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Concordance to National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (GL) for Imaging Work-up of Patients with Metastatic Breast Cancer: An Analysis from the Commercial Managed Care Claims PharMetrics (PM) and SEER/Medicare (SM) Databases

Citation: J Clin Oncol 28:7s, 2010 (suppl; abstr 1104)

Author(s): D. L. McNally, B. S. Seal, J. L. Vandergrift, C. D. Mullins, E. M. Lepisto, J. S. McClure, M. Tangirala; University of Maryland School of Pharmacy, Baltimore, MD; sanofi-aventis, Bridgewater, NJ; National Comprehensive Cancer Network, Fort Washington, PA; School of Pharmacy, University of Maryland, Baltimore, MD; Smith Hanley Consulting Group, Bridgewater, NJ

Abstract:

Background: The NCCN GLs are the standard of care for the treatment of women with metastatic breast cancer (mBC). The primary aim of the current project is to assess concordance between the NCCN GLs and care received using the PM and SM databases (DBs). The PM and SM are patient (PT) care DBs that incorporate medical and pharmaceutical claims data. SM contains data for Medicare PTs while the PM contains data for younger managed-care PTs.

Methods: Claims for PTs diagnosed with metastatic breast cancer from 2002 to 2008 for PM and 2002 to 2005 for SM were examined. Overall, 28,816 women with metastatic breast cancer were identified. Median age at metastatic diagnosis was 40 years in PM and 77 years in SM.

Results: Across the entire study period NCCN GLs recommended chest imaging (CI) and bone scans (BS) as part of the routine work-up for mBC. For PTs in PM, 76% received CI, 56% BS, and 46% both CI and BS as indicated. For PTs in SM, 88% received CI, 63% BS, and 61% both CI and BS during work-up. Concordance rates for imaging were significantly higher in the SM population than the PM populations. Positron-emission tomography (PET) scans were indicated as an optional part of work-up for mBC as a category 2B recommendation until early 2008 when the recommendation was removed. During 2008, 37% of women received nonconcordant PET scans during work-up. Between 2005 and 2007, 29% of women received PET scans as part of initial workup. PET use after 2005 could not be evaluated in SM.

Conclusions: Concordance with NCCN GL recommended imaging for mBC was higher in the SM than PM. In both DBs, concordance with recommendation for bone scans was low. In 2008, a large proportion of women in the PM DB received PET as part of work-up, though this test is not recommended by the NCCN GLs.

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