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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

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Taxanes for Ovarian Cancer: Progress Report

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  1. Taxanes for Ovarian Cancer:Progress Report Rosemary Tate Information Projects Team December 2000

  2. 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)

  3. 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

  4. 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

  5. Data Required • Complete regional coverage • Diagnosis • Patient-based • Chemotherapeutic agents prescribed • Chemotherapeutic line (1st, 2nd, 3rd) • Clinical trial, name, arm

  6. 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

  7. Registry Ovarian Cancer Data(September 2000, excluding certain paths., private & ER hospitals)) N.B. Chemotherapeutic agents, trials and line data not recorded

  8. 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

  9. MEDICARE AUDIT DATA

  10. Medicare Data - Missing Trusts Airedale ) 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?

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. Pharmacy Departmental Software

  18. 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%)

  19. 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%)

  20. 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

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