Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Cancer Control, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Support Care Cancer. 2020 Jun;28(6):2553-2562. doi: 10.1007/s00520-019-05063-x. Epub 2019 Sep 7.
Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling complication of many chemotherapies. We investigated the feasibility of using health plan claims and administrative data to identify CIPN occurrence by comparing patients who received neurotoxic and non-neurotoxic chemotherapies.
The sample included over 53,000,000 patients from two regional and one national insurer in the USA (> 400,000 exposed to chemotherapy). Peripheral neuropathy was identified using a broad definition (definition 1) and a specific definition (i.e., drug-induced polyneuropathy code) (definition 2).
CIPN incidence as measured by definition 1 within 6 months of chemotherapy initiation was 18.1% and 6.2% for patients who received neurotoxic and non-neurotoxic chemotherapy, respectively (relative risk neurotoxic vs. non-neurotoxic (RR), 2.93 (95% CI, 2.87-2.98)). For definition 2, these incidences were 3.6% and 0.1% (RR, 25.2 (95% CI, 22.8-27.8)). The incidences of new analgesic prescriptions for neurotoxic and non-neurotoxic groups were as follows: gabapentin, 7.1%/1.7%; pregabalin, 0.69%/0.31%; and duloxetine, 0.78%/0.76%. The incidence of CIPN as defined by definitions 1 and 2 was low compared with that of published research studies, but the relative risk of CIPN among patients who received neurotoxic chemotherapies compared with those who received non-neurotoxic chemotherapies was high using definition 2.
These data suggest that as used currently by clinicians, administrative codes likely underestimate CIPN incidence. Thus, studies using administrative data to estimate CIPN incidence are not currently feasible. However, the drug-induced polyneuropathy code is a specific indicator of CIPN in administrative data and may be useful for investigating predictors or potentially preventive therapies of CIPN.
化疗引起的周围神经病（CIPN）是许多化疗药物的一种致残性并发症。我们通过比较接受神经毒性和非神经毒性化疗的患者，研究了使用健康计划理赔和行政数据来识别 CIPN 发生的可行性。
该样本包括来自美国两个地区和一个全国保险公司的超过 5300 万患者（超过 40 万名患者接受了化疗）。使用广泛的定义（定义 1）和特定的定义（即药物诱导的多发性神经病代码）（定义 2）来识别周围神经病。
以定义 1 衡量，在化疗开始后 6 个月内，接受神经毒性和非神经毒性化疗的患者的 CIPN 发生率分别为 18.1%和 6.2%（神经毒性与非神经毒性的相对风险（RR）为 2.93（95%CI，2.87-2.98））。对于定义 2，这些发生率分别为 3.6%和 0.1%（RR，25.2（95%CI，22.8-27.8））。新的神经毒性和非神经毒性组镇痛处方的发生率如下：加巴喷丁，7.1%/1.7%；普瑞巴林，0.69%/0.31%；度洛西汀，0.78%/0.76%。使用定义 1 和 2 定义的 CIPN 发生率与已发表的研究相比较低，但使用定义 2 时，接受神经毒性化疗的患者与接受非神经毒性化疗的患者相比，CIPN 的相对风险较高。
这些数据表明，目前临床医生使用的行政代码可能低估了 CIPN 的发生率。因此，使用行政数据估计 CIPN 发生率的研究目前不可行。然而，药物诱导的多发性神经病代码是行政数据中 CIPN 的一个特定指标，可能有助于研究 CIPN 的预测因素或潜在的预防治疗方法。
