The landscape of use of NCCN-guideline chemotherapy regimens in stage I-IIIA breast cancer in an integrated healthcare delivery system.

IF 3 3区 医学 Q2 ONCOLOGY Breast Cancer Research and Treatment Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI:10.1007/s10549-024-07433-4
Jenna Bhimani, Kelli O'Connell, Sonia Persaud, Victoria Blinder, Rachael P Burganowski, Isaac J Ergas, Grace B Gallagher, Jennifer J Griggs, Narre Heon, Tatjana Kolevska, Yuriy Kotsurovskyy, Candyce H Kroenke, Cecile A Laurent, Raymond Liu, Kanichi G Nakata, Donna R Rivera, Janise M Roh, Sara Tabatabai, Emily Valice, Elisa V Bandera, Erin J Aiello Bowles, Lawrence H Kushi, Elizabeth D Kantor
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Abstract

Purpose: The National Comprehensive Cancer Network (NCCN) guidelines recommend a variety of drug combinations with specific administration schedules for the treatment of early-stage breast cancer, allowing physicians to deliver treatments recognizing individual patient complexities, including comorbidities, and patient-physician preference. While use of guideline regimens has shifted over time, there is little data to describe changes in how treatment for early-stage breast cancer has evolved over time.

Methods: In a cohort of 34,109 women treated for stage I-IIIA breast cancer between 2006-2019 at Kaiser Permanente Northern California and Kaiser Permanente Washington, we present the changes in chemotherapy regimens over time, and explore use of NCCN-guideline regimens (GR), guideline regimens used when said regimens were not included in guidelines, referred to as time-discordant regimens (TDR), and non-guideline regimens (NGR). Results are presented by drug combination and over time.

Results: Among 12,506 women receiving chemotherapy, 77.4% (n = 9681) received GRs, 9.1% (n = 1140) received TDRs, and 13.5% (n = 1685) received NGRs. In 2006, AC-T (cyclophosphamide-doxorubicin, paclitaxel) was the most common regimen, with TC (cyclophosphamide-docetaxel) becoming the most prevalent by 2019. NGRs were more common in cyclophosphamide-methotrexate-5-fluorouracil (CMF); cyclophosphamide-doxorubicin-paclitaxel-trastuzumab (ACTH); and paclitaxel-trastuzumab (TH). The use of GR has increased over time (p-trend < 0.001), while use of NGR (both in terms of administration schedule and drug combination) and TDR have decreased, although patterns vary by drug combination.

Conclusion: Chemotherapy delivery has changed markedly over time, with a move toward more use of GR. These data are important for understanding the landscape of chemotherapy delivery in community healthcare settings.

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综合医疗服务系统中 I-IIIA 期乳腺癌 NCCN 指南化疗方案的使用情况。
目的:美国国立综合癌症网络(NCCN)指南推荐了多种药物组合和特定的给药计划用于早期乳腺癌的治疗,使医生能够根据患者的个体复杂性(包括合并症)和患者-医生的偏好提供治疗。虽然随着时间的推移,指导方案的使用也在发生变化,但很少有数据能说明早期乳腺癌的治疗随着时间的推移发生了怎样的变化:在北加州凯泽医疗集团和华盛顿凯泽医疗集团 2006-2019 年间接受 I-IIIA 期乳腺癌治疗的 34109 名女性队列中,我们介绍了化疗方案随时间推移而发生的变化,并探讨了 NCCN 指南方案(GR)的使用情况、在指南中未包含上述方案时使用的指南方案(称为时间不一致方案(TDR))以及非指南方案(NGR)的使用情况。研究结果按药物组合和时间顺序排列:在接受化疗的12506名妇女中,77.4%(n = 9681)接受了GR方案,9.1%(n = 1140)接受了TDR方案,13.5%(n = 1685)接受了NGR方案。2006年,AC-T(环磷酰胺-多柔比星-紫杉醇)是最常见的治疗方案,到2019年,TC(环磷酰胺-多西他赛)成为最普遍的治疗方案。NGR在环磷酰胺-甲氨蝶呤-5-氟尿嘧啶(CMF)、环磷酰胺-多柔比星-紫杉醇-曲妥珠单抗(ACTH)和紫杉醇-曲妥珠单抗(TH)中更为常见。随着时间的推移,GR 的使用有所增加(p-趋势 结论):随着时间的推移,化疗方式发生了显著变化,更多使用了GR。这些数据对于了解社区医疗机构的化疗情况非常重要。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
342
审稿时长
1 months
期刊介绍: Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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