Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Support Care Cancer. 2024 Sep 17;32(10):668. doi: 10.1007/s00520-024-08871-y.
The impact of cancer-related diarrhea (CRD) on changes in cancer therapy remains poorly characterized despite its prevalence.
We performed a longitudinal observational study using IQVIA PharMetrics Plus claims data. Patients included adults with CRD identified by diagnosis codes or pharmacy claims and compared their outcomes to matched (1:1) patients without CRD. Treatment parameters (discontinuation, persistence, augmentation, dose titration, adherence) were evaluated and stratified for the first cancer therapy (chemotherapy vs. targeted therapy vs. both). A multivariate Cox proportional hazards model was used to estimate the difference in risk of each treatment parameter between cohorts, adjusting for cancer type, therapy, and comorbidities.
We identified 104,135 matched pairs of patients with solid (n = 94,411) or hematologic cancers (n = 9,724) receiving chemotherapy (n = 47,220), targeted therapy (n = 2,427), or both (n = 5,313). Patients with CRD discontinued therapy more frequently than those without CRD (chemotherapy [81.5% vs. 62.3%], targeted therapy [69.2% vs. 64.3%], both [96.0% vs. 85.5%], p < 0.0001). The overall proportion of discontinuation was higher (82.4% vs. 64.6%, p < 0.0001), including a higher risk of discontinuation (HR = 1.40, p < 0.001) for patients with CRD. The mean time to discontinuation (59.6 ± 54.1 vs. 68.3 ± 76.6 days), switch (72.0 ± 48.6 vs. 96.9 ± 84.0 days), persistence (95.1 ± 98.1 vs. 154.3 ± 142.7 days), and adherence (25.5% ± 37.2 vs. 47.9 ± 41%) were all lower (p < 0.0001) among patients with CRD.
Patients who develop CRD undergo significant and clinically impactful index treatment discontinuation, treatment switching, and have lower adherence and persistence of anticancer therapy compared to patients without CRD. Strategies to control CRD to optimize cancer therapy are urgently needed.
尽管癌症相关腹泻（CRD）很常见，但它对癌症治疗改变的影响仍未得到充分描述。
我们使用 IQVIA PharMetrics Plus 索赔数据进行了一项纵向观察性研究。通过诊断代码或药房理赔识别出患有 CRD 的患者，并将其结果与无 CRD 的匹配患者（1:1）进行比较。评估并对首次癌症治疗（化疗与靶向治疗与两者）进行分层治疗参数（停药、持续、增效、剂量滴定、依从性）。使用多变量 Cox 比例风险模型估计队列之间每个治疗参数的风险差异，调整癌症类型、治疗和合并症。
我们确定了 104,135 对接受化疗（n=47,220）、靶向治疗（n=2,427）或两者（n=5,313）的实体瘤（n=94,411）或血液系统癌症（n=9,724）的匹配患者。与无 CRD 患者相比，有 CRD 的患者更频繁地停止治疗（化疗 [81.5% vs. 62.3%]，靶向治疗 [69.2% vs. 64.3%]，两者 [96.0% vs. 85.5%]，p<0.0001）。总体停药比例较高（82.4% vs. 64.6%，p<0.0001），包括 CRD 患者停药风险更高（HR=1.40，p<0.001）。停药时间（59.6±54.1 天 vs. 68.3±76.6 天）、换药（72.0±48.6 天 vs. 96.9±84.0 天）、持续时间（95.1±98.1 天 vs. 154.3±142.7 天）和依从性（25.5%±37.2% vs. 47.9%±41%）均较低（p<0.0001）。
与无 CRD 的患者相比，发生 CRD 的患者经历了显著且具有临床意义的指数治疗停药、治疗换药，并且对癌症治疗的依从性和持续性较低。迫切需要控制 CRD 以优化癌症治疗的策略。
