Mount Sinai School of Medicine; Columbia University Medical Center; Bellevue Hospital Center; Harlem Hospital Center; Metropolitan Hospital Center; Montefiore Medical Center; Queens Hospital Center, New York; Elmhurst Hospital Center, Elmhurst, NY; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Rutgers, the State University of New Jersey, New Brunswick, NJ.
J Oncol Pract. 2014 Jan;10(1):48-54. doi: 10.1200/JOP.2013.000920. Epub 2013 Sep 10.
Patients with breast cancer who need adjuvant treatments often fail to receive them. High-quality, community-based patient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant therapies.
We conducted a randomized trial of 374 women (190 assigned intervention [INT], 184 to usual care [UC]) with early-stage breast cancer who underwent surgery between October 2006 and August 2009. After initial needs assessment, individualized action plans were created to connect INT patients with targeted patient-assistance programs; UC patients received an informational pamphlet. Main outcome measures were receiving adjuvant treatment and obtaining help.
High rates of INT and UC patients received treatment: 87% INT versus 91% UC women who underwent lumpectomy received radiotherapy (P = .39); 93% INT versus 86% UC women with estrogen receptor (ER) -negative tumors ≥ 1 cm received chemotherapy (P = .42); 92% INT versus 93% UC women with ER-positive tumors ≥ 1 cm received hormonal therapy (P = .80). Many women reported needs: 63% had informational; 55%, psychosocial; and 53%, practical needs. High rates of INT patients with needs connected with a program within 2 weeks (92%). At 6 months, INT and UC women used patient-assistance programs at similar rates (75% v 76%; P = .54). Women with informational or psychosocial needs were more likely to receive help (relative risk [RR], 1.77; 95% CI, 1.51 to 1.90 and RR, 1.37; 95% CI, 1.06 to 1.61, respectively).
INT and UC patients received high rates of adjuvant treatment regardless of trial assignment. Patients with breast cancer who connect to relevant patient assistance programs receive useful informational and psychosocial but not practical help.
需要辅助治疗的乳腺癌患者常常无法接受治疗。高质量、基于社区的患者援助计划是一种未被充分利用的廉价资源，可以帮助癌症患者获得所需的治疗。我们试图确定将女性与患者援助计划联系起来是否会减少辅助治疗的使用不足。
我们对 2006 年 10 月至 2009 年 8 月期间接受手术治疗的 374 名早期乳腺癌女性（190 名接受干预[INT]，184 名接受常规护理[UC]）进行了随机试验。在初始需求评估后，为 INT 患者制定了个性化行动计划，以将其与目标患者援助计划联系起来；UC 患者收到了宣传册。主要结局测量是接受辅助治疗和获得帮助。
INT 和 UC 患者接受治疗的比例很高：接受保乳手术的 INT 患者中有 87%接受了放疗，UC 患者中有 91%（P=.39）；ER 阴性肿瘤≥1cm 的 INT 患者中有 93%接受了化疗，UC 患者中有 86%（P=.42）；ER 阳性肿瘤≥1cm 的 INT 患者中有 92%接受了激素治疗，UC 患者中有 93%（P=.80）。许多女性报告了需求：63%有信息需求；55%有心理社会需求；53%有实际需求。INT 患者中有 92%在 2 周内将需求与计划联系起来的比例很高。在 6 个月时，INT 和 UC 女性使用患者援助计划的比例相似（分别为 75%和 76%；P=.54）。有信息或心理社会需求的女性更有可能获得帮助（相对风险 [RR]，1.77；95%CI，1.51 至 1.90 和 RR，1.37；95%CI，1.06 至 1.61）。
无论试验分组如何，INT 和 UC 患者接受辅助治疗的比例都很高。与相关患者援助计划联系的乳腺癌患者获得了有用的信息和心理社会支持，但没有获得实际帮助。
