Adjuvant chemotherapy for stage III colon cancer: Do physicians agree about the importance of patient age and comorbidity?
Adjuvant chemotherapy for stage III colon cancer: Do physicians agree about the importance of patient age and comorbidity?
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DOI：
10.1200/jco.2007.15.9434
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发表时间：
2008-05-20
影响因子：
45.3
通讯作者：
Kahn, Katherine L.
中科院分区：
文献类型：
--
作者：
Keating, Nancy L.;Landrum, Mary Beth;Kahn, Katherine L.
PurposeWe调查了癌症医生，以了解患者的年龄和合并症如何影响辅助化疗的建议，以及医生或实践特征是否也会影响这些建议。MethodsNational调查了照顾结直肠癌患者的外科医生和医学肿瘤学家，以了解他们是否会建议对年龄不同的III期结肠癌患者进行辅助化疗（55 vs 80岁）和共病（无、中度、重度充血性心力衰竭[ CHF]）。重复测量logistic回归用于评估患者、医生和实践特征对化疗建议的影响。结果在1，096名医生中，几乎所有医生都建议55岁以上无合并症的患者进行化疗（99.0%），55岁，中度CHF（88.6%），或80岁无合并症（92.6%）;对于55岁的重度CHF患者，（24.9%）或80岁的中度（47.2%）或重度（9.0%）CHF患者（P <0.001）。年轻的医生（P < .001）比其他人更有可能建议辅助化疗的整体，虽然医生的因素解释的变化不大的recommends.ConclusionPhysicians同意的指南，建议辅助化疗的年轻，健康的III期结肠癌患者，但不同的建议，为患者谁是老年人和病情加重。很少有医生或实践特征与建议相关。对于年龄较大和病情较重的患者，所见的个别医生可能会对接受化疗的可能性产生重大影响。更好地了解患者临床特征无法解释的变异来源，可能有助于改善针对最有可能受益的患者的治疗。
PurposeWe surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations.MethodsNational survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage III colon cancer who varied by age ( 55 v 80 years) and comorbid illness ( none, moderate, severe congestive heart failure [ CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations.ResultsOf 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0%), 55-years old with moderate CHF (88.6%), or 80 years old with no comorbidity (92.6%); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9%) or 80-year-old patients with moderate (47.2%) or severe (9.0%) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations.ConclusionPhysicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but differ widely on recommendations for patients who are older and sicker. Few physician or practice characteristics were associated with recommendations. For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy. Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit.