Research Article ISSN 2639-8478

Research Article Cancer Science & Research

Cancer Healthcare Utilization Impact of Precision Therapeutics:

Hospitalization/Emergency Visits

Stephanie Wonnell Yencho1, Jared Austin2, Eric Betka2, Derek Gyori3, Christine Cassidy4, Laura Stanbery5,
Phylicia Aaron5, Charles Brunicardi6, Gerald Edelman4, Lance Dworkin4 and John Nemunaitis5*

Ohio State University Wexner Medical Center, Columbus, Ohio,

1

United States.

2
Department of Pharmacy, University of Toledo Medical Center,
Toledo, Ohio, United States.
*
Correspondence:
Department of Pharmacy and Pharmaceutical Sciences,
3 John Nemunaitis, MD, Gradalis, Inc, Carrollton, Texas, United
University of Toledo, Toledo, Ohio, United States. States.

4
Department of Medicine, University of Toledo, College and Life Received: 07 July 2020; Accepted: 01 August 2020
Sciences, Toledo, Ohio, United States.

5
Gradalis, Inc, Carrollton, Texas, United States.

6
SUNY Downstate Health Sciences University, Brooklyn, New
York, United States.

Citation: Yencho SW, Austin J, Betka E, et al. Cancer Healthcare Utilization Impact of Precision Therapeutics: Hospitalization/
Emergency Visits. Cancer Sci Res. 2020; 3(3): 1-3.

ABSTRACT
Recent advances in comprehensive genomic profiling (CGP) has enabled the detection of actionable mutations with
corresponding molecular targeted therapy, both rapidly and accurately. While the cost of CGP has declined, it is
still unknown how CGP through use of targeted precision therapy effects health care costs. We present evidence
for use of CGP in advanced cancer management and corresponding precision therapy to reduce total healthcare
utilization.

Keywords Moreover, fewer toxic deaths [12], cost effective health management
Cancer, Genomic profiling, Healthcare, Precision therapy. [3-5,11,13] and better health outcomes have been suggested [3].

Introduction Recent retrospective analysis of nearly 30,000 advanced cancer

Precision therapy is rapidly expanding standard of care for patients undergoing CGP testing and receiving target directed
advanced cancer in patients with a relevant molecular signal or precision therapy via FoundationOne (Foundation Medicine,
immune profile [1]. This particularly may affect later stage cancer Boston USA) assessment revealed 7.2 month overall survival
patients who have exhausted standard of care options [2]. Routine advantage compared to patients who did not undergo CGP testing
use of CGP is now standard of care for patients with advanced and/or received non-targeted systemic treatment [16]. Similarly,
cancer. Use of CGP companion diagnostics have demonstrated immune response directed precision therapy mostly related to use
statistically significant benefit in overall survival, relapse free survival of checkpoint inhibitors provided overall survival advantage of 8.5
and progression free survival involving precision therapy [3-11]. months [14].

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Results involving breast cancer screening with mammography in terms
Given advantage of CGP testing to guide optimal cancer treatment, of relationships to clinical benefit and cost. Screening with
we expanded our use of CGP testing towards routine assessment mammography of women between ages 50-69 every 2 years,
with FoundationOne CDx for new therapy consideration of has been shown to prevent one breast cancer death for every 5-9
advanced cancer patients on January 1, 2018. We compiled women screened [15,16]. Cost to payer is $11.40 per client per
objective healthcare utilization evidence retrospectively including year [17]. Whereas, CGP screening of advanced cancer patients
days of hospitalization and emergency room visits from January 1, with non-small cell lung cancer done one time with corresponding
2017 to December 31, 2017 prior to routine molecular profiling and utilization of precision therapy in management revealed similar
compared to January 1, 2018 through August 15, 2018 time period prevention of death for 1 out of 5 per CGP tested patients. Cost
after establishing use of molecular profiling with FoundationOne to payer was considerably less than mammography at $0.20 per
CDx testing in similar advanced late stage cancer patients. client per year [18].
Retrospective analysis was done using consecutive patient medical
records following site Institutional Review Board (IRB) approval. A proportion of patients at our cancer center were also able to
expand treatment options based on CGP guidance of precision
A total of 218 consecutive adult (≥ age 18) patients with advanced therapy. Reitsma et al. [19] suggested further savings involved with
cancer who received systemic therapy had records reviewed; experimental trial opportunity utilizing CGP signal guidance and
97 patients in 2017 and 86 in 2018 (35 patient records were precision drug cost transferred to sponsor. Although verification
excluded from analysis for incomplete emergency visit and/ of activity to the experimental precision therapy is not validated.
or hospitalization information). No difference in demographics Haslem et al. [4 ] published a retrospective analysis of precision
such as age, sex, race, comorbidities (congestive heart failure, therapy outcomes in community managed cancer patients without
hypertension, diabetes, COPD, or chronic kidney disease), type other standard of care options and showed correlated progression
of cancer (stage) or performance level was observed. Nineteen free survival (PFS) improvement (22.9 weeks vs. 12 weeks p <
out of 97 (20%) of patients received precision therapy related to 0.002). This approach would not be recommended in patients
CGP testing in 2017 and 26 of 86 (30%) received precision therapy with early stage disease or for those with an NCCN guideline
in 2018 (3 patients received combination precision therapy and directed therapy option. However, those patients with relevant
chemotherapy and were included in the precision therapy group). targeted clinical trial and/or palliative management options would
be a consideration. Over the next 5 years, given lower toxicity
Review of precision therapy group analysis vs. non-precision profile of precision therapeutics, use will likely be expanded to
therapy from January 1, 2017 to August 15, 2018 suggested a enable earlier stage of disease treatment. Signorovitch [6] et al.
reduction in the average number of days hospitalized per hospital and Chawla [3] et al. found CGP testing as cost effective when
stay per patient admitted in the precision therapy group compared performed early in advanced cancer diagnosis.
to non-precision therapy treated patients (3.36 (1-19) days vs. 4.7
(1-34) days, respectively). Furthermore, toxic events accessed as Conclusion
emergency room visits and acute hospitalization events, identified In conclusion, extensive cancer patient clinical benefit has been
as “total healthcare usage” revealed 35 events occurred in the 45 demonstrated in numerous trials involving CGP testing directed
precision therapy patients and 133 events occurred in the 138 patients precision therapeutics leading to FDA registration of over 100 novel
in the non-precision therapy treatment group. Fisher exact analysis precision therapeutics when based on comparison to standard non-
supported this as a significant difference (p=0.0004). Breakdown of systemic therapy. We believe these results add to accumulating
total healthcare usage parameters are shown in Table 1. evidence that routine use of CGP for cancer care management and
corresponding precision therapy will reduce healthcare cost.
Precision Therapy Non-Precision
(%) Therapy (%)
Acknowledgement
Total patients 45 138
The authors would like to acknowledge Christina Egan for her role
Patients with ER visits 8 (18) 32 (23)
in facilitating the collaboration among authors.
Patients hospitalized 14 (31) 61 (44)
Number of ER visits 10 (22) 47 (33)
Number of hospitalization events 25 (56) 86 (62) References
Table 1: Precision vs. non-precision therapy total healthcare usage
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© 2020 Yencho SW, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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