Evidence map›Paper›PMID 29623630›Full record

ArticlePharmacoEconomics - open2018

The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study.

Malek B Hannouf, Eric Winquist, Salaheddin M Mahmud, Muriel Brackstone, Sisira Sarma, George Rodrigues, Peter K Rogan, Jeffrey S Hoch, Gregory S Zaric

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PharmacoEconomics - open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
0.4field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 14 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Malek B HannoufDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada. mbassamh@uwo.ca.
Eric WinquistDepartment of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Salaheddin M MahmudDepartment of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Muriel BrackstoneDepartment of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Sisira SarmaDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada.
George RodriguesDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada.
Peter K RoganDepartment of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Jeffrey S HochInstitute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Gregory S ZaricDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada.
Western University · CACancer Care Ontario · CAUniversity of Manitoba · CAUniversity of Toronto · CA

Funding

The Canadian Institutes of Health Research (CIHR) 231890
6 · The paper itself

Abstract

purposeSeveral genomic tests have recently been developed to identify the primary tumour in cancer of unknown primary tumour (CUP). However, the value of identifying the primary tumour in clinical practice for CUP patients remains questionable and difficult to prove in randomized trials.

objectiveWe aimed to assess the clinical and economic value of primary tumour identification in CUP using a retrospective matched cohort study.

methodsWe used the Manitoba Cancer Registry to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients as having CUP if their primary tumour was found 6 months or more after initial diagnosis or never found during the course of disease. Otherwise, we considered patients to have metastatic cancer from a known primary tumour (CKP). We linked all patients with Manitoba Health databases to estimate their direct healthcare costs using a phase-of-care approach. We used the propensity score matching technique to match each CUP patient with a CKP patient on clinicopathologic characteristics. We compared treatment patterns, overall survival (OS) and phase-specific healthcare costs between the two patient groups and assessed association with OS using Cox regression adjustment.

resultsOf 5839 patients diagnosed with metastatic cancer, 395 had CUP (6.8%); 1:1 matching created a matched group of 395 CKP patients. CUP patients were less likely to receive surgery, radiation, hormonal and targeted therapy and more likely to receive cytotoxic empiric chemotherapeutic agents. Having CUP was associated with reduced OS (hazard ratio [HR] 1.31; 95% confidence interval 1.1-1.58), but this lost statistical significance with adjustment for treatment differences. CUP patients had a significant increase in the mean net cost of initial diagnostic workup before diagnosis and a significant reduction in the mean net cost of continuing cancer care.

conclusionIdentifying the primary tumour in CUP patients might enable the use of more effective therapies, improve OS and allow more efficient allocation of healthcare resources.

Identifiers

PMID29623630
PMCPMC6103931
OpenAlexW2752473968

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.