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Outcomes and Costs of Treatment for Patients With Metastatic Upper Tract Urothelial Carcinoma
A group of researchers investigated the outcomes and costs associated with the treatment of metastatic upper tract urothelial carcinoma (mUTUC). The authors used claims data to identify synchronous and metachronous patients with mUTUC and created a quality score based on current guidelines to improve quality of care for these patients. Daniel D Joyce, MD, Mayo Clinic, Rochester, MN, and colleagues presented their findings in an abstract at the 2023 ASCO Genitourinary Cancers Symposium.
There is limited availability of population-based studies that evaluate outcomes for patients with mUTUC. Furthermore, these studies tend to focus on patients with synchronous mUTUC as opposed to patients who have progressed to metachronous mUTUC.
Using Surveillance, Epidemiology, and End Results–Medicare linked registry claims data, Joyce and colleagues conducted a study of patients with mUTUC aged ≥66 who were diagnosed between 2004 and 2012. The researchers used the following criteria to assess the quality of care: whether the patient with mUTUC had survived more than 12 months; if the patient had received systemic therapy; and if the patient had received hospice/palliative care.
The authors utilized Kaplan-Meier survival curves and Cox proportional hazard models to compare overall survival between the quality scores (0 vs ≥1) and between patients with synchronous mUTUC vs metachronous mUTUC. Of the 1,223 patients in the study, 381 (31.2%) had synchronous and 842 (68.8%) had metachronous mUTUC.
They also evaluated the health care and Medicare Part D out-of-pocket costs within two years of the patients’ diagnosis. In addition, the researchers completed regression analyses to measure the characteristics associated with quality criteria and total health care costs.
The study found that 40.2% of the patients met at least one quality criterion, and only 4.4% (54) received palliative care services. According to a multivariable analysis, patients with synchronous mUTUC (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.41-0.72) who had at least three comorbidities (OR: 0.68, 95% CI: 0.47-0.98) were less likely to meet at least one quality criterion. Those who fulfilled quality criteria survived longer compared with patients who did not fulfill the criteria (OR: 0.52, 95% CI: 0.46-0.59). If the patient met at least one quality criterion, this was independently associated with increased health care costs ($94,677, 95% CI: $87,702-$101,652 vs $63,575, 95% CI: $59,598–$67,552), according to multivariable regression analysis.
“These findings not only provide guidance for future study of rare diseases using secondary data, but also highlight inadequacies in the current management of mUTUC,” the team concluded.
Reference
Joyce DD, Shan Y, Stewart CA, et al. A SEER-Medicare based quality score for patients with synchronous and metachronous metastatic upper tract urothelial carcinoma and its association with cost of care and survival. Presented at: the 2023 ASCO GU Cancers Symposium; February 16-18, 2023; San Francisco, CA, and virtual; Abstract 482.
