Pretreatment costs of care and time to initial treatment for patients with cancer of unknown primary
Abstract
Aim: Time to treatment and pretreatment costs may be affected by unknown primary tumor site. Methods: This retrospective study used electronic medical record data from patients in ten US community oncology practices. Eligible patients were ≥18 years, diagnosed with cancer of unknown primary (CUP) or known metastatic solid tumor, and presented between 1 January 2012 and 30 June 2014. Results: Patients with CUP (n = 294) had a longer interval than non-CUP patients (n = 92) from presentation to treatment initiation (1.18 vs 0.49 months, p < 0.0001), and had higher pretreatment costs (US$27,882 vs US$20,449, p = 0.0075). When analyzed as monthly cost, the difference between groups in log-cost per month was nonsignificant. Conclusion: Higher pretreatment costs in CUP patients appeared attributable to significantly longer time to initiation of therapy.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest
1.
Pavlidis N, Pentheroudakis G. Cancer of unknown primary site. Lancet 379(9824), 1428–1435 (2012).
2.
Varadhachary GR, Raber MN. Carcinoma of unknown primary site. N. Engl. J. Med. 371(21), 2040 (2014).
3.
Oien K, Dennise JL. Diagnostic work-up of carcinoma of unknown primary: from immunohistochemistry to molecular profiling. Ann. Oncol. 23(Suppl. 10), 271–277 (2012).
• Provides a good overview of the general approach to assessment that has prevailed in management of patients with cancer of unknown primary (CUP).
4.
Massard C, Loriot Y, Fizazi K. Carcinomas of an unknown primary origin – diagnosis and treatment. Nat. Rev. Clin. Oncol. 8(12), 701–710 (2011).
5.
Kaaks R, Sookthai D, Hemminki K et al. Risk factors for cancers of unknown primary site: results from the prospective EPIC cohort. Int. J. Cancer 135(10), 2475–2481 (2014).
• In depth discussion of the behavioral and physiological risk factors for CUP from an international sample.
6.
Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit. Rev. Oncol. Hematol. 69(3), 271–278 (2009).
7.
Mnatsakanyan E, Tung WC, Caine B, Smith-Gagen J. Cancer of unknown primary: time trends in incidence, United States. Cancer Causes Control 25(6), 747–757 (2014).
8.
Ross JS, Wang K, Gay L et al. Comprehensive genomic profiling of carcinoma of unknown primary site: new routes to targeted therapies. JAMA Oncol. 1(1), 40–49 (2015).
• Discusses the opportunities for gene profiling in CUP patients, and notes that most patients have at least one genetic alteration.
9.
American Cancer Society. Cancer Facts & Figures 2016. (2016). www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2016/cancer-facts-and-figures-2016.pdf
10.
Greco FA, Oien K, Erlander M et al. Cancer of unknown primary: progress in the search for improved and rapid diagnosis leading toward superior patient outcomes. Ann. Oncol. 23(2), 298–304 (2012).
11.
Tong KB, Becker SH, Anderson GG. Incidence, costs of care and mortality of medicare beneficiaries diagnosed with cancer of unknown primary (CUP). JMD 8(5), 659 (2006).
12.
Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 26(Suppl. 5), v133–v138 (2015).
• Provides recent treatment guidelines for CUP patients.
13.
Saif Ur Rehman S, Ahluwalia MS, Mashtare TL et al. Cancer of unknown primary presenting with liver metastasis: a cost, time to treatment and outcome analysis. Clin. Oncol. 25(11), 684–685 (2013).
14.
Briasoulis E, Pavlidis N. Cancer of unknown primary origin. Oncologist 2(3), 142–152 (1997).
15.
Barrett M, Steiner C, Sheng M, Bailey M. Healthcare Cost and Utilization Project HCUP) External Cause of Injury Code (E Code) Evaluation Report (Updated with 2013 HCUP Data). 2016. HCUP Methods Series Report # 2016–03 ONLINE. July 26, 2016. U.S. Agency for Healthcare Research and Quality. www.hcup-us.ahrq.gov/reports/methods/methods.jsp
16.
United States Centers for Medicare & Medicaid Services (CMS). Physician Fee Schedule. 2016 July 26 (2014). www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/index.html
17.
Truven Health Analytics. RED BOOK from Micromedex Solutions. 2016 July 26 (2015). http://micromedex.com/redbook
18.
Hannouf MB, Winquist E, Mahmud SM et al. The potential clinical and economic value of primary tumour identification in metastatic cancer of unknown primary tumour: a population-based retrospective matched cohort study. Pharmacoecon Open (2017) (Epub ahead of print).
• Discusses a recent analysis within the Canadian healthcare system regarding clinical and economic impact of a CUP diagnosis.
19.
Soni A. Trends in use and expenditures for cancer treatment among adults 18 and older, U.S. civilian noninstitutionalized population, 2001 and 2011. Statistical Brief #443 (2014). https://meps.ahrq.gov/data_files/publications/st443/stat443.pdf
20.
Schwaederle M, Zhao M, Lee JJ et al. Impact of precision medicine in diverse cancers: a meta-analysis of Phase II clinical trials. J. Clin. Oncol. 33(32), 3817–3825 (2015).
21.
Wheler JJ, Janku F, Naing A et al. Cancer therapy directed by comprehensive genomic profiling: a single center study. Cancer Res. 76(13), 3690–3701 (2016).
22.
Hannouf MB, Winquist E, Mahmud SM et al. Cost–effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary. Pharmacogenomics J. 17(3), 286–300 (2017).
23.
Richardson A, Wagland R, Foster R et al. Uncertainty and anxiety in the cancer of unknown primary patient journey: a multiperspective qualitative study. BMJ Support Palliat. Care 5(4), 366–372 (2015).
24.
Gracia A, Balana C, Kaskens L et al. Economic analysis of epicup, an epigenetic test to predict the tissue of origin in cancer of unknown primary site, the USA payors perspective. Value Health 18(7), A356 (2015).
25.
Smith KA, Dort JC, Hall SF, Rudmik L. Cost-effectiveness of positron emission tomography-CT in the evaluation of cancer of unknown primary of the head and neck. Head Neck 37(12), 1781–1787 (2015).
Information & Authors
Information
Published In
Copyright
© 2018 Future Medicine Ltd.
History
Received: 19 December 2017
Accepted: 26 March 2018
Published online: 1 June 2018
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Pretreatment costs of care and time to initial treatment for patients with cancer of unknown primary. (2018) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2017-0104
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Tobias Martinot, Lydia H.N. Schonewille, Dina Ruano, Elisabeth M.P. Steeghs, Tom van Wezel, Willemijn S.M.E. Theelen, Vincent T.H.B.M. Smit, Petur Snaebjornsson, Egbert F. Smit, Kim Monkhorst, Danielle Cohen, Enrichment of SMARCA4 mutations in lung carcinomas presenting as cancer of unknown primary, Lung Cancer, 10.1016/j.lungcan.2026.109502, (109502), (2026).
- A. Waye, N. Thanh, A. Scott, T. Bond, D. Stewart, Diagnostic Costs of Metastatic and Unknown Primary Cancers in Alberta, Canada, 2017–2021, Cancer Investigation, 10.1080/07357907.2025.2599381, (1-9), (2025).
- Nosheen Fatima, Mina Laiq, Muhammad Rafay, Sara Muhammad Azam, Maseeh uz Zaman, Role of 18FDG PET/CT in Detecting Primary Tumors in Patients with Carcinoma of Unknown Primary: Single-Center Cross-Sectional Study from 2017 to 2023 (Extension Study), World Journal of Nuclear Medicine, 10.1055/s-0044-1795101, 24, 01, (057-063), (2024).
- Arielle van Mourik, Gina Tonkin-Hill, John O’Farrell, Shohei Waller, Lavinia Tan, Richard W. Tothill, David Bowtell, Stephen Fox, Andrew Fellowes, Clare Fedele, Penelope Schofield, Tharani Sivakumaran, Hui-Li Wong, Linda Mileshkin, Six-year experience of Australia’s first dedicated cancer of unknown primary clinic, British Journal of Cancer, 10.1038/s41416-023-02254-6, 129, 2, (301-308), (2023).
- Ella Nissan, Uri Amit, Leo Baron, Amit Zabatani, Damien Urban, Iris Barshack, Tima Davidson, The usefulness of [18F]FDG-PET/CT in detecting and managing cancers with unknown primary site depends on histological subtype, Scientific Reports, 10.1038/s41598-021-96451-z, 11, 1, (2021).
- Mitchell Reitsma, John Fox, Pierre Vanden Borre, Matthew Cavanaugh, Yakov Chudnovsky, Rachel L. Erlich, Thomas E. Gribbin, Rachel Anhorn, Effect of a Collaboration Between a Health Plan, Oncology Practice, and Comprehensive Genomic Profiling Company from the Payer Perspective, Journal of Managed Care & Specialty Pharmacy, 10.18553/jmcp.2019.18309, 25, 5, (601-611), (2019).
