Yen Tina W F, Nattinger Ann B, McGinley Emily L, Fergestrom Nicole, Pezzin Liliana E, Laud Purushottam W
Medical College of Wisconsin, Milwaukee, WI.
J Oncol Pract. 2018 Oct 10:JOP1800277. doi: 10.1200/JOP.18.00277.
: The effect of advanced practice provider (APP) involvement in oncology care on cancer-specific outcomes is unknown. We examined the association between team-based APP-physician care during chemotherapy and chemotherapy-related adverse events (AEs) among women with breast cancer.
: We performed separate nested case-control analyses in two national cohorts of women who received chemotherapy for incident breast cancer. Cohorts were identified from Medicare (≥ 65 years of age) and MarketScan (18 to 64 years of age) data. Cases experienced a chemotherapy-related AE (emergency room visit and/or hospitalization). Controls were matched 1:1 on the basis of each patient's age, comorbidities, census region, state's APP scope of practice regulations, and observation period from chemotherapy initiation to first AE. APP exposure (any outpatient claim billed by an APP during the observation period) was assessed for each matched pair member.
: Among the 1,948 cases in the Medicare cohort, 225 (12%) had APP exposure before the first chemotherapy-related AE, compared with 213 controls (11%; P = .54). Among the 725 cases in the MarketScan cohort, 52 (7%) had APP exposure compared with 65 controls (9%; P = .21). In the matched case-control analysis, there was no association between outpatient APP exposure during chemotherapy and AEs in either cohort (Medicare: OR, 1.06 [95% CI, 0.87 to 1.30]; MarketScan: OR, 0.76 [95% CI, 0.50 to 1.14]).
: Our results suggest that team-based APP-physician care that includes an APP who is billing independently, at least for certain patients receiving chemotherapy, may be a viable strategy to safely leverage the scarce oncology workforce to increase access and delivery of cancer care.
高级执业提供者（APP）参与肿瘤护理对癌症特异性结局的影响尚不清楚。我们研究了乳腺癌女性化疗期间基于团队的APP-医生护理与化疗相关不良事件（AE）之间的关联。
我们在两个接受新发乳腺癌化疗的全国女性队列中进行了单独的巢式病例对照分析。队列数据来自医疗保险（年龄≥65岁）和市场扫描（年龄18至64岁）。病例经历了化疗相关AE（急诊就诊和/或住院）。根据每位患者的年龄、合并症、人口普查区域、该州APP执业范围规定以及从化疗开始到首次AE的观察期，将对照与病例按1:1匹配。对每对匹配成员评估APP暴露情况（观察期内APP开具的任何门诊账单）。
在医疗保险队列的1948例病例中，225例（12%）在首次化疗相关AE之前有APP暴露，相比之下，213例对照（11%）有APP暴露（P = 0.54）。在市场扫描队列的725例病例中，52例（7%）有APP暴露，相比之下，65例对照（9%）有APP暴露（P = 0.21）。在匹配的病例对照分析中，两个队列中化疗期间门诊APP暴露与AE之间均无关联（医疗保险队列：OR，1.06 [95% CI，0.87至1.30]；市场扫描队列：OR，0.76 [95% CI，0.50至1.14]）。
我们的结果表明，基于团队的APP-医生护理，包括至少对某些接受化疗的患者独立计费的APP，可能是一种可行的策略，可安全地利用稀缺的肿瘤学劳动力，以增加癌症护理的可及性和提供。
