Unger Joseph M, Hershman Dawn L, Martin Diane, Etzioni Ruth B, Barlow William E, LeBlanc Michael, Ramsey Scott R
Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH).
J Natl Cancer Inst. 2014 Dec 24;107(2). doi: 10.1093/jnci/dju412. Print 2015 Feb.
Diffusion of new cancer treatments can be both inefficient and incomplete. The uptake of new treatments over time (diffusion) has not been well studied. We analyzed the diffusion of docetaxel in metastatic prostate cancer.
We identified metastatic prostate cancer patients diagnosed from 1995 to 2007 using the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare database. Medicare claims through 2008 were analyzed. We assessed cumulative incidence of docetaxel by socioeconomic, demographic, and comorbidity variables, and compared diffusion patterns to landmark events including release of phase III results and FDA approval dates. We compared docetaxel diffusion patterns in prostate cancer to those in metastatic breast, lung, ovarian, and gastric cancers. To model docetaxel use over time, we used the classic "mixed influence" deterministic diffusion model. All statistical tests were two-sided.
We identified 6561 metastatic prostate cancer patients; 1350 subsequently received chemotherapy. Among patients who received chemotherapy, docetaxel use was 95% by 2008. Docetaxel uptake was statistically significantly slower (P < .01) for patients older than 65 years, blacks, patients in lower income areas, and those who experienced poverty. Eighty percent of docetaxel diffusion occurred prior to the May, 2004 release of phase III results showing superiority of docetaxel over standard-of-care. The maximum increase in the rate of use of docetaxel occurred nearly simultaneously for prostate cancer as for all other cancers combined (in 2000).
Efforts to increase the diffusion of treatments with proven survival benefits among disadvantaged populations could lead to cancer population survival gains. Docetaxel diffusion mostly preceded phase III evidence for its efficacy in castration-resistant prostate cancer, and appeared to be a cancer-wide-rather than a disease-specific-phenomenon. Diffusion prior to definitive evidence indicates the prevalence of off-label chemotherapy use.
新癌症治疗方法的传播可能既低效又不完全。随着时间推移新治疗方法的采用情况（传播）尚未得到充分研究。我们分析了多西他赛在转移性前列腺癌中的传播情况。
我们使用监测、流行病学和最终结果计划（SEER）-医疗保险数据库，确定了1995年至2007年期间诊断为转移性前列腺癌的患者。分析了截至2008年的医疗保险理赔情况。我们根据社会经济、人口统计学和合并症变量评估了多西他赛的累积发病率，并将传播模式与包括III期结果发布和FDA批准日期在内的标志性事件进行了比较。我们将前列腺癌中多西他赛的传播模式与转移性乳腺癌、肺癌、卵巢癌和胃癌中的传播模式进行了比较。为了模拟多西他赛随时间的使用情况，我们使用了经典的“混合影响”确定性传播模型。所有统计检验均为双侧检验。
我们确定了6561例转移性前列腺癌患者；其中1350例随后接受了化疗。在接受化疗的患者中，到2008年多西他赛的使用率为95%。65岁以上患者、黑人、低收入地区患者以及经历贫困的患者，多西他赛的采用在统计学上显著较慢（P < 0.01）。80%的多西他赛传播发生在2004年5月III期结果发布之前，该结果显示多西他赛优于标准治疗。前列腺癌多西他赛使用率的最大增幅与所有其他癌症合并后的情况几乎同时出现（在2000年）。
努力在弱势群体中增加已证明具有生存益处的治疗方法的传播，可能会提高癌症患者群体的生存率。多西他赛的传播大多先于其在去势抵抗性前列腺癌中疗效的III期证据，并且似乎是一种全癌性而非疾病特异性现象。在确凿证据之前的传播表明了非标签化疗使用的普遍性。
