有乳腺癌病史且正在接受激素治疗的女性使用局部雌激素处方的配药率。
Topical Estrogen Prescription Fill Rates for Women With a History of Breast Cancer Who Are Taking Hormone Therapy.
机构信息
Division of General Internal Medicine, the Division of Biostatistics and Bioinformatics, and the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Georgetown University School of Medicine/MedStar Washington Hospital Center, National Center for Advanced Pelvic Surgery, Washington, DC; and the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
出版信息
Obstet Gynecol. 2018 Nov;132(5):1137-1142. doi: 10.1097/AOG.0000000000002914.
OBJECTIVE
To evaluate how often women with a history of breast cancer who are taking hormone therapy (HT) filled prescriptions for topical estrogens and whether this frequency varied over time and by type of HT used.
METHODS
We performed a retrospective cohort study using medical and outpatient drug claims from a large commercial claims database for the years 2010-2015. Women younger than age 65 years taking HT for breast cancer were classified as users of 1) tamoxifen only, 2) aromatase inhibitor(s) only, or 3) any other or multiple HTs. Our outcome variable was filling a prescription for topical estrogen in a given year. We used multivariable logistic regression models estimated with generalized estimating equations to determine whether the fill rate varied over time and by HT category adjusting for age, receipt of surgical or radiation treatment, types of outpatient health care provider visits, and comorbidities.
RESULTS
We identified 352,118 records from 176,012 unique patients (mean age 54.3 years, range 18-64 years) who met eligibility criteria. Aromatase inhibitors were used more commonly (56.0% of patient-years) than tamoxifen (38.8%). Overall, 3.0% (range 2.9-3.1%) of women filled any topical estrogen prescription in a given calendar year. More than half of filled topical estrogen prescriptions were for tablets (57.0%) with the remainder for creams (25.8%) and rings (17.3%). In adjusted analyses, the fill rate for women taking tamoxifen was significantly less (2.4%; 95% CI 2.3-2.5%) than for women taking aromatase inhibitors (3.3%; 95% CI 3.2-3.4%). There was a small but statistically significant increase in fill rates across years (odds ratio 1.03, 95% CI 1.02-1.04).
CONCLUSION
A small proportion of women with a history of breast cancer who were taking HT filled a topical estrogen prescription, with significant differences by type of HT. More evidence is needed to inform national guidelines regarding safety and appropriate use of topical estrogens in this patient population.
目的
评估正在接受激素治疗（HT）的乳腺癌女性患者开具外用雌激素处方的频率，以及这种频率是否随时间和所使用的 HT 类型而变化。
方法
我们使用大型商业索赔数据库中的医疗和门诊药物索赔进行了回顾性队列研究，时间范围为 2010 年至 2015 年。年龄小于 65 岁且因乳腺癌接受 HT 的女性被分为以下三类：1）仅使用他莫昔芬，2）仅使用芳香化酶抑制剂，或 3）使用任何其他或多种 HT。我们的结局变量是在给定年份开具外用雌激素处方的情况。我们使用广义估计方程估计多变量逻辑回归模型，以确定填充率是否随时间和 HT 类别而变化，同时调整年龄、手术或放射治疗的接受情况、门诊医疗服务提供者就诊类型和合并症。
结果
我们从 176012 名患者中识别出 352118 条记录（平均年龄 54.3 岁，范围 18-64 岁），这些患者符合入选标准。芳香化酶抑制剂的使用更为普遍（占患者年数的 56.0%），而他莫昔芬的使用则较少（38.8%）。总体而言，3.0%（范围 2.9-3.1%）的女性在给定的日历年内开具了任何外用雌激素处方。超过一半的外用雌激素处方是片剂（57.0%），其余为乳膏（25.8%）和环（17.3%）。在调整后的分析中，服用他莫昔芬的女性的处方填写率明显较低（2.4%；95%CI 2.3-2.5%），而服用芳香化酶抑制剂的女性的处方填写率较高（3.3%；95%CI 3.2-3.4%）。各年的填写率略有但具有统计学意义的增加（比值比 1.03，95%CI 1.02-1.04）。
结论
患有乳腺癌且正在接受 HT 的女性中，只有一小部分人开具了外用雌激素处方，且处方类型存在显著差异。需要更多的证据来为这一患者群体提供关于外用雌激素的安全性和适当使用的国家指南。
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