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Delivering adjuvant chemotherapy to women with early‐stage breast carcinoma
Author(s) -
Link Brian K.,
Budd G. Thomas,
Scott Shane,
Dickman Elliot,
Paul David,
Lawless Grant,
Lee Martin W.,
Fridman Moshe,
Ford Jon,
Carter William B.
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010915)92:6<1354::aid-cncr1458>3.0.co;2-p
Subject(s) - medicine , stage (stratigraphy) , adjuvant chemotherapy , oncology , chemotherapy , breast carcinoma , carcinoma , adjuvant , mammary carcinoma , breast cancer , general surgery , gynecology , cancer , paleontology , biology
BACKGROUND Variations in practice patterns are markers for the quality of patient care in general medicine, but little is known about variation in care delivered to cancer patients. This study's purpose was to describe chemotherapy use, variations in chemotherapy delivery, and the incidence of complications in community practice settings. METHODS Data describing adjuvant chemotherapy for patients with early‐stage breast carcinoma (ESBC) were collected from an ongoing Oncology Practice Pattern Study at 13 large managed care, academic, and community practices (1111 patients). Data collection included information about diagnoses and adjuvant chemotherapy treatments, laboratory results, supportive care, complications, and treatment modifications. RESULTS The median patient age was 50 years, and most patients had zero to three positive lymph nodes. Chemotherapy regimens consisting of cyclophosphamide, methotrexate, and 5‐fluororacil (CMF) and of doxorubicin and cyclophosphamide (AC) accounted for 76% of the adjuvant therapies used. Overall, 30% of patients had delivered average relative dose intensities ≤ 85% of the referenced targets. Delivered summation dose intensities (SDIs) frequently were well below targeted SDIs. Neutropenia‐related dose modifications occurred for 27.6% of patients and recurred with a 60.7% rate. AC was the regimen delivered with a dose intensity closest to the referenced target. However, patients who were treated with AC regimens and with regimens consisting of cyclophosphamide, doxorubicin, and 5‐fluorouracil had significantly higher rates of chemotherapy‐related complications compared with patients who were treated with CMF regimens in the most recent treatment years. CONCLUSIONS Adjuvant chemotherapy for patients with ESBC frequently is not administered as referenced in off‐protocol community settings. Variation in the delivered SDI raises concerns about potential treatment outcomes and warrants strategies to identify patients who are at risk for complications early in therapy. Cancer 2001;92:1354–67. © 2001 American Cancer Society.