College of Physicians and Surgeons, Columbia University; Mailman School of Public Health, Columbia University; New York Presbyterian Hospital; and St Luke's-Roosevelt Hospital Center, New York, NY.
J Oncol Pract. 2012 May;8(3):156-63. doi: 10.1200/JOP.2011.000371. Epub 2012 Jan 11.
In 2004, the US Food and Drug Administration approved bevacizumab and oxaliplatin for use in metastatic colon cancer and oxaliplatin for localized colon cancer. We investigated the diffusion and predictors of use of these medications in the year after approval.
We used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients older than 65 years diagnosed with stages III and IV colon cancer in 2005. Characteristics of the treating oncologists were identified using the American Medical Association database. We used logistic regression and generalized estimating equations to analyze factors associated with bevacizumab and oxaliplatin use.
Among 1,547 patients with stage III colon cancer who had claims submitted by oncologists, 801 (51.8%) received adjuvant chemotherapy, and of those, 432 (54.1%) received oxaliplatin, whereas 54 (6.7%) received off-label bevacizumab. Among 859 patients with stage IV disease who saw oncologists, 435 (50.6%) received chemotherapy, and of those, 310 (71.3%) received bevacizumab, 289 (66.4%) received oxaliplatin, and 357 (82.1%) received oxaliplatin and/or irinotecan. Older patient age and more comorbidities were associated with nonreceipt of oxaliplatin for stage III disease and oxaliplatin and/or irinotecan for stage IV disease. Having a physician who graduated medical school after 1975 predicted receipt of both adjuvant oxaliplatin (odds ratio [OR], 1.65; 95% CI, 1.11 to 2.45) and oxaliplatin and/or irinotecan for stage IV disease (OR, 2.43; 95% CI, 1.47 to 4.01). None of the factors analyzed predicted bevacizumab receipt.
Uptake of new chemotherapy drugs for patients diagnosed with stages III and IV colon cancer in 2005 was rapid. Physician characteristics were consistently associated with this uptake.
2004 年，美国食品和药物管理局批准贝伐单抗和奥沙利铂用于转移性结肠癌，以及奥沙利铂用于局限性结肠癌。我们调查了这些药物在批准后一年内的使用情况及其扩散情况和预测因素。
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 2005 年被诊断患有 III 期和 IV 期结肠癌且年龄超过 65 岁的患者。使用美国医学协会数据库确定治疗肿瘤学家的特征。我们使用逻辑回归和广义估计方程分析与贝伐单抗和奥沙利铂使用相关的因素。
在 1547 名患有 III 期结肠癌且有肿瘤学家提出索赔的患者中，801 名（51.8%）接受了辅助化疗，其中 432 名（54.1%）接受了奥沙利铂治疗，而 54 名（6.7%）接受了贝伐单抗的标签外治疗。在 859 名患有 IV 期疾病并接受肿瘤学家治疗的患者中，435 名（50.6%）接受了化疗，其中 310 名（71.3%）接受了贝伐单抗治疗，289 名（66.4%）接受了奥沙利铂治疗，357 名（82.1%）接受了奥沙利铂和/或伊立替康治疗。患者年龄较大和合并症较多与 III 期疾病未接受奥沙利铂治疗以及 IV 期疾病未接受奥沙利铂和/或伊立替康治疗有关。毕业于 1975 年后的医生预测会接受辅助奥沙利铂治疗（比值比 [OR]，1.65；95%置信区间，1.11 至 2.45）和 IV 期疾病的奥沙利铂和/或伊立替康治疗（OR，2.43；95%置信区间，1.47 至 4.01）。分析的所有因素均未预测贝伐单抗的使用。
2005 年被诊断患有 III 期和 IV 期结肠癌的患者迅速采用了新的化疗药物。医生的特征始终与这种采用相关。
