Findings show clinical trial participation is not associated with suboptimal end of life care outcomes

To address a gap in knowledge surrounding clinical trial participation impacts on unplanned healthcare utilization and hospice enrollment in adults with cancer, investigators from The US Oncology Network (The Network), the largest organization of its kind dedicated to advancing local cancer care and better patient outcomes, evaluated the episode claims from a prospective longitudinal observational cohort of 121,717 patients receiving cancer care. All patients were from within The Network and participating in the oncology care model (OCM), an alternative payment model pilot from the Centers for Medicare and Medicaid Services (CMS) to promote quality cancer care while reducing costs. Of the patients assessed, 94% were over 65 years of age. The results indicated that:

• Patients enrolled in clinical trials did not have significantly more emergency room or observational visits (23.4%, p 0.11) compared to those not in clinical trials (22.3%).
• Hospitalization rates were significantly higher in clinical trial enrollees compared to patients receiving usual care (25.9% versus 21.9%, p <0.001).
• Clinical trial participants were no less likely (56.8%, p 0.13) to enroll in hospice three or more days prior to their death compared to patients receiving usual care (52.6%).
• Clinical trial participants had significantly higher per-episode savings against the benchmark price ($4,816, p<0.0001) compared to patients receiving usual care ($826).

“There is a perception that older adults with cancer who take part in clinical trials have suboptimal end of life outcomes or that participation in clinical trials may adversely impact cost of care and performance in novel payment models such as the OCM, a perception that results in clinical trial access barriers,” said co-first author Puneeth Indurlal, MD, MS, MBBS, senior director of Care Transformation for The Network. “The findings demonstrate that while more hospitalizations were observed, clinical trial participation is not associated with suboptimal end of life care when it comes to hospice enrollment and duration or increased emergency room and healthcare utilization. In fact, clinical trial participants saw relative cost savings against the benchmark compared to patients receiving usual care in the OCM. These data highlight that clinical trial participation for older cancer patients should not be ruled out of a treatment plan while participating in novel payment models.”

Study Methodology

A prospective longitudinal observational cohort of patients were identified who were cared for in 11 states within 323 clinics in 14 multi-site community practices in The Network participating in the OCM. Data (episode claims, medical records, episodes) were extracted from OCM performance periods (PP) 3-11 between July 1, 2017, and June 30, 2022. Propensity score matching by PP, age, gender, date of death, and cancer type identified the analysis cohort of matched episodes. The cohort was then stratified by trial participation (clinical trial participation vs usual care) to compare total cost of care (TCOC), drug expenditures, hospice care, unplanned healthcare utilization (ER visits), and hospitalizations.

Results from this study were presented in a rapid oral presentation at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

Other Research and Additional Activity at ASCO 2024

The Network is presenting 14 studies at ASCO 2024. The research spans clinical, operational, and financial domains, with key topics including the impact of biosimilars, understanding the nuances of novel payment models, assessing the drug cost trends for key therapeutic agents in oncology, and the impact of the integration of remote clinical oncology pharmacists into routine precision medicine. Click here for a brochure of all The Network’s presentations at ASCO 2024.

“It is important to measure and understand the effects that emerging products, pricing, and support have on patients in the community setting to ensure a more holistic approach to cancer care,” said Marcus Neubauer, MD, chief medical officer, The Network. “The research completed in the community provides unique insights into the challenges and impact of cancer care delivery outside more traditional academic settings, and we’re proud of the presentations selected for inclusion at this year’s ASCO Annual Meeting.”

The Network is supported by McKesson, which has an unmatched portfolio of oncology businesses and partners that provide research, insights, technologies, and services that are helping address barriers and improve cancer and specialty care. At ASCO, McKesson-supported businesses including The Network, Ontada, and Sarah Cannon Research Institute (SCRI), are part of more than 160 abstracts and presentations. These are inclusive of oral and poster presentations, educational sessions, late-breaking studies, and early-phase studies. Click here for a full list of SCRI-affiliated studies and presentations and here for Ontada-affiliated abstracts.

Additionally, McKesson participated in two thought leadership panels. Michelle Lockyer, chief strategy officer of Oncology for McKesson, participated in a McKinsey-hosted panel titled, “The Heart of the Matter – Themes in Patient Centricity,” on May 31. Michelle brought her perspective on how the patient experience in oncology trials can be improved.

McKesson and The Network will also be taking part in a panel hosted by Endpoints on June 4, 11:00 a.m.-11:30 a.m. CDT to discuss, “Overcoming Access Challenges in Cancer Care.” Jason Hammonds, chief operating officer, Oncology & Specialty, McKesson, and Dr. Ishwaria Subbiah, executive director of Cancer Care Equity and Professional Wellness, SCRI, and medical director of Supportive Care Oncology, Health Equity & Professional Well-being, The Network, will be participating in this live event with two external experts. Click here to register.

About The US Oncology Network

Every day, The US Oncology Network (The Network) helps approximately 2,600 independent providers deliver value-based, integrated care to patients — close to home. Through The Network, these independent doctors come together to form a community of shared expertise and resources dedicated to advancing local cancer care and to delivering better patient outcomes. The Network provides practices with access to coordinated resources, best business practices, and the experience, infrastructure, and support of McKesson Corporation. This collaboration allows the providers in The Network to focus on the health of their patients, while McKesson focuses on the health of their practices. The Network is committed to the success of independent practices, everywhere.

About McKesson Oncology and Specialty Solutions

It’s an unprecedented time for patients living with cancer as life sciences companies race to create new, cutting-edge therapies. With cancer care becoming more targeted, providers, life sciences companies, and payers face a multitude of challenges and complexity in the development of new treatments and making them accessible to patients in need. At McKesson, our unmatched portfolio of oncology businesses and partners provide research, insights, technologies, and services that are helping to address these hurdles and improve cancer and specialty care.

• McKesson is fueling discovery by helping patients participate in cutting-edge clinical trials closer to home through the joint venture between US Oncology Research and Sarah Cannon Research Institute.
• The US Oncology Network and McKesson Provider Solutions are advancing specialty care and high-quality cancer care in the communities where patients live by supporting the practices of thousands of independent, community-based providers.
• Ontada^®, a McKesson business dedicated to oncology, generates real-world data (RWD) and real-world evidence (RWE), and provides clinical education and provider technology to inform and improve cancer care.
• As one of the largest distributors of oncology and specialty medicines, we are ensuring medicines make their way to those who are counting on them.
• And through CoverMyMeds, Biologics by McKesson, and GPO services, our work continues to help patients access, afford, and adhere to their medicines. 

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