Link B K, Budd G T, Scott S, Dickman E, Paul D, Lawless G, Lee M W, Fridman M, Ford J, Carter W B
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52242, USA.
Cancer. 2001 Sep 15;92(6):1354-67. doi: 10.1002/1097-0142(20010915)92:6<1354::aid-cncr1458>3.0.co;2-p.
Variations in practice patterns are markers for the quality of patient care in general medicine, but little is known about variation in care delivered to cancer patients. This study's purpose was to describe chemotherapy use, variations in chemotherapy delivery, and the incidence of complications in community practice settings.
Data describing adjuvant chemotherapy for patients with early-stage breast carcinoma (ESBC) were collected from an ongoing Oncology Practice Pattern Study at 13 large managed care, academic, and community practices (1111 patients). Data collection included information about diagnoses and adjuvant chemotherapy treatments, laboratory results, supportive care, complications, and treatment modifications.
The median patient age was 50 years, and most patients had zero to three positive lymph nodes. Chemotherapy regimens consisting of cyclophosphamide, methotrexate, and 5-fluororacil (CMF) and of doxorubicin and cyclophosphamide (AC) accounted for 76% of the adjuvant therapies used. Overall, 30% of patients had delivered average relative dose intensities </= 85% of the referenced targets. Delivered summation dose intensities (SDIs) frequently were well below targeted SDIs. Neutropenia-related dose modifications occurred for 27.6% of patients and recurred with a 60.7% rate. AC was the regimen delivered with a dose intensity closest to the referenced target. However, patients who were treated with AC regimens and with regimens consisting of cyclophosphamide, doxorubicin, and 5-fluorouracil had significantly higher rates of chemotherapy-related complications compared with patients who were treated with CMF regimens in the most recent treatment years.
Adjuvant chemotherapy for patients with ESBC frequently is not administered as referenced in off-protocol community settings. Variation in the delivered SDI raises concerns about potential treatment outcomes and warrants strategies to identify patients who are at risk for complications early in therapy.
实践模式的差异是普通医学中患者护理质量的标志，但对于癌症患者护理的差异了解甚少。本研究的目的是描述社区实践环境中化疗的使用情况、化疗实施的差异以及并发症的发生率。
从一项正在进行的肿瘤学实践模式研究中收集了13家大型管理式医疗、学术和社区医疗机构（1111例患者）中早期乳腺癌（ESBC）患者辅助化疗的数据。数据收集包括诊断和辅助化疗治疗、实验室结果、支持性护理、并发症以及治疗调整等信息。
患者中位年龄为50岁，大多数患者有零至三个阳性淋巴结。由环磷酰胺、甲氨蝶呤和5-氟尿嘧啶（CMF）以及阿霉素和环磷酰胺（AC）组成的化疗方案占所用辅助治疗的76%。总体而言，30%的患者平均相对剂量强度≤参考目标的85%。所给予的累积剂量强度（SDIs）经常远低于目标SDIs。27.6%的患者发生了与中性粒细胞减少相关的剂量调整，且复发率为60.7%。AC是剂量强度最接近参考目标的方案。然而，在最近治疗年份中，与接受CMF方案治疗的患者相比，接受AC方案以及由环磷酰胺、阿霉素和5-氟尿嘧啶组成的方案治疗的患者化疗相关并发症发生率显著更高。
在非协议社区环境中，ESBC患者的辅助化疗常常未按照参考方案进行。所给予的SDI存在差异，这引发了对潜在治疗结果的担忧，并且需要采取策略来在治疗早期识别有并发症风险的患者。
