Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Neuro Oncol. 2020 Sep 29;22(9):1339-1347. doi: 10.1093/neuonc/noaa054.
Brain metastases (BM) cause symptoms that supportive medications can alleviate. We assessed whether racial disparities exist in supportive medication utilization after BM diagnosis.
Medicare-enrolled patients linked with the Surveillance, Epidemiology, and End Results program (SEER) who had diagnoses of BM between 2007 and 2016 were identified. Fourteen supportive medication classes were studied: non-opioid analgesics, opioids, anti-emetics, anti-epileptics, headache-targeting medications, steroids, cognitive aids, antidepressants, anxiolytics, antidelirium/antipsychotic agents, muscle relaxants, psychostimulants, sleep aids, and appetite stimulants. Drug administration ≤30 days following BM diagnosis was compared by race using multivariable logistic regression.
Among 17,957 patients, headache aids, antidepressants, and anxiolytics were prescribed less frequently to African Americans (odds ratio [95% CI] = 0.81 [0.73-0.90], P < 0.001; OR = 0.68 [0.57-0.80], P < 0.001; and OR = 0.68 [0.56-0.82], P < 0.001, respectively), Hispanics (OR = 0.83 [0.73-0.94], P = 0.004 OR = 0.78 [0.64-0.97], P = 0.02; and OR = 0.63 [0.49-0.81], P < 0.001, respectively), and Asians (OR = 0.81 [0.72-0.92], P = 0.001, OR = 0.67 [0.53-0.85], P = 0.001, and OR = 0.62 [0.48-0.80], P < 0.001, respectively) compared with non-Hispanic Whites. African Americans also received fewer anti-emetics (OR = 0.75 [0.68-0.83], P < 0.001), steroids (OR = 0.84 [0.76-0.93], P < 0.001), psychostimulants (OR = 0.14 [0.03-0.59], P = 0.007), sleep aids (OR = 0.71 [0.61-0.83], P < 0.001), and appetite stimulants (OR = 0.85 [0.77-0.94], P = 0.002) than Whites. Hispanic patients less frequently received antidelirium/antipsychotic drugs (OR = 0.57 [0.38-0.86], P = 0.008), sleep aids (OR = 0.78 [0.64-0.94, P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.04). Asian patients received fewer opioids (OR = 0.86 [0.75-0.99], P = 0.04), anti-emetics (OR = 0.83 [0.73-0.94], P = 0.004), anti-epileptics (OR = 0.83 [0.71-0.97], P = 0.02), steroids (OR = 0.81 [0.72-0.92], P = 0.001), muscle relaxants (OR = 0.60 [0.41-0.89], P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.03). No medication class was prescribed significantly less frequently to Whites.
Disparities in supportive medication prescription for non-White/Hispanic groups with BM exist; improved provider communication and engagement with at-risk patients is needed.
1. Patients with BM commonly experience neurologic symptoms.2. Supportive medications improve quality of life among patients with BM.3. Non-White patients with BM receive fewer supportive medications than White patients.
脑转移（BM）会导致症状，支持性药物可以缓解这些症状。我们评估了在 BM 诊断后，支持性药物的使用是否存在种族差异。
我们确定了 2007 年至 2016 年间在医疗保险中登记的与监测、流行病学和最终结果（SEER）计划相关联的患有 BM 的患者。研究了 14 种支持性药物类别：非阿片类镇痛药、阿片类药物、止吐药、抗癫痫药、头痛靶向药物、类固醇、认知辅助药物、抗抑郁药、抗焦虑药、抗痴呆/抗精神病药物、肌肉松弛剂、精神兴奋剂、睡眠辅助药物和食欲刺激剂。使用多变量逻辑回归比较了种族之间 BM 诊断后 30 天内药物的给药情况。
在 17957 名患者中，非裔美国人（优势比[95%置信区间] = 0.81[0.73-0.90]，P <0.001）、西班牙裔（优势比[95%置信区间] = 0.83[0.73-0.94]，P = 0.004；OR = 0.78[0.64-0.97]，P = 0.02）和亚洲人（优势比[95%置信区间] = 0.81[0.72-0.92]，P = 0.001；OR = 0.67[0.53-0.85]，P = 0.001；OR = 0.62[0.48-0.80]，P <0.001）接受头痛辅助药物、抗抑郁药和抗焦虑药的频率低于非西班牙裔白人。非裔美国人还接受了较少的止吐药（优势比[95%置信区间] = 0.75[0.68-0.83]，P <0.001）、类固醇（优势比[95%置信区间] = 0.84[0.76-0.93]，P <0.001）、精神兴奋剂（优势比[95%置信区间] = 0.14[0.03-0.59]，P = 0.007）、睡眠辅助药物（优势比[95%置信区间] = 0.71[0.61-0.83]，P <0.001）和食欲刺激药物（优势比[95%置信区间] = 0.85[0.77-0.94]，P = 0.002）比白人。西班牙裔患者接受抗痴呆/抗精神病药物（优势比[95%置信区间] = 0.57[0.38-0.86]，P = 0.008）、睡眠辅助药物（优势比[95%置信区间] = 0.78[0.64-0.94]，P = 0.01）和食欲刺激药物（优势比[95%置信区间] = 0.87[0.76-0.99]，P = 0.04）的频率较低。亚洲患者接受的阿片类药物（优势比[95%置信区间] = 0.86[0.75-0.99]，P = 0.04）、止吐药（优势比[95%置信区间] = 0.83[0.73-0.94]，P = 0.004）、抗癫痫药（优势比[95%置信区间] = 0.83[0.71-0.97]，P = 0.02）、类固醇（优势比[95%置信区间] = 0.81[0.72-0.92]，P = 0.001）、肌肉松弛剂（优势比[95%置信区间] = 0.60[0.41-0.89]，P = 0.01）和食欲刺激药物（优势比[95%置信区间] = 0.87[0.76-0.99]，P = 0.03）的频率明显较低。没有任何药物类别明显比白人患者的频率低。
非白人和西班牙裔患者 BM 患者的支持性药物处方存在差异；需要改善与高危患者的提供者沟通和参与。
