Thomas Morrow — Page 3

Oral dosage forms are the most common mode of drug delivery in most disease areas. However, cancer therapy is associated predominately with intravenous (IV) chemotherapy. Interest in oral anticancer drugs is growing because they may reduce costs and improve patient satisfaction. Continued research comparing oral with IV drug therapy will increase physician and patient confidence in oral therapy. Medicare must expand its coverage to include legitimate oral chemotherapy, and coverage rules must be clearly communicated to physicians. The adoption of appropriate oral chemotherapy reimbursement standards will probably prompt the pharmaceutical industry to continue research and development of oral dosage forms. Oral therapy can potentially reduce resource utilization and health care system costs, improve drug safety, and enhance patient satisfaction.

Administration, Oral↗

PubMedDate not supplied

Chemotherapy dose intensity determination as a quality of care measure for managed care organizations in the treatment of early-stage breast cancer.

The objective of this study was to demonstrate how a clinical practice database can be used to illustrate the variations in adjunctive chemotherapy for breast cancer, to describe a measure of dose intensity (DI) to monitor that variation, and to design interventions to maximize a full-planned dose. An arbitrary sample of oncology practices across the United States was selected, each providing data on 10-20 patients treated with adjuvant chemotherapy for early-stage breast cancer. Data on 17,566 patients from 1,438 sites were collected, consisting of patient characteristics including age, number of positive nodes, planned and delivered chemotherapy agents, and a sample of absolute neutrophil or white blood cell counts by cycle. Mean age of the patient cohort was 48.5 years, and 54% of patients were below the age of 49. Treatment for the disease has changed during the 2 periods studied, 1983-1994 and 1995-1999. Use of Adriamycin/Cytoxan (AC) increased, whereas use of Cytoxan/Adriamycin/Fluorouracil (CAF) and full-dose Cytoxan/Methotrexate/Fluorouracil (CMF1) decreased. However, the less intense Cytoxan/Methotrexate/Fluorouracil combination (CMF2) has seen an actual increase in use during the 2 periods. Within the context of oncology care, including chemotherapy, full-dose intensive therapy and cure has always been the ultimate goal. In this study only 10% of the patients given AC received less than 85% of the full referenced dose, whereas about 20% of those receiving the other combinations fell into this category. Also, the summation dose intensity (SDI), a measure tying level of dose to survival, was highest in the AC group and lowest in the CMF2 group. Dose delays and dose reductions appear to account for the decrease in DI in the CMF1, CMF2, and CAF groups. DI, particularly SDI of adjuvant chemotherapy, which ties level of dose to survival in breast cancer patients, appears to be a reliable measure with which to assess the quality of care in community oncology practices. The 2 measures presented in this paper may be useful to managed care organizations for monitoring quality outcomes in this serious disease. Because one of the major reasons for reduction in chemotherapy dose appears to be neutropenia and its complications, these organizations can establish programs using DI as a basis for developing guidelines to optimize the clinical benefits of growth factors.

Adult↗