Accordino Melissa K, Wright Jason D, Vasan Sowmya, Neugut Alfred I, Hillyer Grace C, Hu Jim C, Hershman Dawn L
Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, and Dawn L. Hershman, Columbia University; and Jim C. Hu, Weill Cornell Medicine, New York, NY.
J Clin Oncol. 2016 Aug 20;34(24):2820-6. doi: 10.1200/JCO.2016.66.6313. Epub 2016 May 9.
The optimal frequency of monitoring patients with metastatic breast cancer (MBC) is unknown; however, data suggest that intensive monitoring does not improve outcomes. We performed a population-based analysis to evaluate patterns and predictors of extreme use of disease-monitoring tests (serum tumor markers [STMs] and radiographic imaging) among women with MBC.
The SEER-Medicare database was used to identify women with MBC diagnosed from 2002 to 2011 who underwent disease monitoring. Billing dates of STMs (carcinoembryonic antigen and/or cancer antigen 15-3/cancer antigen 27.29) and imaging tests (computed tomography and/or positron emission tomography) were recorded; if more than one STM or imaging test were completed on the same day, they were counted once. We defined extreme use as > 12 STM and/or more than four radiographic imaging tests in a 12-month period. Multivariable analysis was used to identify factors associated with extreme use. In extreme users, total health care costs and end-of-life health care utilization were compared with the rest of the study population.
We identified 2,460 eligible patients. Of these, 924 (37.6%) were extreme users of disease-monitoring tests. Factors significantly associated with extreme use were hormone receptor-negative MBC (odds ratio [OR], 1.63; 95% CI, 1.27 to 2.08), history of a positron emission tomography scan (OR, 2.92; 95% CI, 2.40 to 3.55), and more frequent oncology office visits (OR, 3.14; 95% CI, 2.49 to 3.96). Medical costs per year were 59.2% higher in extreme users. Extreme users were more likely to use emergency department and hospice services at the end of life.
Despite an unknown clinical benefit, approximately one third of elderly women with MBC were extreme users of disease-monitoring tests. Higher use of disease-monitoring tests was associated with higher total health care costs. Efforts to understand the optimal frequency of monitoring are needed to inform clinical practice.
转移性乳腺癌（MBC）患者的最佳监测频率尚不清楚；然而，数据表明强化监测并不能改善预后。我们进行了一项基于人群的分析，以评估MBC女性患者过度使用疾病监测检查（血清肿瘤标志物[STM]和影像学检查）的模式及预测因素。
利用监测、流行病学与最终结果-医疗保险（SEER-Medicare）数据库识别出2002年至2011年期间确诊为MBC且接受疾病监测的女性患者。记录STM（癌胚抗原和/或癌抗原15-3/癌抗原27.29）和影像学检查（计算机断层扫描和/或正电子发射断层扫描）的计费日期；如果同一天完成多项STM或影像学检查，则只计一次。我们将过度使用定义为在12个月内进行>12次STM检查和/或超过4次影像学检查。采用多变量分析确定与过度使用相关的因素。在过度使用者中，将总医疗费用和临终医疗利用情况与研究人群的其他患者进行比较。
我们确定了2460例符合条件的患者。其中，924例（37.6%）为疾病监测检查的过度使用者。与过度使用显著相关的因素包括激素受体阴性的MBC（比值比[OR]，1.63；95%置信区间[CI]，1.27至2.08）、正电子发射断层扫描史（OR，2.92；95%CI，2.40至3.55）以及更频繁的肿瘤门诊就诊（OR，3.14；95%CI，2.49至3.96）。过度使用者每年的医疗费用高出59.2%。过度使用者在临终时更有可能使用急诊科和临终关怀服务。
尽管临床获益不明，但约三分之一的老年MBC女性患者为疾病监测检查的过度使用者。疾病监测检查的更高使用频率与更高的总医疗费用相关。需要努力了解最佳监测频率，以为临床实践提供依据。
