Health Care Contact Days and Outcomes in Clinical Trials vs Routine Care Among Patients With Non–Small Cell Lung Cancer
Notice bibliographique
Résumé
Importance: Although patients enrolled in trials have superior survival outcomes compared with those in routine practice, it is unknown whether such differences extend to contact days, a measure of time toxicity. Objective: To evaluate differences in contact days for patients with advanced stage non-small cell lung cancer (NSCLC) receiving care in trials or routine practice. Design, Setting, and Participants: This population-based, retrospective, matched cohort study assessed adults from Ontario, Canada, who were diagnosed with advanced-stage NSCLC between January 1, 2010, and December 31, 2017, and who died between January 1, 2010, and December 31, 2019. The maximum follow-up time from diagnosis was 2 years. Data analysis was performed from May 5, 2024, to October 22, 2024. Exposure: Patients receiving specific, systemic, palliative-intent, cancer-directed drug(s) as part of a trial were matched 1:1 with patients who received the same drug(s) after approval in routine practice in the same line of treatment. Main Outcomes and Measures: Contact days (days with in-person health care contact) were identified through administrative claims data. Models were fitted with cubic splines to describe trajectories of weekly percentage of contact days. Results: Of the 250 patients (mean [SD] age, 63.6 [9.2] years; 140 [56.0%] male), 125 were trial participants and 125 were receiving care in routine practice. Trial participants were younger (median [IQR] age, 63 [56-69] years vs 64 [58-70] years in routine care patients; standardized difference, 0.21) and had fewer comorbidities (eg, hypertension [45 (36.0%) vs 59 (47.2%); standardized difference, 0.23]). Median (IQR) contact days from diagnosis to death were higher for trial participants compared with those in routine practice (79 [62-104] vs 68 [46-98] days; standardized difference, 0.26). However, trial participants had a longer median (IQR) overall survival (eg, 12.8 [8.7-18.0] vs 10.5 [5.2-14.7] months; standardized difference, 0.46) and a slightly lower median percentage of contact days after adjusting for survival (20.3% [95% CI, 18.1%-21.7%] vs 21.2% [95% CI, 19.3%-25.7%]). During treatment, trial participants experienced a lower median percentage of contact days (18.4% [95% CI, 16.3%-20.8%] vs 25.5% [95% CI, 20.7%-30.3%]); inpatient care accounted for 18.5% (95% CI, 11.1%-29.6%) of on-treatment contact days for trial participants vs 40.0% (95% CI, 30.0%-47.6%) in routine practice. Normalized contact-day trajectories were U-shaped for all groups, with lower peaks and troughs among trial participants. Conclusions and Relevance: In this population-based cohort study, patients receiving systemic therapy as part of trials experienced a lower percentage of contact days, accounted for by greater hospitalization rates in routine practice. Addressing the predominantly outpatient, protocol-mandated visits may represent opportunities to decrease trial-related time toxicity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».