Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
Oncol Res Treat. 2016;39(7-8):417-22. doi: 10.1159/000447280. Epub 2016 Jun 29.
The present study was designed to obtain insights into guideline adherence regarding the use of expensive drugs in The Netherlands in daily practice and into the patients' perspective on the decision-making process.
A retrospective review of medical charts regarding the use of trastuzumab in early and metastatic breast cancer (EBC/MBC) and bortezomib in multiple myeloma (MM) was conducted. Prescription according to clinical practice guidelines was assessed. The review was supplemented with patient interviews.
Of 702 adjuvant-treated EBC patients, 97% had a documented human epidermal growth factor receptor 2 (HER2) testing (23% HER2 positive). 92% (147/160) of the HER2-positive EBC patients were treated with trastuzumab. Of 594 MBC patients, 81% had a documented HER2 testing (19% HER2 positive). 82% (75/91) of the HER2-positive MBC patients were treated with trastuzumab. Of 68 MM patients, 50% were treated with bortezomib. Reasons not to treat were consistent with the guidelines. Patients were generally satisfied with the decision-making process; improvements in patient education were suggested (e.g., repeating the information given, adding information on side effects).
Guidelines were generally well followed with respect to trastuzumab and bortezomib, indicating that funding did not influence the treatment decisions of physicians. In view of the growing numbers of both cancer patients and expensive new anticancer drugs, and increasing budget constraints, it is unclear whether the present-day policies will guarantee a similar level of guideline adherence. Patient involvement in decision-making could be increased by improving the patient education on treatment.
本研究旨在深入了解荷兰在日常实践中昂贵药物使用的指南遵循情况，以及患者对决策过程的看法。
对早期和转移性乳腺癌（EBC/MBC）中曲妥珠单抗和多发性骨髓瘤（MM）中硼替佐米的使用进行了回顾性病历审查。评估了根据临床实践指南开具的处方。审查工作补充了患者访谈。
在 702 例辅助治疗 EBC 患者中，97%有记录的人表皮生长因子受体 2（HER2）检测（23%HER2 阳性）。92%（147/160）HER2 阳性 EBC 患者接受了曲妥珠单抗治疗。在 594 例 MBC 患者中，81%有记录的 HER2 检测（19%HER2 阳性）。82%（75/91）HER2 阳性 MBC 患者接受了曲妥珠单抗治疗。在 68 例 MM 患者中，有 50%接受了硼替佐米治疗。不治疗的原因与指南一致。患者对决策过程普遍满意；建议改进患者教育（例如，重复提供的信息，添加有关副作用的信息）。
在曲妥珠单抗和硼替佐米方面，指南总体上得到了很好的遵循，这表明资金并未影响医生的治疗决策。鉴于癌症患者和昂贵的新型抗癌药物数量不断增加，以及预算限制日益增加，目前的政策是否能保证类似的指南遵循水平尚不清楚。通过改善治疗方面的患者教育，可以提高患者对决策的参与度。
