Real-world risk assessment and treatment initiation among patients with myelofibrosis at community oncology practices in the United States

Srdan Verstovsek, Jingbo Yu, Jonathan K. Kish, Dilan Paranagama, Jill Kaufman, Callan Myerscough, Michael R. Grunwald, Philomena Colucci, Ruben Mesa

Research output: Contribution to journalArticle

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 physician-assigned 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.

Original languageEnglish (US)
Pages (from-to)2555-2564
Number of pages10
JournalAnnals of Hematology
Volume99
Issue number11
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Chart review
  • IPSS
  • Myelofibrosis
  • Risk stratification
  • Treatment patterns

ASJC Scopus subject areas

  • Hematology

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  • Cite this

    Verstovsek, S., Yu, J., Kish, J. K., Paranagama, D., Kaufman, J., Myerscough, C., Grunwald, M. R., Colucci, P., & Mesa, R. (Accepted/In press). Real-world risk assessment and treatment initiation among patients with myelofibrosis at community oncology practices in the United States. Annals of Hematology, 99(11), 2555-2564. https://doi.org/10.1007/s00277-020-04055-w