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• W4381620072 abstract "Background Population-based studies evaluating outcomes for metastatic upper tract urothelial carcinoma (mUTUC) are sparse and rarely capture both patients with de novo (synchronous) metastases and those who progress to metastatic disease (metachronous). Herein we evaluated the outcomes and costs associated with synchronous and metachronous mUTUC, utilizing a novel Methodology. Additionally, we created a guideline-based quality score to improve care in this space. Patients and Methods We identified all patient with mUTUC aged 66 years and older included in the SEER-Medicare linked database between 2004 and 2012. Achievement of three quality criteria was assessed: 1) cancer-specific survival (CSS)>12 months; 2) receipt of systemic therapy; 3) receipt of hospice/palliative care. Total healthcare and out-of-pocket costs were evaluated. Regression analyses were performed to assess characteristics associated with quality criteria and total healthcare costs. Results Of the 1,223 patients identified, at least one quality criterion was met in just 40.2% and only 54 patients (4.4%) received palliative care. In multivariable analysis, patients with synchronous mUTUC (OR:0.55, 95%CI:0.41–0.72), and at least 3 comorbidities (OR:0.68, 95%CI:0.47–0.98) were less likely to achieve at least one quality criterion. Meeting at least one quality criterion was associated with increased costs ($94,677, 95%CI:87,702–101,652 vs. $63,575, 95%CI:59,598–67,552). Conclusions Less than half of patients with mUTUC met at least one quality criterion. Quality score achievement was associated with a modest increase in total healthcare spending. These findings not only provide guidance for future study of rare diseases using secondary data, but also highlight inadequacies in the current management of mUTUC. MicroAbstract Comprehensive analyses including both metachronous and synchronous metastatic upper tract urothelial carcinoma are limited. In this retrospective cohort study, we evaluated oncologic outcomes and costs associated with management of metastatic upper tract disease using the SEER-Medicare database and evaluated quality of care in this space using a novel and easily applied metric. Less than half of patients met quality care criteria. Those that did meet criteria experienced longer overall survival at marginally increased costs." @default.
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• W4381620072 date "2023-06-01" @default.
• W4381620072 modified "2023-10-16" @default.
• W4381620072 title "A SEER-Medicare Based Quality Score for Patients With Metastatic Upper Tract Urothelial Carcinoma" @default.
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• W4381620072 doi "https://doi.org/10.1016/j.clgc.2023.06.010" @default.
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