Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer

Kathryn J Ruddy, Holly K. Van Houten, Lindsey R. Sangaralingham, Rachel A. Freedman, Carrie A Thompson, Shahrukh K. Hashmi, Ahmedin Jemal, Tufia C Haddad, Sarah Mougalian, Jeph Herrin, Cary Gross, Nilay D Shah

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Purpose: The Oncology Care Model was developed, in part, to reduce acute care use during the 6 months after chemotherapy initiation. However, little is known about the impact of chemotherapy regimen on acute care needs, or about later acute care. We sought to assess acute care use over 2 years in patients receiving four contemporary adjuvant chemotherapy regimens for breast cancer. Methods: Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify women with early-stage breast cancer 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. Rates of hospitalizations and emergency department (ED) visits that did not lead to hospitalizations were compared during four sequential 6-month periods among recipients of these four regimens using negative binomial regression (TC = reference). Results: We identified 8621 eligible patients, 87.2% younger than 65. Over 6 months, 11.9% were hospitalized and 17.1% had ED visits. Over 24 months, 17.9% were hospitalized and 28.3% visited the ED. Adjusted rates of hospitalizations/100 patients were significantly higher in AC-T and TAC compared to TC recipients in the first 6 months (14.9, 21.9, and 11.3, respectively, p < 0.001). There were no hospitalization rate differences among regimens later. ED visit rates did not differ significantly by regimen during any 6-month period. Conclusion: Higher rates of hospitalizations in recipients of AC-T and TAC were restricted to the chemotherapy administration period, and did not persist afterwards.

Original languageEnglish (US)
Pages (from-to)515-525
Number of pages11
JournalBreast Cancer Research and Treatment
Volume164
Issue number3
DOIs
StatePublished - Aug 1 2017

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Adjuvant Chemotherapy
Cyclophosphamide
docetaxel
Doxorubicin
Breast Neoplasms
Hospitalization
Hospital Emergency Service
Paclitaxel
Drug Therapy
Therapeutics
Insurance
Databases

Keywords

  • Breast neoplasms
  • Delivery of health care
  • Drug therapy
  • Hospitalization
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer. / Ruddy, Kathryn J; Van Houten, Holly K.; Sangaralingham, Lindsey R.; Freedman, Rachel A.; Thompson, Carrie A; Hashmi, Shahrukh K.; Jemal, Ahmedin; Haddad, Tufia C; Mougalian, Sarah; Herrin, Jeph; Gross, Cary; Shah, Nilay D.

In: Breast Cancer Research and Treatment, Vol. 164, No. 3, 01.08.2017, p. 515-525.

Research output: Contribution to journalReview article

Ruddy, Kathryn J ; Van Houten, Holly K. ; Sangaralingham, Lindsey R. ; Freedman, Rachel A. ; Thompson, Carrie A ; Hashmi, Shahrukh K. ; Jemal, Ahmedin ; Haddad, Tufia C ; Mougalian, Sarah ; Herrin, Jeph ; Gross, Cary ; Shah, Nilay D. / Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer. In: Breast Cancer Research and Treatment. 2017 ; Vol. 164, No. 3. pp. 515-525.
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abstract = "Purpose: The Oncology Care Model was developed, in part, to reduce acute care use during the 6 months after chemotherapy initiation. However, little is known about the impact of chemotherapy regimen on acute care needs, or about later acute care. We sought to assess acute care use over 2 years in patients receiving four contemporary adjuvant chemotherapy regimens for breast cancer. Methods: Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify women with early-stage breast cancer 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. Rates of hospitalizations and emergency department (ED) visits that did not lead to hospitalizations were compared during four sequential 6-month periods among recipients of these four regimens using negative binomial regression (TC = reference). Results: We identified 8621 eligible patients, 87.2{\%} younger than 65. Over 6 months, 11.9{\%} were hospitalized and 17.1{\%} had ED visits. Over 24 months, 17.9{\%} were hospitalized and 28.3{\%} visited the ED. Adjusted rates of hospitalizations/100 patients were significantly higher in AC-T and TAC compared to TC recipients in the first 6 months (14.9, 21.9, and 11.3, respectively, p < 0.001). There were no hospitalization rate differences among regimens later. ED visit rates did not differ significantly by regimen during any 6-month period. Conclusion: Higher rates of hospitalizations in recipients of AC-T and TAC were restricted to the chemotherapy administration period, and did not persist afterwards.",
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T1 - Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer

AU - Ruddy, Kathryn J

AU - Van Houten, Holly K.

AU - Sangaralingham, Lindsey R.

AU - Freedman, Rachel A.

AU - Thompson, Carrie A

AU - Hashmi, Shahrukh K.

AU - Jemal, Ahmedin

AU - Haddad, Tufia C

AU - Mougalian, Sarah

AU - Herrin, Jeph

AU - Gross, Cary

AU - Shah, Nilay D

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose: The Oncology Care Model was developed, in part, to reduce acute care use during the 6 months after chemotherapy initiation. However, little is known about the impact of chemotherapy regimen on acute care needs, or about later acute care. We sought to assess acute care use over 2 years in patients receiving four contemporary adjuvant chemotherapy regimens for breast cancer. Methods: Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify women with early-stage breast cancer 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. Rates of hospitalizations and emergency department (ED) visits that did not lead to hospitalizations were compared during four sequential 6-month periods among recipients of these four regimens using negative binomial regression (TC = reference). Results: We identified 8621 eligible patients, 87.2% younger than 65. Over 6 months, 11.9% were hospitalized and 17.1% had ED visits. Over 24 months, 17.9% were hospitalized and 28.3% visited the ED. Adjusted rates of hospitalizations/100 patients were significantly higher in AC-T and TAC compared to TC recipients in the first 6 months (14.9, 21.9, and 11.3, respectively, p < 0.001). There were no hospitalization rate differences among regimens later. ED visit rates did not differ significantly by regimen during any 6-month period. Conclusion: Higher rates of hospitalizations in recipients of AC-T and TAC were restricted to the chemotherapy administration period, and did not persist afterwards.

AB - Purpose: The Oncology Care Model was developed, in part, to reduce acute care use during the 6 months after chemotherapy initiation. However, little is known about the impact of chemotherapy regimen on acute care needs, or about later acute care. We sought to assess acute care use over 2 years in patients receiving four contemporary adjuvant chemotherapy regimens for breast cancer. Methods: Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify women with early-stage breast cancer 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. Rates of hospitalizations and emergency department (ED) visits that did not lead to hospitalizations were compared during four sequential 6-month periods among recipients of these four regimens using negative binomial regression (TC = reference). Results: We identified 8621 eligible patients, 87.2% younger than 65. Over 6 months, 11.9% were hospitalized and 17.1% had ED visits. Over 24 months, 17.9% were hospitalized and 28.3% visited the ED. Adjusted rates of hospitalizations/100 patients were significantly higher in AC-T and TAC compared to TC recipients in the first 6 months (14.9, 21.9, and 11.3, respectively, p < 0.001). There were no hospitalization rate differences among regimens later. ED visit rates did not differ significantly by regimen during any 6-month period. Conclusion: Higher rates of hospitalizations in recipients of AC-T and TAC were restricted to the chemotherapy administration period, and did not persist afterwards.

KW - Breast neoplasms

KW - Delivery of health care

KW - Drug therapy

KW - Hospitalization

KW - Toxicity

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