Shirai Takako, Imanaka Yuichi, Sekimoto Miho, Ishizaki Tatsuro
Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Obstet Gynaecol Res. 2009 Oct;35(5):926-34. doi: 10.1111/j.1447-0756.2009.01033.x.
Evidence-based clinical practices can improve patient outcomes, especially in the area of chemotherapy. In Japan, it is not known how well physicians adhere to evidence-based chemotherapy guidelines. This study aimed to assess physician compliance with national guidelines for ovarian cancer primary chemotherapy in Japan.
Using an administrative database, we analyzed 209 cases of surgical laparotomy without neoadjuvant chemotherapy as the primary intervention for adnexal cancer. Cases were identified across seven teaching hospitals between 2003 and 2006.
Of the 136 patients receiving inpatient chemotherapy, 101 cases (74%) were treated with platinum-taxane therapy. In five hospitals, platinum-taxane therapy was used in more than 75% of patients, compared to 56% and 32% in the other two hospitals, respectively. The proportion of patients receiving paclitaxel and carboplatin concomitant therapy (TC therapy) was 67%, although significant variation was noted between hospitals (range 32% to 94%, P < 0.001). Of the 91 patients receiving TC therapy, 59 (65%) were given full-dose monthly regimens, while 32 cases (35%) were treated with divided doses weekly. Weekly TC therapy was more frequently provided in hospitals with a low volume of patients receiving TC therapy. Patients under the age of 65 receiving inpatient chemotherapy were more likely to receive full-dose regimens than patients 65 or older (68% vs 43%, P = 0.005). Publication of national treatment guidelines did not appear to substantially impact chemotherapy practice patterns.
Adherence to standardized chemotherapy was comparable to rates in European countries, although rates among hospitals differed significantly. Elderly patients were more likely to receive divided-dose regimens.
循证临床实践可改善患者预后，尤其是在化疗领域。在日本，尚不清楚医生对循证化疗指南的遵循程度如何。本研究旨在评估日本医生对卵巢癌一线化疗国家指南的依从性。
利用一个行政数据库，我们分析了209例未进行新辅助化疗的手术剖腹探查病例，这些病例作为附件癌的主要干预措施。病例来自2003年至2006年期间的七家教学医院。
在136例接受住院化疗的患者中，101例（74%）接受了铂类-紫杉烷治疗。在五家医院中，超过75%的患者使用了铂类-紫杉烷治疗，而在另外两家医院中，这一比例分别为56%和32%。接受紫杉醇和卡铂联合治疗（TC方案）的患者比例为67%，尽管各医院之间存在显著差异（范围为32%至94%，P<0.001）。在91例接受TC方案治疗的患者中，59例（65%）采用每月全剂量方案，而32例（35%）采用每周分剂量治疗。在接受TC方案治疗患者数量较少的医院中，更频繁地采用每周TC方案治疗。65岁以下接受住院化疗的患者比65岁及以上患者更有可能接受全剂量方案（68%对43%，P=0.005）。国家治疗指南的发布似乎并未对化疗实践模式产生实质性影响。
对标准化化疗的依从性与欧洲国家的比率相当，尽管各医院之间的比率存在显著差异。老年患者更有可能接受分剂量方案。
