Real-world risk assessment and treatment initiation among patients with myelofibrosis at community oncology practices in
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ORIGINAL ARTICLE
Real-world risk assessment and treatment initiation among patients with myelofibrosis at community oncology practices in the United States Srdan Verstovsek 1 & Jingbo Yu 2 & Jonathan K. Kish 3 & Dilan Paranagama 2 & Jill Kaufman 3 & Callan Myerscough 3,4 & Michael R. Grunwald 5 & Philomena Colucci 2 & Ruben Mesa 6 Received: 13 April 2020 / Accepted: 22 April 2020 # The Author(s) 2020
Abstract Myelofibrosis (MF) is a chronic myeloproliferative neoplasm with a prevalence of 4 to 6 per 100,000 people in the USA. Treatment recommendations are risk-adapted. This study was conducted to evaluate how physicians risk-stratify patients at the time of MF diagnosis, the accuracy of the risk stratification, and its effect on treatment selection. Medical charts were reviewed at US community hematology/oncology practices in the Cardinal Health Oncology Provider Extended Network; patient clinical characteristics, risk stratification, and treatment data were collected. Physician-assigned risk categorizations were compared with data-derived risk categorizations based on the International Prognostic Scoring System, the system recommended at diagnosis. A total of 491 patients diagnosed with MF between 2012 and 2016 (mean [SD] age at diagnosis, 65.4 [11.8] years; 54.8% male, 69.2% with primary MF) were included. Risk categorization was not assigned for 30.1% of patients. Of the patients with a physicianassigned risk categorization (n = 343), a scoring system was used in 49.9%. Compared with data-derived risk categorizations, 42.9% of physician-assigned risk categorizations were incorrect; 85.0% of incorrect physician-assigned risk categorizations were underestimations. Notably, 38.5% of patients with data-derived intermediate- or high-risk categorizations did not initiate treatment within 120 days of diagnosis. Among patients with data-derived intermediate risk, those with an underestimated physician-assigned risk categorization were significantly less likely to receive treatment within 120 days of diagnosis (51.6% with correct physician-assigned categorization vs 18.5% with underestimated risk categorization; P = 0.0023). These results highlight the gap in risk assessment and the importance of accurate risk stratification at diagnosis. Keywords Myelofibrosis . Risk stratification . IPSS . Chart review . Treatment patterns
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04055-w) contains supplementary material, which is available to authorized users. * Srdan Verstovsek [email protected] 1
Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
2
Incyte Corporation, Wilmington, DE, USA
3
Cardinal Health Specialty Solutions, Dublin, OH, USA
4
Present address: Ohio State University, Columbus, OH, USA
5
Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
6
UT Health San Antonio Cancer Center, San Antonio, TX, USA
Background Myelofibrosis (MF) is a myeloproliferative neoplasm cha
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