PDF(Sci-hub)
Abstract：
We examined guideline-concordant initial systemic treatment among women with metastatic breast cancer, its predictors, and if guideline-concordant treatment was associated with mortality, healthcare utilization and Medicare expenditures.
This retrospective observational cohort study was conducted using the Surveillance, Epidemiology, End Results-Medicare linked database. Women aged 66-90 years diagnosed with metastatic breast cancer during 2010-2013 (N = 1282) were included. The National Comprehensive Cancer Network treatment guidelines were used to determine the guideline-concordant initial systemic treatment following cancer diagnosis. A logistic regression analysis was conducted to examine significant predictors of guideline-concordant treatment. Generalized linear regressions were used to examine the association between guideline-concordant treatment and healthcare utilization and average monthly Medicare expenditures.
About 74% of the study cohort received guideline-concordant initial systemic treatment. Women who received guideline-concordant treatment were significantly more likely to be comparatively younger (p < 0.05), were married/partnered (p = 0.0038), had HER2 positive tumors, and had good performance status. Adjusted hazards ratios for all-cause (2.364, p < 0.0001) and breast-cancer specific mortality (2.179, p < 0.0001) were higher for women who did not receive guideline-concordant treatment. Rates of healthcare utilization were also higher for women not receiving guideline-concordant treatment. Average monthly Medicare expenditures were 100.4% higher (95% confidence interval: $77.3%-126.5%) for women who did not receive guideline-concordant treatment compared to those who received guideline-concordant treatment (p < 0.0001).
One fourth of the study cohort did not receive guideline-concordant initial systemic treatment. Guideline-concordant initial treatment was associated with reduced mortality, and lower healthcare utilization and Medicare expenditures in women with metastatic breast cancer.
This retrospective observational cohort study was conducted using the Surveillance, Epidemiology, End Results-Medicare linked database. Women aged 66-90 years diagnosed with metastatic breast cancer during 2010-2013 (N = 1282) were included. The National Comprehensive Cancer Network treatment guidelines were used to determine the guideline-concordant initial systemic treatment following cancer diagnosis. A logistic regression analysis was conducted to examine significant predictors of guideline-concordant treatment. Generalized linear regressions were used to examine the association between guideline-concordant treatment and healthcare utilization and average monthly Medicare expenditures.
About 74% of the study cohort received guideline-concordant initial systemic treatment. Women who received guideline-concordant treatment were significantly more likely to be comparatively younger (p < 0.05), were married/partnered (p = 0.0038), had HER2 positive tumors, and had good performance status. Adjusted hazards ratios for all-cause (2.364, p < 0.0001) and breast-cancer specific mortality (2.179, p < 0.0001) were higher for women who did not receive guideline-concordant treatment. Rates of healthcare utilization were also higher for women not receiving guideline-concordant treatment. Average monthly Medicare expenditures were 100.4% higher (95% confidence interval: $77.3%-126.5%) for women who did not receive guideline-concordant treatment compared to those who received guideline-concordant treatment (p < 0.0001).
One fourth of the study cohort did not receive guideline-concordant initial systemic treatment. Guideline-concordant initial treatment was associated with reduced mortality, and lower healthcare utilization and Medicare expenditures in women with metastatic breast cancer.
摘要：
我们检查了转移性乳腺癌女性的指南一致的初始全身治疗，它的预测因素，如果指南一致的治疗与死亡率相关，医疗保健利用和医疗保险支出。
这项回顾性观察性队列研究使用监测，流行病学,最终结果-医疗保险链接数据库。纳入2010-2013年期间诊断为转移性乳腺癌的66-90岁女性(N=1282)。国家综合癌症网络治疗指南用于确定癌症诊断后指南一致的初始全身治疗。进行了逻辑回归分析，以检查指南一致治疗的重要预测因素。广义线性回归用于检查指南一致治疗和医疗保健利用与平均每月医疗保险支出之间的关联。
约74%的研究队列接受了指南一致的初始全身治疗。接受指南一致治疗的女性更可能相对年轻（p<0.05），已婚/有伴侣(p=0.0038)，有HER2阳性肿瘤，并有良好的表现状态。对于未接受指南一致治疗的女性，全因（2.364，p<0.0001）和乳腺癌特异性死亡率（2.179，p<0.0001）的调整后风险比更高。未接受指南一致治疗的女性的医疗保健利用率也较高。与接受指南一致治疗的女性相比，未接受指南一致治疗的女性平均每月医疗保险支出高出100.4%(95%置信区间：77.3%-126.5%)(p<0.0001)。
1/4的研究队列未接受指南一致的初始全身治疗。指南一致的初始治疗与死亡率降低相关，转移性乳腺癌女性的医疗保健利用率和医疗保险支出较低。
这项回顾性观察性队列研究使用监测，流行病学,最终结果-医疗保险链接数据库。纳入2010-2013年期间诊断为转移性乳腺癌的66-90岁女性(N=1282)。国家综合癌症网络治疗指南用于确定癌症诊断后指南一致的初始全身治疗。进行了逻辑回归分析，以检查指南一致治疗的重要预测因素。广义线性回归用于检查指南一致治疗和医疗保健利用与平均每月医疗保险支出之间的关联。
约74%的研究队列接受了指南一致的初始全身治疗。接受指南一致治疗的女性更可能相对年轻（p<0.05），已婚/有伴侣(p=0.0038)，有HER2阳性肿瘤，并有良好的表现状态。对于未接受指南一致治疗的女性，全因（2.364，p<0.0001）和乳腺癌特异性死亡率（2.179，p<0.0001）的调整后风险比更高。未接受指南一致治疗的女性的医疗保健利用率也较高。与接受指南一致治疗的女性相比，未接受指南一致治疗的女性平均每月医疗保险支出高出100.4%(95%置信区间：77.3%-126.5%)(p<0.0001)。
1/4的研究队列未接受指南一致的初始全身治疗。指南一致的初始治疗与死亡率降低相关，转移性乳腺癌女性的医疗保健利用率和医疗保险支出较低。
