Cheng Alex C, Levy Mia A
Vanderbilt University Medical Center, Nashville, TN.
JCO Clin Cancer Inform. 2019 Feb;3:1-10. doi: 10.1200/CCI.18.00122.
Patients with breast cancer spend a large amount of time and effort receiving treatment. When the number of health care tasks exceeds a patient's ability to manage that workload, they could become overburdened, leading to decreased plan adherence. We used electronic health record data to retrospectively assess dimensions of treatment workload related to outpatient encounters, commuting, and admissions.
Using tumor registry and scheduling data, we evaluated the sensitivity of treatment workload measures to detect expected differences in breast cancer treatment burden by stage. We evaluated the impact of the on-body pegfilgrastim injector on the treatment workload of patients undergoing a specific chemotherapy protocol.
As hypothesized, patients with higher stage cancer experienced higher treatment workload. Over the first 18 months after diagnosis, patients with stage III disease spent a median of 81 hours (interquartile range [IQR], 39 to 113 hours) in outpatient clinics, commuted 61 hours (IQR, 32 to 86 hours), and spent $1,432 (IQR, $690 to $2,552) in commuting costs. In contrast, patients with stage I disease spent a median of 29 hours (IQR, 18 to 46 hours in clinic), commuted for 34 hours (IQR, 19 to 55 hours), and spent $834 (IQR, $389 to $1,649) in commuting costs. In addition, we substantiated claims that the pegfilgrastim on-body injector was effective in reducing some dimensions of workload such as unique appointment days.
Treatment workload measures capture an important dimension in the experience of patients with cancer. Patients and health care organizations can use workload measures to plan and allocate resources, leading to higher quality and better coordinated care.
乳腺癌患者花费大量时间和精力接受治疗。当医疗保健任务的数量超过患者管理该工作量的能力时，他们可能会不堪重负，导致治疗计划依从性下降。我们使用电子健康记录数据回顾性评估与门诊就诊、通勤和住院相关的治疗工作量维度。
利用肿瘤登记和排班数据，我们评估了治疗工作量测量方法在检测不同分期乳腺癌治疗负担预期差异方面的敏感性。我们评估了皮下注射培非格司亭注射器对接受特定化疗方案患者治疗工作量的影响。
正如所假设的，癌症分期较高的患者治疗工作量更大。在诊断后的前18个月，III期疾病患者在门诊诊所花费的时间中位数为81小时（四分位间距[IQR]，39至113小时），通勤时间为61小时（IQR，32至86小时），通勤费用为1432美元（IQR，690至2552美元）。相比之下，I期疾病患者在诊所花费的时间中位数为29小时（IQR，18至46小时），通勤时间为34小时（IQR，19至55小时），通勤费用为834美元（IQR，389至1649美元）。此外，我们证实了皮下注射培非格司亭注射器在减少某些工作量维度（如独特预约天数）方面是有效的。
治疗工作量测量方法捕捉到了癌症患者就医体验中的一个重要维度。患者和医疗保健组织可以使用工作量测量方法来规划和分配资源，从而实现更高质量和更协调的护理。
