Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Breast Cancer Res Treat. 2011 Jun;127(2):511-20. doi: 10.1007/s10549-010-1216-1. Epub 2010 Oct 26.
Chemotherapy is vital for breast cancer management, but early onset toxicities like neutropenia hinder its administration. Primary prophylactic (PP) use of colony- stimulating factors (CSF) helps prevent neutropenia and ensures successful chemotherapy completion. Nevertheless, lack of specific guidelines for CSF administration in older patients has lead to unexplained geographic and racial, and counter-intuitive clinical variations in CSF administration. This study examined the reasons for these variations and for the first time looked at variations in PP-CSF administration and duration of administration in breast cancer patients receiving chemotherapy. This retrospective observational study of newly diagnosed breast cancer patients receiving chemotherapy used SEER-Medicare data from 1994-2003. Regression analyses were used to explore the factors associated with PP-CSF administration and duration of administration. Clinical and therapeutic characteristics previously unexplored by other studies were included. Univariate analyses demonstrated geographic, racial and clinical disparities similar to previous studies. However, clinical correlations resolved to statistical insignificance after inclusion of chemotherapy characteristics. The analysis showed that significant geographic and racial disparities existed. History of recent antibiotic use was associated with shorter PP-CSF administration. Physicians' decision to administer PP-CSF is predominantly driven by neutropenia risk associated with pre-planned chemotherapy regimen. Older, sicker women at a higher risk of neutropenia receive less intense/toxic chemotherapy and thus do not require PP-CSF. Geographic variations are driven by proportion of physicians administering PP-CSF with no evidence for overuse among specific physicians. Association of recent antibiotic use with shorter PP-CSF administration suggests intended substitution of the expensive PP-CSF with prophylactic antibiotics.
化疗对于乳腺癌的治疗至关重要，但中性粒细胞减少等早期毒性反应会妨碍化疗的进行。集落刺激因子（CSF）的预防性（PP）使用有助于预防中性粒细胞减少症并确保化疗的顺利完成。然而，由于缺乏针对老年患者 CSF 给药的具体指南，导致 CSF 给药在地域、种族和临床方面存在不合理的差异。本研究旨在探讨这些差异的原因，以及首次观察接受化疗的乳腺癌患者中 PP-CSF 给药和给药持续时间的差异。本研究回顾性观察了 1994 年至 2003 年期间接受化疗的新诊断乳腺癌患者的 SEER-Medicare 数据。回归分析用于探讨与 PP-CSF 给药和给药持续时间相关的因素。纳入了其他研究未涉及的临床和治疗特征。单变量分析显示存在与以往研究相似的地域、种族和临床差异。然而，纳入化疗特征后，临床相关性降至统计学无显著性。分析表明存在显著的地域和种族差异。近期使用抗生素的病史与 PP-CSF 给药时间缩短有关。医生是否决定给予 PP-CSF 主要取决于与预先计划的化疗方案相关的中性粒细胞减少风险。处于较高中性粒细胞减少风险的年龄较大、病情较重的女性接受的化疗毒性较低，因此不需要 PP-CSF。地域差异是由给予 PP-CSF 的医生比例驱动的，而不是特定医生过度使用的证据。近期使用抗生素与 PP-CSF 给药时间缩短相关，表明有意用昂贵的预防性 CSF 替代预防性抗生素。
