Dobie Sharon A, Baldwin Laura-Mae, Dominitz Jason A, Matthews Barbara, Billingsley Kevin, Barlow William
Department of Family Medicine, University of Washington, Seattle, WA 98195-6390, USA.
J Natl Cancer Inst. 2006 May 3;98(9):610-9. doi: 10.1093/jnci/djj159.
Certain factors, such as race or age, are known to be associated with variation in initiation of adjuvant chemotherapy for stage III colon cancer, but little is known about what factors are associated with completion of adjuvant therapy. To determine whether predictors of initiation also predict completion, we analyzed Surveillance, Epidemiology, and End Results (SEER) program data linked to Medicare claims. We investigated mortality as a means to testing the validity of the completion measure that we created.
We studied 3193 stage III colon cancer patients whose diagnosis was recorded in 1992-1996 SEER program data linked to 1991-1998 Medicare claims and who initiated adjuvant chemotherapy after colon cancer resection. We defined a measure of adjuvant chemotherapy completion as one chemotherapy administration claim in a month. We tested the validity of the created measure and its relation to 3-year cancer mortality adjusted for demographic, clinical, and environmental variables. We explored the association of patient characteristics and treating physician characteristics with chemotherapy completion by use of multivariable logistic regression modeling.
Of the 3193 patients, 2497 (78.2%) completed the course. Risk of cancer-related mortality was statistically significantly lower among those completing chemotherapy (relative risk = 0.79, 95% confidence interval = 0.69 to 0.89) than those with no adjuvant therapy. Patients who were female, widowed, increasingly elderly, rehospitalized, and living in certain regions were less likely to complete adjuvant chemotherapy than other patients. Race and other clinical, environmental, and physician characteristics were not associated with completion of therapy.
Factors associated with incomplete adjuvant chemotherapy may represent physical frailty, treatment complications, and lack of social and psychological support. Interventions to mitigate these influences are a logical next step toward increasing chemotherapy completion rates.
已知某些因素，如种族或年龄，与III期结肠癌辅助化疗起始的差异相关，但对于哪些因素与辅助治疗的完成相关却知之甚少。为了确定起始治疗的预测因素是否也能预测治疗的完成情况，我们分析了与医疗保险理赔数据相链接的监测、流行病学和最终结果（SEER）项目数据。我们将死亡率作为检验我们所创建的治疗完成指标有效性的一种手段进行了研究。
我们研究了3193例III期结肠癌患者，这些患者的诊断记录于1992 - 1996年SEER项目数据中，并与1991 - 1998年医疗保险理赔数据相链接，且在结肠癌切除术后开始了辅助化疗。我们将辅助化疗完成情况定义为一个月内有一次化疗给药理赔记录。我们检验了所创建指标的有效性及其与经人口统计学、临床和环境变量调整后的3年癌症死亡率之间的关系。我们通过多变量逻辑回归模型探讨了患者特征和治疗医生特征与化疗完成情况之间的关联。
在这3193例患者中，2497例（78.2%）完成了疗程。完成化疗的患者中癌症相关死亡风险在统计学上显著低于未接受辅助治疗的患者（相对风险 = 0.79，95%置信区间 = 0.69至0.89）。女性、丧偶、年龄较大、再次住院以及居住在某些地区的患者比其他患者完成辅助化疗的可能性更小。种族以及其他临床、环境和医生特征与治疗的完成情况无关。
与辅助化疗未完成相关的因素可能代表身体虚弱、治疗并发症以及缺乏社会和心理支持。减轻这些影响的干预措施是提高化疗完成率的合理下一步举措。
