Risk of Hospitalization According to Chemotherapy Regimen in Early-Stage Breast Cancer

Barcenas, Carlos H.; Niu, Jiangong; Zhang, Ning; Zhang, Yufeng; Buchholz, Thomas A.; Elting, Linda S.; Hortobágyi, Gabriel N.; Smith, Benjamin D.; Giordano, Sharon H.

doi:10.1200/jco.2013.49.3676

Cited by 103 publications

(92 citation statements)

References 42 publications

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“…These differences remained statistically significant, even after adjustment for a variety of other factors that might affect visit frequency. Our findings are consistent with data from Barcenas et al, 4 showing higher rates of hospitalization during AC-T and TAC. We suspect that greater outpatient health care use during and after AC-T and TAC might, in part, reflect a greater burden of toxicity among recipients of combined anthracycline and taxane therapy.…”

Section: Discussionsupporting

confidence: 93%

“…2–4 Barcenas et al 4 reported significantly higher rates of hospitalization in early stage breast cancer patients who received anthracycline-based chemotherapy than in those who received docetaxel/cyclophosphamide (TC), suggesting that TC carries less risk of acute severe toxicity. Similarly, in already-published work, our group reported higher adjusted rates of hospitalizations during the chemotherapy administration period among early stage breast cancer patients who received anthracycline-based chemotherapy compared with those who received TC.…”

Section: Introductionmentioning

confidence: 99%

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Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Leal

Houten

Sangaralingham

et al. 2018

Clinical Breast Cancer

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Administrative claims data from a commercial insurance database were analyzed to evaluate differences in rates of outpatient office visits during the year after completion of 4 chemotherapy regimens for early stage breast cancer. Combined anthracycline/taxane was associated with more frequent office visits than docetaxel-cyclophosphamide or doxorubicin-cyclophosphamide, possibly because of greater long-term toxicities. Primary care visits were infrequent. Background: Treatment-related toxicity can vary substantially between chemotherapy regimens. In this study we evaluated the frequency of outpatient office visits among a cohort of early stage breast cancer survivors after completion of 4 different adjuvant chemotherapy regimens to better understand how differences in toxicities between regimens might affect health care use. Materials and Methods: We analyzed administrative claims data from a US commercial insurance database (OptumLabs) to identify women who received adjuvant doxorubicin/cyclophosphamide (AC), AC followed or preceded by docetaxel or paclitaxel (AC-T), AC concurrent with docetaxel or paclitaxel (TAC), or docetaxel/cyclophosphamide (TC) between 2008 and 2014. We compared mean numbers of visits per patient (adjusted for age, race/ethnicity, region, year, surgery type, radiation, chronic conditions, and previous hospitalizations) across the different regimens (TC = reference) for 12 months, starting 4 months after the end of chemotherapy. Results: In 6247 eligible patients, the mean adjusted number of outpatient visits per patient was significantly higher in patients who received AC-T (8.1) or TAC (7.3) than TC (6.5) or AC (6.0; P < .001 for comparisons of AC-T and TAC with TC), primarily because of differences in Medical Oncology visits. Approximately 40% did not see a primary care provider at all during this time frame. Conclusions: AC-T and TAC are associated with more subsequent outpatient visits than TC. Visits to primary care providers are infrequent during the year after completion of chemotherapy.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Leal

Houten

Sangaralingham

et al. 2018

Clinical Breast Cancer

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“…In BC and other tumours, elderly patients have a higher risk of treatment interruption, neutropenia and hospitalization due to side effects [97] [98][99] [100]. Hospitalization is especially worrisome since it can lead to classical complications such as delirium and these can seriously impair functionality, with long term impact on both quality of life and survival [101] [102].…”

Section: Toxicitiesmentioning

confidence: 99%

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

Pondé

Lago

Azim

2016

Expert Review of Anticancer Therapy

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Elderly women with early breast cancer (BC) form a heterogeneous and large subgroup (41.8% of women with BC are over 65). Decision making in this subgroup is made more difficult by lack of familiarity with their physical, cognitive and social issues. Adequate management depends on biological factors and accurate clinical evaluation through comprehensive geriatric assessment (CGA). CGA can help to better select and determine potential risks factors for patients who are candidates for adjuvant chemotherapy. It is still recently introduced in geriatric oncology and there is a lack of awareness of its importance. Available data on adjuvant chemotherapy for BC is limited but suggests it can be of benefit for well selected patients, though the risk of short and long-term toxicity is significant. Here we provide a discussion of the key practical issues in decision making in the setting of adjuvant chemotherapy for elderly BC patients.

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“…A study of medical insurance claims patients in the United States found that, as of 2007, adjuvant tac chemotherapy was used in approximately 20% of women less than 65 years of age and in nearly 10% of women more than 65 years of age 10 ; however, fec-d use was not reported. In contrast, a population-based cohort of Canadian women treated between 2003 and 2009 reported that 55.6% received fec-d; tac use was not reported, however 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Acute and late toxicities should, therefore, affect treatment decision-making. The bcirg 001 study 6 and retrospective analyses 10 suggest that tac is associated with a significant risk of febrile neutropenia (particularly in the absence of primary g-csf support) and hospitalization. And although pacs-01 reported a relatively low incidence of febrile neutropenia 8 , retrospective studies have documented much higher rates of febrile neutropenia and hospitalization 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Real-World Adjuvant TAC or FEC-D for HER2-Negative Node-Positive Breast Cancer in Women Less Than 50 Years of Age

et al. 2016

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Purpose We compared the efficacy, toxicity, and use of granulocyte colony-stimulating factor (g-csf) with tac (docetaxel-doxorubicin-cyclophosphamide) and fec-d (5-fluorouracil-epirubicin-cyclophosphamide followed by docetaxel) in women less than 50 years of age. MethodsThe study included all women more than 18 years but less than 50 years of age with her2-negative, ResultsThe patient groups were well-balanced, except that radiotherapy use was higher in the tac group (91.9% vs. 79.9%, p < 0.001). At a median follow-up of 49.6 months, disease-free survival was 91.4% for tac and 92.0% for fec-d (p = 0.76). Overall survival (os) was 96% with tac and 95.3% with fec-d (p = 0.86).The incidences of grades 3 and 4 toxicities were similar in the two groups (all p > 0.05). Overall, febrile neutropenia (fn) was reported in 11.6% of tac patients and 15.7% of fec-d patients (p = 0.26). However, use of g-csf was higher in the tac group than in the fec-d group (96.4% vs. 71.5%, p < 0.001). Hospitalization for fn was required in 10.5% of tac patients and 13.0% of fec-d patients (p = 0.41). In g-csf-supported and -unsupported patients receiving tac, fn occurred at rates of 11.1% and 33.3% respectively (p = 0.08); in patients receiving the fec portion of fec-d, those proportions were 2.9% and 8.1% respectively (p = 0.24); and in patients receiving docetaxel after fec, the proportions were 4.1% and 17.6% respectively (p < 0.001). ConclusionsIn women less than 50 years of age receiving adjuvant tac or fec-d, we observed no differences in efficacy or other nonhematologic toxicities. Based on the timing and rates of fn, use of prophylactic g-csf should be routine for the docetaxel-containing portion of treatment; however, prophylactic g-csf could potentially be avoided during the fec portion of fec-d treatment.

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Risk of Hospitalization According to Chemotherapy Regimen in Early-Stage Breast Cancer

Cited by 103 publications

References 42 publications

Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

Real-World Adjuvant TAC or FEC-D for HER2-Negative Node-Positive Breast Cancer in Women Less Than 50 Years of Age

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