Results from Eisai Inc's online national survey of cancer patients, published in the 2012 Eisai Oncology Digest, provide insight into how patients view their treatment.
Managing patients with cancer is extremely complex. Each patient with cancer is unique, and treatment options will vary depending on the type and stage of cancer and individual patient characteristics. Moreover, physicians and patients have preferences for certain tests and treatments; such preferences may be in confl ict with the services covered by patients’ health insurance providers. To help healthcare professionals understand some of this complexity, Eisai Inc sponsored an online national survey that asked patients with cancer about their experiences. Complete results from this survey were recently published in the 2012 Eisai Oncology Digest.1 This is the first article in a 3-part series that highlights fi ndings from the survey; it describes the patient survey population and their overall perceptions of treatment and its goals.
A total of 418 adult patients treated or recently treated (within past 5 years) for cancer participated in the survey. All patients were aware of their health insurance/drug coverage status and were currently receiving treatment with prescription medications (for any condition). More women participated in the survey than men (Table 1). Of the 418 patients, approximately one-third were between the ages of 21 and 54, one-third were between the ages of 55 and 64, and one-third were between the ages of 65 and 84. At the time of the survey, 237 participants (64%) were cancer free, while 151 (36%) had cancer.
The stage of cancer was implied based on whether the cancer was localized (confi ned to primary cancer site), regional (spread to regional lymph nodes), or distant (ie, metastasized). In the majority (69%) of patients surveyed, the cancer was localized, but the stage at diagnosis varied among cancer types (ie, 85% of prostate cancer was localized whereas 54% of colon/rectal cancer was regional/distant) (
). The most common cancer types in this survey population were similar to those reported by the National Cancer Institute.2
TESTING AND SCREENING FOR CANCER
Prior to cancer diagnosis, most patients (as appropriate) received a mammogram (89%), Papanicolaou (Pap) test (89%), or prostate-specifi c antigen (PSA) test (85%) (Table 2). The lowest rates of screening related to testing for cervical human papillomavirus (HPV) (28%) and sigmoidoscopy (21%). Overall, the rates for testing/screening “prior to diagnosis” were significantly higher than those “since diagnosis” excepting oral cancer screenings, PSA blood tests, and skin checks. Results were similar in the subset of patients (n = 267) who were currently cancer free, suggesting an opportunity for improvement in screenings post diagnosis as part of a surveillance plan for cancer recurrence.
It should be noted that some of the screenings/tests were dependent on age. For example, colorectal and breast cancer screenings/tests were more prevalent in the older age groups, whereas HPV testing was more prevalent in the younger age groups. These age-related trends coincide with the testing and screening recommendations of the American Cancer Society (ACS) to: (1) perform mammograms annually beginning at age 40; (2) begin testing for colorectal cancer at age 50; and (3) begin screening for cervical cancer by age 18.3 While the percentages in Table 2 are respectable, better adherence to the ACS recommendations would increase the rates of testing.
CANCER TREATMENT AND GOALSType of Treatment
The type of cancer therapy varied greatly due to the variety of cancer types and cancer stages that were represented in this survey. Treatment modalities included:
• Surgery, 79%
• Radiation, 51%
• Chemotherapy, 40%
• Investigative therapy, 8%
• Supportive therapy, 7%
• Other, 8% (50% of those reported hormonal therapy)
Excluding surgery, patients with regional/distant cancers were significantly more likely to have all modalities of treatment than those with localized cancers. A total of 57% of patients reported more than 1 type of cancer treatment. Among patients receiving multiple treatments, 21% had surgery and radiation; 20% had surgery, radiation, and chemotherapy; and 12% had surgery and chemotherapy. Younger patients were more likely to receive surgery, radiation, and chemotherapy.
Of those who received intravenous (IV) chemotherapy, most received treatment in a hospital outpatient department (41%), followed by a doctor’s offi ce (31%), an infusion center separate from the hospital or doctor’s office (28%), and at home (1%). These percentages were similar to those obtained in a 2010 survey by Eisai,4 with 1 exception. Current data indicate a signifi cant increase from 2010 (14%) to 2012 (28%) in the percentage of patients receiving IV treatment at infusion centers.4 Freestanding
ambulatory infusion centers operate essentially as doctors’ offi ces, but infusions are provided pursuant to a physician’s orders and are performed and managed by a registered nurse and registered pharmacist. This trend is expected to increase, as specialty pharmacies have invested heavily in infusion centers (and home infusion centers). Whether the increased share in infusion centers will lead to a signifi cant reduction in hospital outpatient use remains to be seen, but it is expected that it will.
Patients were generally satisfi ed where they received IV chemotherapy. Still, those receiving infusions at a doctor’s office reported slightly higher levels of satisfaction than those receiving treatment at a freestanding infusion center. Patients receiving oral or self-injectable chemotherapy delivered by a specialty pharmacy or a mail order pharmacy reported the highest level of satisfaction. Data suggest improvement opportunities with in-offi ce pharmacies and local retail pharmacies.
Goals of Treatment
Respondents’ answers to goals of treatment varied. A total of 69% of patients reported remission as their goal, whereas 44% and 31% stated prolonged life and preserved quality of life, respectively. Surprisingly, patient age was not correlated with goal of treatment. However, the stage of cancer infl uenced goal of treatment (Figure). The top chosen treatment goal among patients with distant cancers was prolonged life. Despite the perception that these patients tend to receive only palliative care for improved quality of life, it is an important finding that many have chosen extended survival as their goal.
The 2012 Eisai Oncology Digest provides healthcare professionals with valuable insight on how patients with cancer view their treatment. High rates of screening were associated with common cancers, but results indicate that there is room for improvement and better adherence to guidelines. Most patients have the treatment goal of cancer remission. However, the primary goal of patients with more advanced cancer is prolonging life. Knowledge of these goals may infl uence how physicians approach the treatment and management of localized versus advanced cancers in the future.
Although patients were given chemotherapy in varied settings, most were satisfied with how they received medication. This topic will be explored further in the second article in this series, which will detail how respondents felt about the quality of their care and counseling/communication. The final article in this series will describe insurance and cost obstacles that patients encountered during treatment.