Validation and application of a death proxy in adult cancer patients
Validation and application of a death proxy in adult cancer patients
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DOI：
10.1002/pds.2257
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发表时间：
2012-07-01
影响因子：
2.6
通讯作者：
Pearson, Sallie-Anne
中科院分区：
文献类型：
--
作者：
Mealing, Nicole M.;Dobbins, Timothy A.;Pearson, Sallie-Anne
目的 用于药物流行病学研究的数据集并不总是提供死亡事实。在缺乏死亡数据的情况下，代理可能是适当的替代品。本研究的目的是验证成年癌症患者死亡的替代指标，并评估其在估计两组癌症患者的生存时的表现。方法 我们使用 12 394 名患有肺癌、结直肠癌、乳腺癌或前列腺癌的澳大利亚退伍军人的数据，按癌症类型总体评估了 30 天、60 天、90 天和 180 天的替代指标。如果最后一次配药记录与观察期结束时之间的差异超过代理截止值，则代理表明死亡。然后，我们将实际生存率与 90 天代理估计值进行了比较，其中包括 4090 名拥有药品完全权利的退伍军人和 3704 名接受曲妥珠单抗治疗 HER2+ 转移性乳腺癌的澳大利亚女性。结果 90 天代理是最佳的，总体敏感性为 99.3%（95%CI：98.499.7），特异性为 97.6%（95%CI：91.899.4）。当根据癌症类型和疾病传播进行评估时，这些指标仍然很高。使用最保守的死亡日期估计（最后一次配药日期）的代理应用通常会低估生存期，根据死亡事实估计的生存期比生存期短最多 3 个月。结论 在无法获得死亡事实的情况下，90 天死亡替代指标是确定慢性人群死亡情况的有力替代方法。该代理可能对一系列慢性疾病有效，因为它依赖于个体患者的定期配药记录。版权所有 (c) 2011 John Wiley & Sons, Ltd.
Purpose Fact of death is not always available on data sets used for pharmacoepidemiological research. Proxies may be an appropriate substitute in the absence of death data. The purposes of this study were to validate a proxy for death in adult cancer patients and to assess its performance when estimating survival in two cohorts of cancer patients. Methods We evaluated 30-, 60-, 90- and 180-day proxies overall and by cancer type using data from 12 394 Australian veterans with lung, colorectal, breast or prostate cancer. The proxy indicated death if the difference between the last dispensing record and the end of the observational period exceeded the proxy cutoff. We then compared actual survival to 90-day proxy estimates in a subset of 4090 veterans with full entitlements for pharmaceutical items and in 3704 Australian women receiving trastuzumab for HER2+ metastatic breast cancer. Results The 90-day proxy was optimal with an overall sensitivity of 99.3% (95%CI: 98.499.7) and a specificity of 97.6% (95%CI: 91.899.4). These measures remained high when evaluated by cancer type and spread of disease. The application of the proxy using the most conservative date of death estimate (date of last dispensing) generally underestimated survival, with estimates up to 3?months shorter than survival based on fact of death. Conclusions A 90-day death proxy is a robust substitute to identify death in a chronic population when fact of death is not available. The proxy is likely to be valid across a range of chronic diseases as it relies on the presence of regular dispensing records for individual patients. Copyright (c) 2011 John Wiley & Sons, Ltd.