Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975-1999.
Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975-1999.
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DOI：
10.1093/jnci/94.21.1626
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发表时间：
2002-11
期刊：
影响因子：
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通讯作者：
A. Mariotto;E. Feuer;L. Harlan;L. Wun;Karen A. Johnson;J. Abrams
中科院分区：
文献类型：
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作者：
A. Mariotto;E. Feuer;L. Harlan;L. Wun;Karen A. Johnson;J. Abrams
背景了解临床研究结果的传播趋势有助于估计其对人群的益处。我们评估了 1975 年至 1999 年美国早期乳腺癌辅助多药化疗、他莫昔芬以及两种疗法联合使用的趋势。 方法 从 8 个监测、流行病学和最终结果 (SEER) 登记处获得了 1975 年至 1999 年诊断为 I、II 和 IIIA 期乳腺癌的 217 508 名患者的治疗数据。计划。根据一系列基于人群的护理模式 (POC) 研究的信息进行调整后，根据这些数据开发了传播模型，这些研究从 SEER 登记中随机选择病例患者。 POC 研究包括 1987 年至 1991 年以及 1995 年诊断的 7116 名患者，这些患者已从本次分析中使用的 SEER 数据中排除。结果 建模的传播总体上与 POC 观察到的每种治疗的比例相一致。绝经前女性中多药化疗的使用率较高，绝经后女性中他莫昔芬的使用率较高。多药化疗对诊断为淋巴结阳性 II+ 期或 IIIA 期癌症的绝经后妇女的使用在 1983 年达到顶峰，然后到 1986 年有所下降，表明它已被他莫昔芬取代。 1986 年之后，几乎所有阶段和年龄的多药化疗和他莫昔芬的联合使用都有所增加。 20 世纪 90 年代初期后，患有 II+ 期或 III 期乳腺癌的绝经后女性中他莫昔芬的使用量有所下降。结论 观察到的传播模式表明，临床试验的结果相当快地传播给社区医生及其患者。
BACKGROUND Understanding trends in the dissemination of findings from clinical research can help in estimating their population-level benefits. We evaluated trends in the use of adjuvant multi-agent chemotherapy, tamoxifen, and the combination of both treatments for early-stage breast cancer in the United States from 1975 through 1999. METHODS Data on treatment of 217 508 patients diagnosed from 1975 through 1999 with stages I, II, and IIIA breast cancer were obtained from eight registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Models of dissemination were developed from these data after adjustment based on information from a series of population-based Patterns of Care (POC) studies that randomly selected case patients from the SEER registries. The POC studies included 7116 patients diagnosed from 1987 through 1991 and in 1995 who were eliminated from the SEER data used in this analysis. RESULTS The modeled disseminations were generally compatible with the POC-observed proportions of each treatment. The use of multi-agent chemotherapy was higher among premenopausal women, and the use of tamoxifen was higher among postmenopausal women. The use of multi-agent chemotherapy for postmenopausal women diagnosed with lymph node-positive stage II+ or stage IIIA cancer reached a peak in 1983 and then decreased through 1986, indicating its substitution with tamoxifen. After 1986, the combined use of multi-agent chemotherapy and tamoxifen increased for almost all stages and ages. After the early 1990s, tamoxifen use in postmenopausal women with stage II+ or stage III breast cancer declined. CONCLUSIONS The observed dissemination patterns suggest that the results of clinical trials are disseminated fairly rapidly to community-based physicians and their patients.