Background: With recent advances in the treatment of non-small-cell lung cancer (NSCLC) and current fiscal constraints within publicly funded health care systems, understanding the real-world economic effect of lung cancer management has become important. The objective of the present study was to determine the costs and resources used in the management of nsclc cohorts in Ontario. Methods: Patients diagnosed between 1 April 2010 and 31 March 2015 were identified in the Ontario Cancer Registry and linked to provincial administrative databases, capturing resources such as hospitalizations, cancer clinic visits, physician services, and systemic therapies or radiotherapy. A cost-of-illness analysis using a bottom-up approach and the GETCOST macro available at ices determined the overall total and mean costs in 2017 Canadian dollars. Resource utilization results were analyzed according to the total number of encounters per resource, the number of patients using each resource, and the number of encounters per patient. A separate cost-and-resource analysis was conducted for radiotherapy. Results: The 24,729 NSCLC patients identified included 4542 with stage iii unresectable disease and 10,103 with stage iv nonsquamous disease. The overall total cost for all nsclc patients was $1.9 billion, with inpatient hospitalizations ($635.2 million), cancer clinic visits ($323.7 million), and physician services ($301.4 million) being the top cost contributors. The mean cost per patient was $76,816. The total cost of radiotherapy was $38.5 million. Conclusions: Real-world costs for the management of nsclc during the 5-year period examined were substantial, despite the fact that median survival was poor and treatment information was limited.

Background: Breast cancer (bca) is the type of cancer most frequently diagnosed among women in Canada. Breast cancer is categorized into various molecular subtypes by the expression of estrogen receptor (er), progesterone receptor (pgr), and her2 (human epidermal growth factor receptor 2). Currently, Canada has no national cancer registry with epidemiology data by subtype. Thus, we conducted a study to determine incidence, survival, and clinicopathologic characteristics by bca subtype [triple negative breast cancer (tnbc); her2+; and hormone receptor–positive (hr+), her2–] in Canadian women newly diagnosed with bca. Methods: Female patients diagnosed between 1 April 2012 and 31 March 2016 (fiscal 2012–2015) were identified in the Ontario Cancer Registry, and individual patient data were linked to data in provincial health administrative databases. Descriptive statistics and Kaplan–Meier curves were generated. Results: In this cohort, 3277 women (9.5%) had tnbc, 4902 (14.3%) had her2+ bca, and 22,247 (64.8%) had hr+, her2–breast cancer. The annual incidence was 15 per 100,000 for the tnbc group, 21–23 per 100,000 for the her2+ group, and 97–105 per 100,000 for the hr+, her2– group. The lowest median overall survival (mos) of 8.9 months was observed in women with clinical stage iv tnbc. In comparison, the mos was 37.3 months in those with her2+ disease and 35.2 months in those with and hr+, her2– metastatic bca. Conclusions: In the present study, the most recent and largest administrative database analysis of a Canadian population to date, we observed a subtype distribution consistent with previously reported data, together with comparable annual incidence and overall survival patterns.

Background: Almost half of all patients with non-small-cell lung cancer (nsclc) present with stage iv disease. The objective of the present study was to characterize treatment patterns and survival outcomes in patients with advanced nsclc. Methods: We conducted a longitudinal population-level study in patients diagnosed with stage iv nsclc in Ontario between 1 April 2010 and 31 March 2015, with follow-up to 31 March 2017 for overall survival and treatment sequence. Patients were stratified as nonsquamous or squamous histology. A sub-analysis was conducted for patients with nonsquamous histology who received targeted therapies, on the assumption that their tumours were EGFR mutation–positive (EGFRm+). Treatment patterns were determined, and survival was calculated from date of diagnosis to death or censoring. Results: Of 24,729 nsclc cases identified, stage iv disease was diagnosed in 49.2%, histology was nonsquamous in 10,103, and EGFRm+ was assumed in 508. Median patient age ranged from 69 to 72 years for the three cohorts. For patients with nonsquamous histology, palliative radiotherapy was the most frequently used first-line treatment (44.4%), followed by no treatment (26.7%) and chemotherapy (14.9%). In the EGFRm+ cohort, 75.6% received gefitinib as first- or second-line therapy, and almost half (47.4%) the 473 patients with squamous histology treated with first-line chemotherapy received cisplatin or carboplatin with gemcitabine. Median overall survival in the nonsquamous and squamous cohorts was 4.9 and 4.6 months respectively; it was 17.6 months for patients who were EGFRm+. Conclusions: Survival of patients with stage iv nsclc remains poor, with the exception of patients who are EGFRm+. Only 14.9% of patients received first-line chemotherapy; the mainstay of treatment was palliative radiotherapy.

Background: The management of unresectable stage iii non-small-cell lung cancer (NSCLC) is complex and best determined through multidisciplinary consultation. A longitudinal, population-level study was carried out to describe the management approach and outcomes of treatment in the real-world setting in Ontario. Methods: Individuals diagnosed with nsclc between 1 April 2010 and 31 March 2015 were identified in the Ontario Cancer Registry. Unresectable disease was defined as no surgery reported within 3 months of diagnosis. Initial treatments included radiotherapy (RT, curative or palliative), chemotherapy, targeted therapy, and chemoradiation [CRT, concurrent (cCRT) or sequential (sCRT)]. Survival was calculated from diagnosis with stage III disease to death or last follow-up. Results: Of the 24,729 individuals diagnosed with nsclc, 5243 (21.2%) had stage iii disease, with most of the latter group (4542, 86.6%) having unresectable disease. Median age was 70 years, and 54.2% were men. The frequency of first-line treatment was cCRT, 22.1%; palliative rt, 21.0%; curative rt, 19.6%; no treatment, 19.6%; chemotherapy alone, 11.6%; sCRT, 5.4%; and targeted therapy, 0.7%. Median overall survival (mOS) was 14.2 months [95% confidence interval (CI): 13.6 months to 14.7 months], with the longest survival observed in patients who received targeted therapy (mOS: 34.7 months; 95% CI: 21.4 months to 51.2 months), and the poorest, in those receiving no cancer treatment (mOS: 5.9 months; 95% CI: 5.0 months to 6.4 months). The mOS in patients receiving cCRT was 23.6 months (95% CI: 21.4 months to 25.6 months). Conclusions: Guideline-recommended cCRT is undertaken in only a small proportion of patients with unresectable NSCLC in Ontario. The reasons for low uptake of that recommendation are only partly understood.

Objective: Systemic sclerosis (SSc) is a rare autoimmune disease. Pulmonary complications of SSc are some of the leading causes of morbidity and mortality. The objective of this study was to determine prevalence and survival estimates of SSc and SSc with interstitial lung disease (SSc-ILD) in the Canadian province of Ontario using administrative data over 10 years.Methods: Using International Classification of Diseases, 10th revision codes adapted for Canada (ICD-10-CA), adult patients diagnosed with SSc and SSc-ILD between April 1, 2008, and March 31, 2018, were identified from the National Ambulatory Care Reporting System and the Discharge Abstract Database administrative databases. SSc was identified first, and ILD was included if presence occurred after SSc diagnosis. Prevalence estimates were determined for both SSc and SSc-ILD. For survival rates, Kaplan-Meier survival curves were generated.Results: At the start of the 2017/18 fiscal year (final year of the cohort), there were 2114 prevalent SSc cases for a cumulative prevalence of 19.1 per 100,000 persons, as well as 257 prevalent cases of SSc-ILD that generated a prevalence of 2.3 cases per 100,000 persons. Mean ages were 57 and 58 years with 84% and 80% females for patients with SSc and SSc-ILD, respectively. One-, 5-, and 10-year survival rates were 85.0%, 64.5%, and 44.9% for the SSc group and 77.1%, 44.4%, and 22.0% for the SSc-ILD group, respectively.Conclusion: To our knowledge, this study provides the first population-based estimates of SSc and SSc-ILD in Canada for prevalence and survival. Results confirm that the prevalence estimates of SSc-ILD fall within the Canadian threshold for rare disease. It also demonstrates the poor survival in SSc, especially when ILD is also present.

Background: In 2020, approximately 3100 Canadian women were diagnosed with ovarian cancer (OC), with 1950 women dying of this disease. Prognosis for OC remains poor, with 70% to 75% of cases diagnosed at an advanced stage and an overall 5-year survival of 46%. Current standard of care in Canada involves a combination of cytoreductive surgery and platinum-based chemotherapy. Objective: There are few studies reporting current OC costs. This study sought to determine patient characteristics and costs to the health system for OC in Ontario, Canada. Methods: Women diagnosed with OC in Ontario between 2010 and 2017 were identified. The cohort was linked to provincial administrative databases to capture treatment patterns, survival, and costs. Overall total and mean cost per patient (unadjusted) were reported in 2017 Canadian dollars, using a macro-based costing methodology called GETCOST. It is programmed to determine the costs of short-term and long-term episodes of health-care resources utilized. Results: Of the 2539 OC patients included in the study, the mean age at diagnosis was 60.4±11.35 years. The majority were diagnosed with stage III disease (n=1247). The only treatment required for 74% of stage I patients and 54% of stage II patients was first-line (1L) platinum chemotherapy; in advanced stages (III/IV) 24% and 20%, respectively, did not receive further treatment after 1L therapy. The median overall survival (mOS) for the whole cohort was 5.13 years. Survival was highest in earlier stage disease (mOS not reached in stage I/II), and dropped significantly in advanced stage patients (stage III: mOS=4.09 years; stage IV: mOS=3.47 years). Overall mean costs in patients stage I were CAD $58 099 compared to CAD $124 202 in stage IV. Discussion: The majority of OC patients continue to be diagnosed with advanced disease, which is associated with poor survival and increased treatment costs. Increased awareness and screening could facilitate diagnosis of earlier stage disease and reduce high downstream costs for advanced disease. Conclusion: Advanced OC is associated with poor survival and increased costs, mainly driven by hospitalizations or cancer clinic visits. The introduction of new targeted therapies such as olaparib could impact health system costs, by offsetting higher downstream costs while also improving survival.