Oncologists' and Primary Care Physicians' Awareness of Late and Long-Term Effects of Chemotherapy: Implications for Care of the Growing Population of Survivors
Oncologists' and Primary Care Physicians' Awareness of Late and Long-Term Effects of Chemotherapy: Implications for Care of the Growing Population of Survivors
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DOI：
10.1200/jop.2013.001121
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发表时间：
2014-03-01
影响因子：
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通讯作者：
Virgo, Katherine S.
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文献类型：
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作者：
Nekhlyudov, Larissa;Aziz, Noreen M.;Virgo, Katherine S.
目的：癌症幸存者的数量很大，而且还在不断增长。然而，在成功完成治疗后，许多人经历了化疗相关的晚期或长期影响（LEs）。医生对LEs的了解程度尚不清楚。方法：我们对1130名肿瘤学家和1072名初级保健提供者（pcp）进行了全国代表性的调查。受访者被要求选择他们观察到的或看到报告的用于治疗乳腺癌和结肠癌的五种化疗药物的LEs。我们描述并比较了肿瘤学家和pcp对特定LEs的认识。使用多元逻辑回归模型，我们确定了医生对与药物相关的主要LEs的认识的预测因子。结果：几乎所有肿瘤学家（95%）报告心功能障碍是阿霉素的LE，周围神经病变是紫杉醇（97%）和奥沙利铂（97%）的LE。这些le分别由55%、27%和22%的pcp报告。大多数肿瘤学家报告说，环磷酰胺的LEs患者意识到过早绝经（71%）和继发性恶性肿瘤（62%），而pcp患者分别只有15%和17%。65%的肿瘤学家和仅6%的pcp确定了与所有四种药物相关的主要LEs。结论：半数以上的pcp意识到心功能障碍是阿霉素的一种LE，但对其他LE的认识有限。由于pcp可能不会直接暴露于化疗相关的LEs，肿瘤学家必须在患者转到初级保健机构时向pcp传达这些信息。需要对照顾日益增多的癌症幸存者的所有提供者进行教育。
Purpose: The population of cancer survivors is large and growing. Yet after successful completion of treatment, many experience chemotherapy-related late or long-term effects (LEs). The extent to which physicians are aware of LEs is unknown.Methods: We conducted a nationally representative survey of 1,130 oncologists and 1,072 primary care providers (PCPs). Respondents were asked to select the LEs they had either observed or seen reported for five chemotherapy agents used to treat breast and colon cancers. We described and compared oncologists' and PCPs' awareness of the specified LEs. Using multivariate logistic regression models, we determined predictors of physicians' awareness of the main LEs associated with the agents.Results: Almost all oncologists (95%) reported awareness of cardiac dysfunction as an LE of doxorubicin and peripheral neuropathy as an LE of paclitaxel (97%) and oxaliplatin (97%). These LEs were reported by 55%, 27%, and 22% of PCPs, respectively. Most oncologists reported awareness of premature menopause (71%) and secondary malignancies (62%) as LEs of cyclophosphamide, compared with only 15% and 17% of PCPs, respectively. Main LEs associated with all four agents were identified by 65% of oncologists and only 6% of PCPs.Conclusion: Although more than half of PCPs were aware of cardiac dysfunction as an LE of doxorubicin, awareness of other LEs was limited. Because PCPs may not be directly exposed to chemotherapy-related LEs, oncologists must communicate this information to PCPs as patients transition to primary care settings. Education for all providers caring for the growing population of cancer survivors is needed.