Department of Hospital Pharmacy, Technische Universität München, Munich, Germany.
Ann Oncol. 2011 Oct;22(10):2310-9. doi: 10.1093/annonc/mdq759. Epub 2011 Feb 22.
Multidrug chemotherapy (CT) is still associated with relevant side-effects. We assessed, under current practice patterns, frequency and severity of CT-induced toxicity and its economic consequences.
Prospective, multicentre, longitudinal, observational cohort study with lymphoproliferative disorder (LPD) and non-small-cell lung cancer (NSCLC) patients, receiving first- or second-line (immuno-) CT (excluding myeloablative CT). Data were collected from patient interviews and preplanned chart reviews. Costs in 2007 euros are presented from the provider perspective.
Two hundred and seventy-three patients (n = 153 LPD; n = 120 NSCLC) undergoing a total of 1004 CT cycles were assessable (age ≥65 years, 40%; female, 36%; Eastern Cooperative Oncology Group performance status ≥2, 11%; tumour stage ≥III, 56%; history of comorbidity, 80%). Fifty percent of cycles were associated with grade 3/4 toxicity and 37% (n = 371) with at least one hospital stay (outpatient/day care n = 154; intensive care n = 19). Mean (median) toxicity-related costs amounted to €1032 (€86) per cycle. Costs rose exponentially with the number of grade 3/4 adverse drug reactions (ADRs) and were highest in cycles affected by more than four ADRs, €10 881 (€5455); in cycles with intensive care, €14 121 (€8833); and in cycles affected by grade 3/4 infections and febrile neutropenia/leukopenia, €7093 (€4531) and €5170 (€2899), respectively. Five percent of CT cycles accounted for 56% of total expenses.
Individualised supportive care strategies are needed. Future research should focus on identifying toxicity clusters and patient characteristics predictive for high costs.
多药化疗（CT）仍与相关副作用相关。我们评估了在当前实践模式下，CT 诱导的毒性的频率和严重程度及其经济后果。
这是一项前瞻性、多中心、纵向、观察性队列研究，纳入患有淋巴增生性疾病（LPD）和非小细胞肺癌（NSCLC）的患者，接受一线或二线（免疫）CT（不含骨髓清除性 CT）治疗。数据来自患者访谈和预计划的病历回顾。2007 年欧元的成本从提供者的角度呈现。
共评估了 273 名患者（LPD 患者 153 名，NSCLC 患者 120 名）共进行了 1004 个 CT 周期（年龄≥65 岁，40%；女性，36%；东部合作肿瘤学组表现状态≥2，11%；肿瘤分期≥III 期，56%；合并症病史，80%）。50%的周期与 3/4 级毒性相关，37%（n=371）至少有一次住院（门诊/日间护理 n=154；重症监护 n=19）。毒性相关的平均（中位数）成本为每个周期 1032 欧元（86 欧元）。成本随 3/4 级不良药物反应（ADR）数量呈指数级增长，在受超过 4 个 ADR 影响的周期中最高，为 10881 欧元（5455 欧元）；在受重症监护影响的周期中，为 14121 欧元（8833 欧元）；在受 3/4 级感染和发热性中性粒细胞减少/白细胞减少影响的周期中，分别为 7093 欧元（4531 欧元）和 5170 欧元（2899 欧元）。5%的 CT 周期占总费用的 56%。
需要个体化的支持性护理策略。未来的研究应侧重于确定毒性簇和预测高成本的患者特征。
