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 Yorks Network (Aug 98), Northern (May 99) National Cancer Guidance (July 99) NICE (May 00)

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

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

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

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

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

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

MEDICARE AUDIT DATA

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?

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

Clinicians’ patients receiving Taxol 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

Treatment pathway of patients receiving Taxol 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

Clinicians’ patients receiving Taxol Patients prescribed Taxol 7 months to 12.5 years after diagnosis, mean 3.5 years 12/30 (40%) who received Taxol were diagnosed /30 (3%) chemotherapy date = Taxol date (7 months after diagnosis) 15/30 (50%) patients now dead, given Taxol in year preceding death

Trust/Hospital Pharmacy Data Held 30/31 (97%) Pharmacies returned completed questionnaires 18/30 (60%) reported that they prescribed taxanes –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

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

Pharmacy Departmental Software

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%)

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%)

Further Possibilities Leeds/Yorkshire clinicians’ data Medical records –sampling 2 x 6 months’ of data? Change inclusion criteria to taxanes prescribed rather than patients diagnosed Prospective regional data collection of pharmacy data MUST be able to identify ALL patients who received taxanes in study sample