癌症 Medicare 患者中红细胞生成刺激剂使用的医师特征和变异性。
Physician characteristics and variability of erythropoiesis-stimulating agent use among Medicare patients with cancer.
机构信息
Columbia University, New York, NY, USA.
出版信息
J Clin Oncol. 2011 Sep 1;29(25):3408-18. doi: 10.1200/JCO.2010.34.5462. Epub 2011 Aug 1.
PURPOSE
Drugs are usually approved for a specific indication on the basis of randomized trials. However, once approved, these treatments are often used differently than as tested in trials. We performed an analysis to determine the patterns of use of erythropoiesis-stimulating agents (ESAs).
METHODS
We used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients age 65 years or older with breast, lung, or colon cancer diagnosed between 1995 and 2005 who had one ESA and chemotherapy claim. Associations of patient, tumor, and physician-related factors with receipt of ESAs were analyzed.
RESULTS
Of 21,091 patients analyzed, 5,099 (24.2%) received ESAs for 1 week or less (misuse), and 1,601 (7.6%) received ESAs for more than 14 weeks (prolonged use). Receipt of ESAs while not actively receiving chemotherapy (off label) occurred in 2,876 patients (13.6%). In a multivariable analysis, ESA misuse was associated with MD degree, female sex of physician, and earlier year of medical school graduation. Private practice physicians (odds ratio [OR], 0.78; 95% CI, 0.72 to 0.84) and high-volume physicians (OR, 0.78; 95% CI, 0.72 to 0.85) were less likely to use 1 week or less of ESA treatment. Treatment by high-volume oncologists (OR, 1.33; 95% CI, 1.14 to 1.55) and by oncologists who graduated from US medical schools (OR, 1.26; 95% CI, 1.12 to 1.42) predicted prolonged-duration ESA use, whereas female oncologists (OR, 0.79; 95% CI, 0.68 to 0.93) were less likely to prescribe prolonged ESA treatment. Private practice physicians (OR, 1.18; 95% CI, 1.02 to 1.38) and high-volume providers (OR, 1.58; 95% CI, 1.33 to 1.87) were more likely to prescribe more than 24 weeks of ESA treatment.
CONCLUSION
Our study demonstrated widespread variability in the use of ESAs. Physician characteristics exerted substantial influence on ESA use. Policies to discourage inappropriate use of cancer therapies are needed.
目的
药物通常是根据随机试验为特定适应症而批准的。然而，一旦获得批准，这些治疗方法的使用方式往往与试验中的使用方式不同。我们进行了一项分析，以确定促红细胞生成素刺激剂（ESA）的使用模式。
方法
我们使用监测、流行病学和最终结果-医疗保险数据库，确定了 1995 年至 2005 年间被诊断患有乳腺癌、肺癌或结肠癌且年龄在 65 岁或以上的患者，这些患者有一个 ESA 和化疗的索赔。分析了患者、肿瘤和医生相关因素与接受 ESA 之间的关联。
结果
在分析的 21091 名患者中，有 5099 名（24.2%）接受了 1 周或更短时间的 ESA（滥用），1601 名（7.6%）接受了超过 14 周的 ESA（延长使用）。在 2876 名患者（13.6%）中，在未接受化疗的情况下（标签外）接受了 ESA。在多变量分析中，ESA 滥用与 MD 学位、女性医生性别和医学院毕业较早有关。私人执业医生（比值比[OR]，0.78；95%置信区间，0.72 至 0.84）和高容量医生（OR，0.78；95%置信区间，0.72 至 0.85）不太可能使用 1 周或更短时间的 ESA 治疗。由高容量肿瘤学家（OR，1.33；95%置信区间，1.14 至 1.55）和毕业于美国医学院的肿瘤学家（OR，1.26；95%置信区间，1.12 至 1.42）治疗预测延长 ESA 治疗时间，而女性肿瘤学家（OR，0.79；95%置信区间，0.68 至 0.93）不太可能开处延长 ESA 治疗。私人执业医生（OR，1.18；95%置信区间，1.02 至 1.38）和高容量提供者（OR，1.58；95%置信区间，1.33 至 1.87）更有可能开处超过 24 周的 ESA 治疗。
结论
我们的研究表明，ESA 的使用存在广泛的差异。医生特征对 ESA 的使用有很大影响。需要制定政策来劝阻不适当的癌症治疗方法的使用。
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