2016年5月9日，美國臨床腫瘤學(xué)會(huì)（ASCO）官方期刊《臨床腫瘤學(xué)雜志》在線發(fā)表了美國哥倫比亞大學(xué)醫(yī)學(xué)院、紐約威爾康奈爾醫(yī)學(xué)院的研究報(bào)告：轉(zhuǎn)移性乳腺癌女性疾病復(fù)查的次數(shù)與費(fèi)用。
該研究根據(jù)SEER醫(yī)保數(shù)據(jù)庫2002～2011年2460例轉(zhuǎn)移性乳腺癌女性多變量分析發(fā)現(xiàn)，雖然頻繁復(fù)查并不改善結(jié)局、臨床獲益未知，但是大約三分之一（37.6%）轉(zhuǎn)移性乳腺癌老年女性疾病復(fù)查（如CEA和/或CA15-3/CA27.29等血清腫瘤指標(biāo)檢查、CT和/或PET等放射影像檢查）過于頻繁（每12個(gè)月血清腫瘤指標(biāo)檢查＞12次和/或放射影像檢查＞4次），顯著相關(guān)因素包括HR陰性（比值比1.63，95%置信區(qū)間：1.27～2.08）、PET史（比值比2.92，95%置信區(qū)間：2.40～3.55）、腫瘤科就診較頻繁（比值比3.14，95%置信區(qū)間：2.49～3.96）。疾病復(fù)查過于頻繁，造成每年醫(yī)療費(fèi)用增加59.2%，而且可能在生命終末期需要更多的急診和臨終關(guān)懷服務(wù)。
因此，有必要在臨床實(shí)踐中告知患者復(fù)查的最佳次數(shù)。
J Clin Oncol. 2016 May 9. [Epub ahead of print]
Use and Costs of Disease Monitoring in Women With Metastatic Breast Cancer.
Accordino MK, Wright JD, Vasan S, Neugut AI, Hillyer GC, Hu JC, Hershman DL.
Columbia University College of Physicians and Surgeons; Columbia University; Weill Cornell Medicine, New York, NY.
PURPOSE: The optimal frequency of monitoring patients with metastatic breast cancer (MBC) is unknown; however, data suggest that intensive monitoring does not improve outcomes. We performed a population-based analysis to evaluate patterns and predictors of extreme use of disease-monitoring tests (serum tumor markers [STMs] and radiographic imaging) among women with MBC.
METHODS: The SEER-Medicare database was used to identify women with MBC diagnosed from 2002 to 2011 who underwent disease monitoring. Billing dates of STMs (carcinoembryonic antigen and/or cancer antigen 15-3/cancer antigen 27.29) and imaging tests (computed tomography and/or positron emission tomography) were recorded; if more than one STM or imaging test were completed on the same day, they were counted once. We defined extreme use as > 12 STM and/or more than four radiographic imaging tests in a 12-month period. Multivariable analysis was used to identify factors associated with extreme use. In extreme users, total health care costs and end-of-life health care utilization were compared with the rest of the study population.
RESULTS: We identified 2,460 eligible patients. Of these, 924 (37.6%) were extreme users of disease-monitoring tests. Factors significantly associated with extreme use were hormone receptor-negative MBC (odds ratio [OR], 1.63; 95% CI, 1.27 to 2.08), history of a positron emission tomography scan (OR, 2.92; 95% CI, 2.40 to 3.55), and more frequent oncology office visits (OR, 3.14; 95% CI, 2.49 to 3.96). Medical costs per year were 59.2% higher in extreme users. Extreme users were more likely to use emergency department and hospice services at the end of life.
CONCLUSION: Despite an unknown clinical benefit, approximately one third of elderly women with MBC were extreme users of disease-monitoring tests. Higher use of disease-monitoring tests was associated with higher total health care costs. Efforts to understand the optimal frequency of monitoring are needed to inform clinical practice.
PMID: 27161970
PII: JCO666313
DOI: 10.1200/JCO.2016.66.6313
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