Completion of therapy by medicare patients with stage III colon cancer
Completion of therapy by medicare patients with stage III colon cancer
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DOI：
10.1093/jnci/djj159
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发表时间：
2006-05-03
影响因子：
10.3
通讯作者：
Barlow, William
中科院分区：
文献类型：
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作者：
Dobie, Sharon A.;Baldwin, Laura-Mae;Barlow, William
背景某些因素，如种族或年龄，已知与III期结肠癌辅助化疗开始的变化相关，但对哪些因素与辅助治疗的完成相关知之甚少。为了确定启动的预测因素是否也预测完成，我们分析了与医疗保险索赔相关的监测、流行病学和最终结果（SEER）计划数据。我们调查了死亡率，以此来测试我们创建的完成测量的有效性。研究方法：我们研究了3193例III期结肠癌患者，其诊断记录在1992-1996年SEER项目数据中，与1991-1998年医疗保险索赔相关，并在结肠癌切除术后开始辅助化疗。我们将辅助化疗完成的指标定义为一个月内一次化疗给药要求。我们测试了所创建的测量方法的有效性及其与经人口统计学、临床和环境变量调整后的3年癌症死亡率的关系。我们通过多变量逻辑回归模型探讨了患者特征和治疗医生特征与化疗完成的相关性。结果：3193例患者中，2497例（78.2%）完成了疗程。与未接受辅助治疗的患者相比，完成化疗的患者的癌症相关死亡风险在统计学上显著降低（相对风险= 0.79，95%置信区间= 0.69 - 0.89）。女性、丧偶、年龄增长、再次住院和居住在某些地区的患者完成辅助化疗的可能性低于其他患者。种族和其他临床、环境和医生特征与治疗完成无关。结论：与不完全辅助化疗相关的因素可能包括身体虚弱、治疗并发症以及缺乏社会和心理支持。减轻这些影响的干预措施是提高化疗完成率的合理下一步。
Background. Certain factors, such as race or age, are known to be associated with variation in initiation of adjuvant chemotherapy for stage III colon cancer, but little is known about what factors are associated with completion of adjuvant therapy. To determine whether predictors of initiation also predict completion, we analyzed Surveillance, Epidemiology, and End Results (SEER) program data linked to Medicare claims. We investigated mortality as a means to testing the validity of the completion measure that we created. Methods: We studied 3193 stage III colon cancer patients whose diagnosis was recorded in 1992-1996 SEER program data linked to 1991-1998 Medicare claims and who initiated adjuvant chemotherapy after colon cancer resection. We defined a measure of adjuvant chemotherapy completion as one chemotherapy administration claim in a month. We tested the validity of the created measure and its relation to 3-year cancer mortality adjusted for demographic, clinical, and environmental variables. We explored the association of patient characteristics and treating physician characteristics with chemotherapy completion by use of multivariable logistic regression modeling. Results: Of the 3193 patients, 2497 (78.2%) completed the course. Risk of cancer-related mortality was statistically significantly lower among those completing chemotherapy (relative risk = 0.79, 95% confidence interval = 0.69 to 0.89) than those with no adjuvant therapy. Patients who were female, widowed, increasingly elderly, rehospitalized, and living in certain regions were less likely to complete adjuvant chemotherapy than other patients. Race and other clinical, environmental, and physician characteristics were not associated with completion of therapy. Conclusions: Factors associated with incomplete adjuvant chemotherapy may represent physical frailty, treatment complications, and lack of social and psychological support. Interventions to mitigate these influences are a logical next step toward increasing chemotherapy completion rates.