Discussion
aggressive hematological cancers, hematologic malignancies
SECONDARY, HEMATOLOGIC MALIGNANCIES
In this secondary analysis of the LY.12 trial, we demonstrate that measures of time spent in healthcare can be extracted from completed RCTs. In LY.12, despite broadly comparable short- and long-term oncologic outcomes, the GDP arm experienced fewer contact days. The sources of contact days also differed between arms, with the GDP arm spending relatively more days receiving outpatient chemotherapy, and the DHAP arm spending many more days in the hospital. Such information can add help patients and care partners understand expected time use, and guide decision-making for patients with aggressive hematological cancers, who already spend a significant portion of time with healthcare contact.The primary finding of this work is that time spent undergoing treatment can be gleaned from secondary analyses of available data from previously published clinical trials. Our initial approach was to use clinical trial protocols and publications to reconstruct the course of the average patient on the trial arms, but this involved making several assumptions.These data also provide elements of detail that can help improve care for vulnerable patients. First, over the 6-10 week salvage chemotherapy period, participants in both arms spent more than one in 3 days with healthcare contact. While patients often receive extensive logistic support during and after stem cell transplant, this is not always true during salvage regimens.This work has limitations. First, the current measure itself has limitations. It currently does not consider home-based care or telemedicine visits, and does not consider care partner time use. It is currently not quality-weighted. Ongoing qualitative work is addressing this. Second, the exact date of contact for a few outpatient visits was missing. We considered these visits to be on a separate day. We were unable to capture some trial-related contact days, eg, related to screening, prior to the date of assignment. These issues applied to both arms and should not affect comparisons.In conclusion, we demonstrate that secondary analyses of a completed cooperative group trial that prospectively collected resource utilization data can be used to extract measures of time use. Data on patterns of time use in oncology clinical trial reports can supplement oncology efficacy data to aid patient-oncologist decision making, especially when differences in efficacy are small. This work is particularly relevant to people with hematologic malignancies who already face significant time with healthcare contact.