Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Alexis D. Leal, Holly Van Houten, Lindsey Sangaralingham, Rachel A. Freedman, Ahmedin Jemal, Heather B. Neuman, Tufia C. Haddad, Robert W. Mutter, Theresa H Keegan, Sarah S. Mougalian, Charles L. Loprinzi, Cary P. Gross, Nilay Shah, Kathryn J. Ruddy

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalClinical Breast Cancer
DOIs
StateAccepted/In press - 2017

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Adjuvant Chemotherapy
Cyclophosphamide
Doxorubicin
Survival Rate
docetaxel
Breast Neoplasms
Outpatients
Paclitaxel
Drug Therapy
Primary Health Care
Office Visits
Medical Oncology
Insurance
Survivors
Hospitalization
Databases
Radiation
Delivery of Health Care

Keywords

  • Breast neoplasms
  • Follow-up
  • Health care use
  • Outpatient
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Leal, A. D., Van Houten, H., Sangaralingham, L., Freedman, R. A., Jemal, A., Neuman, H. B., ... Ruddy, K. J. (Accepted/In press). Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens. Clinical Breast Cancer. https://doi.org/10.1016/j.clbc.2017.09.011

Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens. / Leal, Alexis D.; Van Houten, Holly; Sangaralingham, Lindsey; Freedman, Rachel A.; Jemal, Ahmedin; Neuman, Heather B.; Haddad, Tufia C.; Mutter, Robert W.; Keegan, Theresa H; Mougalian, Sarah S.; Loprinzi, Charles L.; Gross, Cary P.; Shah, Nilay; Ruddy, Kathryn J.

In: Clinical Breast Cancer, 2017.

Research output: Contribution to journalArticle

Leal, AD, Van Houten, H, Sangaralingham, L, Freedman, RA, Jemal, A, Neuman, HB, Haddad, TC, Mutter, RW, Keegan, TH, Mougalian, SS, Loprinzi, CL, Gross, CP, Shah, N & Ruddy, KJ 2017, 'Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens', Clinical Breast Cancer. https://doi.org/10.1016/j.clbc.2017.09.011
Leal, Alexis D. ; Van Houten, Holly ; Sangaralingham, Lindsey ; Freedman, Rachel A. ; Jemal, Ahmedin ; Neuman, Heather B. ; Haddad, Tufia C. ; Mutter, Robert W. ; Keegan, Theresa H ; Mougalian, Sarah S. ; Loprinzi, Charles L. ; Gross, Cary P. ; Shah, Nilay ; Ruddy, Kathryn J. / Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens. In: Clinical Breast Cancer. 2017.
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abstract = "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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T1 - Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

AU - Leal, Alexis D.

AU - Van Houten, Holly

AU - Sangaralingham, Lindsey

AU - Freedman, Rachel A.

AU - Jemal, Ahmedin

AU - Neuman, Heather B.

AU - Haddad, Tufia C.

AU - Mutter, Robert W.

AU - Keegan, Theresa H

AU - Mougalian, Sarah S.

AU - Loprinzi, Charles L.

AU - Gross, Cary P.

AU - Shah, Nilay

AU - Ruddy, Kathryn J.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Breast neoplasms

KW - Follow-up

KW - Health care use

KW - Outpatient

KW - Toxicity

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