Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA.
Am J Manag Care. 2010 Jul;16(7):515-22.
To test the hypotheses that African American patients and older patients with stage IV colorectal cancer were less likely to receive newer chemotherapy agents.
Retrospective cohort design.
Among 5068 Surveillance, Epidemiology, and End Results-Medicare patients diagnosed as having stage IV colorectal cancer between 2000 and 2002, a total of 2466 received chemotherapy and were included in the analysis. Irinotecan hydrochloride was the first of the "newer" chemotherapy agents and was marketed in 2000 as a first-line add-on agent. Descriptive statistics were generated, and a multivariable logistic regression was run to estimate the odds of receiving irinotecan among African American patients and older patients and within 2 months of chemotherapy initiation.
African American patients had lower odds of initiating treatment with a newer chemotherapy than white patients (adjusted odds ratio, 0.641; 95% confidence interval, 0.453-0.907). An age disparity was also found, with all older age groups being significantly less likely to initiate treatment with a newer chemotherapy than the youngest age group: the adjusted odds of receiving newer chemotherapy agents (relative to patients aged 66-70 years) were lower and significant among patients aged 71 to 75, 76 to 80, and older than 80 years (odds ratios, 0.708, 0.527, and 0.213, respectively).
Disparities in chemotherapy selection exist among patients receiving chemotherapy for stage IV colorectal cancer. On initiating chemotherapy, African American patients and older patients were less likely to receive a newer agent.
检验以下假设，即非裔美国患者和 4 期结直肠癌老年患者接受新型化疗药物的可能性较低。
回顾性队列设计。
在 5068 例接受 Surveillance，Epidemiology，and End Results-Medicare 监测并确诊为 4 期结直肠癌的患者中，共有 2466 例患者接受了化疗并纳入分析。盐酸伊立替康是第一代“新型”化疗药物，于 2000 年上市，作为一线附加治疗药物。生成描述性统计数据，并进行多变量逻辑回归分析，以评估非裔美国患者和老年患者接受伊立替康治疗的可能性，以及在化疗开始后 2 个月内接受伊立替康治疗的可能性。
与白人患者相比，非裔美国患者接受新型化疗药物治疗的可能性较低（调整后的优势比，0.641；95%置信区间，0.453-0.907）。还发现了年龄差异，所有年龄较大的组与最年轻的年龄组相比，接受新型化疗药物治疗的可能性显著降低：与 66-70 岁年龄组相比，71-75 岁、76-80 岁和年龄大于 80 岁的患者接受新型化疗药物的调整后的优势比分别较低且具有统计学意义（比值比分别为 0.708、0.527 和 0.213）。
接受 4 期结直肠癌化疗的患者中存在化疗药物选择的差异。在开始化疗时，非裔美国患者和老年患者接受新型药物的可能性较低。
