The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study

Malek B. Hannouf (), Eric Winquist, Salaheddin M. Mahmud, Muriel Brackstone, Sisira Sarma, George Rodrigues, Peter K. Rogan, Jeffrey Hoch and Gregory S. Zaric
Additional contact information
Malek B. Hannouf: Western University
Eric Winquist: Western University
Salaheddin M. Mahmud: University of Manitoba
Muriel Brackstone: Western University
George Rodrigues: Western University
Peter K. Rogan: Western University
Gregory S. Zaric: Western University

PharmacoEconomics - Open, 2018, vol. 2, issue 3, No 5, 255-270

Abstract: Abstract Purpose Several genomic tests have recently been developed to identify the primary tumour in cancer of unknown primary tumour (CUP). However, the value of identifying the primary tumour in clinical practice for CUP patients remains questionable and difficult to prove in randomized trials. Objective We aimed to assess the clinical and economic value of primary tumour identification in CUP using a retrospective matched cohort study. Methods We used the Manitoba Cancer Registry to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients as having CUP if their primary tumour was found 6 months or more after initial diagnosis or never found during the course of disease. Otherwise, we considered patients to have metastatic cancer from a known primary tumour (CKP). We linked all patients with Manitoba Health databases to estimate their direct healthcare costs using a phase-of-care approach. We used the propensity score matching technique to match each CUP patient with a CKP patient on clinicopathologic characteristics. We compared treatment patterns, overall survival (OS) and phase-specific healthcare costs between the two patient groups and assessed association with OS using Cox regression adjustment. Results Of 5839 patients diagnosed with metastatic cancer, 395 had CUP (6.8%); 1:1 matching created a matched group of 395 CKP patients. CUP patients were less likely to receive surgery, radiation, hormonal and targeted therapy and more likely to receive cytotoxic empiric chemotherapeutic agents. Having CUP was associated with reduced OS (hazard ratio [HR] 1.31; 95% confidence interval 1.1–1.58), but this lost statistical significance with adjustment for treatment differences. CUP patients had a significant increase in the mean net cost of initial diagnostic workup before diagnosis and a significant reduction in the mean net cost of continuing cancer care. Conclusion Identifying the primary tumour in CUP patients might enable the use of more effective therapies, improve OS and allow more efficient allocation of healthcare resources.

Date: 2018
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s41669-017-0051-2 Abstract (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:pharmo:v:2:y:2018:i:3:d:10.1007_s41669-017-0051-2

Ordering information: This journal article can be ordered from
http://www.springer.com/adis/journal/41669

DOI: 10.1007/s41669-017-0051-2

Access Statistics for this article

PharmacoEconomics - Open is currently edited by Timothy Wrightson and Christopher Carswell

More articles in PharmacoEconomics - Open from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().