Improving quality of life after cancer care
By Henry J Henk, PhD; Darshak Sanghavi, MD; and Samantha Noderer, MA, OptumLabs
Researchers and clinicians have been working hard for decades to improve the quality of U.S. health care delivered to patients. In particular, our country has made significant improvements in the treatment of cancer. Overall, the death rate from cancer in the U.S. fell by 25 percent from 1990 to 2014. And now, approximately 70 percent of people diagnosed with cancer of any kind may expect to live five years or more.
But as we get better at saving lives, how can we do more to preserve quality of life after treatment? And how can we accelerate broader use of treatment strategies that have a positive impact over both the short and long term? At OptumLabs®, we’re collaborating with cancer experts from our partner community around a longitudinal data set to understand and act on these important questions — to better understand what helps patients live healthier, higher-quality lives.
The heart of the matter
Let’s take pediatric leukemia as an example. With today’s advanced medicine and technology, the vast majority of kids diagnosed with this serious cancer survive. Yet, these young survivors often face health problems in the future caused by the side effects of cancer treatments. For example, a very effective and powerful chemotherapy drug called doxorubicin has been associated with serious heart problems 5, 10 or 20 years down the line.
A breakthrough occurred in 1995 when the FDA approved a new drug called dexrazoxane, which is designed to protect the heart from damage caused by powerful chemotherapy. The drug was first approved and used in patients with breast cancer, but its use was unproven for other types of cancer. In 2004, a study in the New England Journal of Medicine found pediatric patients with acute lymphoblastic leukemia (ALL) who were given dexrazoxane had less heart cell damage (indicated by an increase in cardiac troponin) in the short term, without compromising the effectiveness of the chemotherapy they were receiving. In 2014, dexrazoxane received FDA-designated orphan drug status for prevention of heart damage in children and adolescents receiving chemotherapy. Over the next few years, more research was published on the favorable effects of this drug.
Some may have expected this collection of early evidence to help change pediatric cancer care in recent years. But without more long-term evidence about the safety and effectiveness of dexrazoxane, is it enough to change practice? We turned to the OptumLabs data to find out.
Using de-identified OptumLabs claims data; we studied 499 pediatric patients with acute myeloid leukemia (AML) or acute lymphoid leukemia (ALL) who received doxorubicin chemotherapy between January 1993 and December 2010. Only 16 (3.2 percent) were treated with the heart-protecting dexrazoxane. A similar study on a different dataset published in Pediatric Blood Cancer found even lower use among patients with AML and ALL between January 1999 and December 2009. This was not surprising, given the lack of favorable evidence during that time period.
Percentage of pediatric patients with ALL or AML who received dexrazoxane with chemotherapy,
We looked back at the OptumLabs data for 2014–2016 to see if the FDA designation and favorable research were having an impact, and we found that rates had increased somewhat. Among 299 patients with several types of common pediatric cancers (AML or ALL as well other leukemia/lymphoma, CNS/brain, sarcoma/bone) who received doxorubicin, 28 (9.4 percent) received dexrazoxane.
Our initial findings suggest that early evidence on short-term effectiveness of a drug is often not enough to get clinicians to use it. We also know that there are no guidelines recommending routine use of dexrazoxane, which are key drivers of broad uptake. There are some treatment protocols that recommend it for pediatric patients receiving a high dose of chemotherapy (cumulatively over 200 mg/m2). Nevertheless, this preliminary analysis helps us ask follow-up research questions that can get at the long-term outcomes associated with the drug and help identify the right patients for this treatment.
That’s why the OptumLabs Data Warehouse — which contains data spanning 25 years and covers more than 160 million de-identified lives across claims and clinical information — can help us explore important questions about cancer care and survivorship.
The OptumLabs Cancer Research Collaborative
With this in mind, last year, The American Cancer Society and OptumLabs co-founded the OptumLabs Cancer Research Collaborative (CRC) to accelerate cancer research and translation through collaborative studies and research-driven data improvements. We’re convening expert participants from organizations such as Stand Up To Cancer, Harvard Pilgrim Health Care Institute, Mayo Clinic, University of California Health, Yale and leadership from Optum Clinical Services and UnitedHealthcare Oncology.
The CRC is looking not only at cardiac impacts of cancer therapies, but at many other issues in cancer treatment and survivorship. The OptumLabs data contains information on components such as benefit design and prior authorization that are well suited for studying the cost of cancer care — one of the biggest challenges for survivors and the health care system at large — as well as long-term outcomes. Through this, we’re answering questions that can help us determine what quality care looks like, such as:
- How are cancer care guidelines being followed?
- How are cancer survivors using the health care system — what does it cost and is it effective?
- What kind of chemotherapy toxicities are manifesting in survivors long-term?
- What secondary risk factors are leading to poor health outcomes in cancer survivors — such as obesity and smoking?
There are roughly 20 cancer-related research projects underway, and several recently completed on topics such as breast cancer survivorship care, emergency department use among colorectal cancer patients and cardio-toxicities associated with new cancer treatment drugs.
With support from AARP, we are also working on developing quality measures with our partners at Tufts Medical Center that help identify cancer care-related adverse events and medical errors. Better measurement in these areas could help clinicians inform patients about treatment options, surface areas for health care delivery improvements and guide researchers and policymakers.
It is gratifying that more people are surviving cancer than ever before. Just as important, OptumLabs and our partners are working to make sure that our health care system not only knows which treatments work, but also which treatments may lead to a higher-quality life for patients down the road.
ABOUT THE AUTHORS
- Henry J Henk, PhD, is vice president of research at OptumLabs
- Darshak Sanghavi, MD, is chief medical officer at OptumLabs
- Samantha Noderer, MA, is communications and translation manager at OptumLabs