The Cancer Consortium (Text Version)

---

On September 14, 2009, Deborah Schrag made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1 MB).

---

Slide 1

The Cancer Consortium

Deborah Schrag, MD (PI)
Caprice Christian Greenberg, MD, MPH

Brigham and Women's Hospital
Dana-Farber Cancer Institute
 

 

Slide 2

Why Cancer?

• Burden
  • 1.4 million new cancer cases in 2008
  • 566,000 cancer deaths
• Costly
  • Cancer treatment ~5% national health expenditures
• Variation in treatment
• Small efficacy trials can lead to FDA approval of new agents with uncertain effectiveness in the broader population
• Not all interventions are evaluated with RCTs

 

Slide 3

The Goals

• How do we move from the evidence base provided by efficacy trials to "non-trial" cancer population?
• Provide expertise in and advance the development of CER in cancer
• Ensure stakeholder input
• Assist AHRQ and policymakers in prioritizing cancer-related research

 

Slide 4

Consortium Structure

• Data Committee
• Clinical Committee
• Methods Committee
• Stakeholder Committee

• Executive Committee
• AHRQ
• BWH/DFCI
• UNC

 

Slide 5

Cancer Consortium

• Coordinating Center
  • Brigham and Women's Hospital and the Dana-Farber Cancer Institute
  • Deborah Schrag, CAN DEcIDE PI
  • Sebastian Schneeweiss, DEcIDE PI
  • Caprice Greenberg MD, Lead Stakeholder Input
• Affiliate Center
  • University of North Carolina
  • Michael Murray, DEcIDE PI
  • William Carpenter, PhD, CAN DEcIDE PI

 

Slide 6

Current Work Assignments

1. Chemotherapy for stage III/IV colorectal cancer in diverse populations
2. Analytic Briefs for Supporting Comparative Effectiveness Research and Systematic Reviews in Cancer
3. Stakeholder Support and Meeting
4. Biologic therapy in colorectal cancer
5. Anticoagulation for Venous Thromboembolic Events in Patients with Cancer

 

Slide 7

Current Work Assignments

1. Chemotherapy for stage III/IV colorectal cancer in diverse populations
2. Analytic Briefs for Supporting CER and Systematic Reviews in Cancer
3. Stakeholder Support and Meeting
4. Biologic therapy in colorectal cancer
5. Anticoagulation for Venous Thromboembolic Events in Patients with Cancer

 

Slide 8

Analytic Briefs for Supporting Comparative Effectiveness Research and Systematic Reviews in Cancer

 

Slide 9

Phase 1: Identifying Options for Implementation

• Identification of prospective drugs, devices and diagnostics for study
• Identification of prospective datasets for examination of these interventions
• Development and refinement of reporting format that is most conducive to stakeholder uptake of analysis results

 

Slide 10

Phase 1: Identifying Options for Implementation

• Identification of prospective drugs, devices and diagnostics for study
  • High-risk drugs
  • Drugs that build to high-volume utilization
  • Those that are more expensive than alternatives
• Identification of prospective datasets for examination of these interventions
• Development and refinement of reporting format that is most conducive to stakeholder uptake of analysis results

 

Slide 11

Phase 1: Identifying Options for Implementation

• Identification of prospective drugs, devices and diagnostics for study
• Identification of prospective datasets for examination of these interventions
  • SEER-Medicare
  • CanCORS
  • Carolina Mammography Registry
• Development and refinement of reporting format that is most conducive to stakeholder uptake of analysis results

 

Slide 12

Phase 1: Identifying Options for Implementation

• Identification of prospective drugs, devices and diagnostics for study
• Identification of prospective datasets for examination of these interventions
• Development and refinement of reporting format that is most conducive to stakeholder uptake of analysis results
  • Real-time reports (ongoing monitoring)
  • Final reports (drug effectiveness review)

 

Slide 13

Phase 2: Topic Generation for
CE Analysis

• Criteria for selection
  • Impact in terms of number of lives with special consideration of the impact for federal programs Medicare and Medicaid
  • Feasibility in terms of data sources available within rapid time frame of DEcIDE contract
  • Team's own level of interest, expertise and enthusiasm for conducting these analyses

 

Slide 14

Phase 2: Topic Generation for CE Analysis

• Examples of potential topics
  • LMWH v. Coumadin to prevent recurrent VTE for advanced cancer patients
  • Chemoprevention of Breast Cancer
    • No treatment, Tamoxifen, Raloxifene, Letrozole
  • G-CSF v. no G-CSF for prophylaxis against febrile neutropenia that are moderately myelosupressive

 

Slide 15

Phase 2: Topic Generation for CE Analysis

• Additional topics generated
  • Prevention
    • Smoking cessation treatments
  • Diagnoses
    • Different technologies for breast cancer screening (mammogram v. MRI)
  • Treatment
    • Brachytherapy v. standard v. proton beam radiation for prostate cancer
  • Supportive Care
    • Zyprexa for palliation of symptoms at the close of life

 

Slide 16

Stakeholder Support and Meeting

 

Slide 17

Main Objective

• Identify and convene a stakeholder committee
• Develop research protocol concepts for the highest impact areas to be addressed in cancer CER

 

Slide 18

Stakeholder Committee

• Fall, 2009 - Kick-off meeting
  • Assemble the constituency
  • Determine proposed role in future CE studies
  • Generate and prioritize proposed research topics
• Spring, 2010 - Follow-up meeting
  • Review and refine proposed topics
  • Identify top priority areas for CER by consortium
• Infrastructure will allow ongoing collaboration and continuous interfacing with stakeholders

 

Slide 19

Stakeholder Examples - 1

• Federal Agencies
  • National Cancer Institute
  • Center for Disease Control
  • Center for Medicare and Medicaid
• Payors
  • Blue Cross/Blue Shield
  • Hospital Corporation of America
  • Cancer Research Network
  • UnitedHealth Group

 

Slide 20

Stakeholder Examples - 2

• Professional Societies
  • American Cancer Society
  • American Society of Clinical Oncology
  • American College of Surgeons
  • Society of Surgical Oncology
  • American Society of Therapeutic Radiation and Oncology
  • Oncology Nursing Society
  • American Society for Clinical Pathology

 

Slide 21

Plan for Development

• Stage 1: Prioritized list of topics
  • Generated at the Stakeholder Meeting #1
• Stage 2: Project proposals
  • Each priority topic will be developed into a 1 page summary by the study team
  • Presented for feedback at Stakeholder Meeting #2
• Stage 3: Research protocol concepts

 

Slide 22

Deliverables

• CER Protocol Concepts
  • Designed to develop scientific evidence that will meet the needs of defined stakeholders for decision making, whether at the patient, clinician or policy level
  • Submitted to AHRQ for peer review and potentially public review
  • Research to be carried out by the Consortium, other DEcIDE Centers or through other AHRQ programs