Changing Treatment Paradigms for Myelodysplastic Syndromes in a Community Oncology Practice: Georgia Cancer Specialists' Experience

Abstract Background Criteria for adoption of new therapies and treatment paradigms in community oncology practices can differ substantively from that of academic medical centers. Differences arise, in part, from the influence of patient mix, available resources and services offered, physician/staff experiences, and the adherence to uniform treatment guidelines. Georgia Cancer Specialists (GCS) is a 31-site community-based group practice with 41 hematologists/oncologists motivated to standardize medical decision-making and optimize patient outcomes and health-care resource utilization. Patients and Methods Using our integrated electronic medical records and billing database (OASIS), we conducted a retrospective evaluation to assess the impact of 3 new agents (decitabine, 5-azacitidine, and lenalidomide) on practice patterns and outcomes in an elderly population with myelodysplastic syndrome (MDS) in the community setting. From January 2006 to June 2007, data from 1161 patients with MDS (mean age, 71 years; 63% women; 60% Medicare/Medicaid recipients) were collected. Of these, 76 patients (6.5%) received ≥ 1 MDS-indicated therapeutic agent (47% decitabine, 32% 5-azacitidine, 46% lenalidomide; 25% received ≥ 2 agents) for a median of 3, 2, and 3 cycles, respectively. Results In general, the data suggest that patients receiving MDS-therapeutic agents had hematologic improvement and experienced reductions in transfusion requirements. The GCS population and treatment-related data reflect the uptake of new MDS therapeutic agents introduced proactively into a real-world community oncology practice and supplements information from randomized clinical trials. Conclusion Data derived from the community setting have the potential to provide important insights about actual disease prevalence, patient demographics, factors that influence medical careseeking, clinical management, and outcomes outside of academic institutions.