title: Use of Bevacizumab in Community Settings: Toxicity Profile and Risk of Hospitalization in Patients With Advanced Non-Small-Cell Lung Cancer.
abstract: OBJECTIVE
  Little is known regarding toxicities and hospitalizations in community-based settings for patients with advanced non-small-cell lung cancer (NSCLC) who received commonly prescribed carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) chemotherapy.
  
  
  METHODS
  Patients with stages IIIB-IV NSCLC age ≥ 21 years diagnosed between 2005 and 2010 who received first-line CP or CPB were identified at four health maintenance organizations (N = 1,109). Using patient and tumor characteristics and hospital and ambulatory encounters from automated data in the 180 days after chemotherapy initiation, the association between CP and CPB and toxicities and hospitalizations were evaluated with χ(2) tests and propensity score-adjusted regression models.
  
  
  RESULTS
  Patients who received CPB were significantly younger and had significantly more bleeding, proteinuria, and GI perforation events (all P < .05). For these patients, the unadjusted odds ratio associated with the likelihood of having a hospitalization was 0.46 (95% CI, 0.32 to 0.67). As shown by multivariable and propensity score-adjusted models, patients who received CPB were less likely to have been hospitalized (odds ratio, 0.48; 95% CI, 0.32 to 0.71) and had fewer total hospitalizations (rate ratio, 0.62; 95% CI, 0.47 to 0.82) and hospital days (rate ratio, 0.53; 95% CI, 0.47 to 0.60) than patients who received CP.
  
  
  CONCLUSIONS
  Consistent with earlier randomized clinical trials, significantly more toxicity events were identified in patients treated with CPB. However, both unadjusted and adjusted models showed that patients who received CPB were less likely than patients who received CP to experience a hospital-related event after the initiation of chemotherapy. Findings here confirm the need for adherence to clinical recommendations for judicious use of CPB, but provide reassurance regarding the relative risk for hospitalizations.
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA Nikki.M.Carroll@kp.org.
authors.forename: Nikki M
authors.initials: NM
authors.lastname: Carroll
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Alex
authors.initials: A
authors.lastname: Menter
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kushi
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Aiello Bowles
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Loggers
authors.affiliation: Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab