Ruddy Kathryn J, Van Houten Holly K, Sangaralingham Lindsey R, Freedman Rachel A, Thompson Carrie A, Hashmi Shahrukh K, Jemal Ahmedin, Haddad Tufia C, Mougalian Sarah, Herrin Jeph, Gross Cary, Shah Nilay
Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Breast Cancer Res Treat. 2017 Aug;164(3):515-525. doi: 10.1007/s10549-017-4280-y. Epub 2017 May 10.
The Oncology Care Model was developed, in part, to reduce acute care use during the 6 months after chemotherapy initiation. However, little is known about the impact of chemotherapy regimen on acute care needs, or about later acute care. We sought to assess acute care use over 2 years in patients receiving four contemporary adjuvant chemotherapy regimens for breast cancer.
Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify women with early-stage breast cancer who received adjuvant doxorubicin-cyclophosphamide (AC), AC followed or preceded by docetaxel or paclitaxel (AC-T), AC concurrent with docetaxel or paclitaxel (TAC), or docetaxel-cyclophosphamide (TC) between 2008 and 2014. Rates of hospitalizations and emergency department (ED) visits that did not lead to hospitalizations were compared during four sequential 6-month periods among recipients of these four regimens using negative binomial regression (TC = reference).
We identified 8621 eligible patients, 87.2% younger than 65. Over 6 months, 11.9% were hospitalized and 17.1% had ED visits. Over 24 months, 17.9% were hospitalized and 28.3% visited the ED. Adjusted rates of hospitalizations/100 patients were significantly higher in AC-T and TAC compared to TC recipients in the first 6 months (14.9, 21.9, and 11.3, respectively, p < 0.001). There were no hospitalization rate differences among regimens later. ED visit rates did not differ significantly by regimen during any 6-month period.
Higher rates of hospitalizations in recipients of AC-T and TAC were restricted to the chemotherapy administration period, and did not persist afterwards.
肿瘤护理模式的开发部分是为了减少化疗开始后6个月内的急性护理使用。然而，对于化疗方案对急性护理需求的影响，或对后期急性护理的影响知之甚少。我们试图评估接受四种当代乳腺癌辅助化疗方案的患者在2年内的急性护理使用情况。
使用来自美国大型商业保险数据库（OptumLabs数据仓库）的管理索赔数据，回顾性识别2008年至2014年间接受辅助多柔比星-环磷酰胺（AC）、多西他赛或紫杉醇之前或之后的AC（AC-T）、多西他赛或紫杉醇与AC同时使用（TAC）或多西他赛-环磷酰胺（TC）的早期乳腺癌女性。使用负二项回归（以TC为参照）比较这四种方案接受者在四个连续6个月期间的住院率和未导致住院的急诊科（ED）就诊率。
我们确定了8621名符合条件的患者，87.2%年龄小于65岁。在6个月内，11.9%的患者住院，17.1%的患者有ED就诊。在24个月内，17.9%的患者住院，28.3%的患者就诊于ED。在最初的6个月里，与接受TC的患者相比，AC-T和TAC接受者的调整后住院率/100患者显著更高（分别为14.9、21.9和11.3，p<0.001）。之后各方案之间的住院率没有差异。在任何6个月期间，各方案的ED就诊率没有显著差异。
AC-T和TAC接受者较高的住院率仅限于化疗给药期，之后并未持续。
