 99Pinderfields Unix Pharmacy system,
hoping for Access archivesoon
QEH, Gateshead AscribeSouth Tyneside PICKScunthorpe MMTSouth Cleveland Excel (1998 only)Sunderland Royal Excel (after 1998)St James’s MAGIC
Pharmacy Departmental Software
Pharmacy Department Comments (13/18 or 72%)
• missing information can be obtained from clinician involved (28%)
• could cross-reference with other data sources to cope with lack of diagnosis/staging info. but would involve “mammoth task of paper sorting” (22%)
• only one consultant prescribes taxanes for ovarian cancer in our hospital (17%)
Pharmacy Department Comments (continued)
• patients receiving taxanes referred to Cancer Centre (6%)
• “patient numbers very small” (6%)
• “regional database on treatment would be helpful” (6%)
• taxanes only used with small number of private patients (6%)
Summary of Data SourcesData Source Registry Medicare NGOG Clinician’s
OwnPharmacy
DepartmentsCompleteRegionalCoverage
100% 95% 25%* 10%* 97%
ReliableDiagnosisInformation
100% 0% 100% 100%# 28%
Patient-basedData
100% 0% 100% 100% 87%
ReliableTaxolInformation
0% 100% 0% 100% 76%
Reliable LineInformation
0% 0% 0% 72% 20%
Reliable TrialInformation
0% 0% 100% 0% 36%
OVERALLAVERAGE
50% 33% 54% 64% 57%
* estimated# when used in conjunction with Registry database
Further Possibilities• Leeds/Yorkshire clinicians’ data• Medical records
– sampling 2 x 6 months’ of data?• Change inclusion criteria to taxanes prescribed
1998 - 2000 rather than patients diagnosed 1998 - 2000
• Prospective regional data collection of pharmacy data
• MUST be able to identify ALL patients who received taxanes in study sample