Alexis D Leal1, Holly Van Houten2, Lindsey Sangaralingham2, Rachel A Freedman3, Ahmedin Jemal4, Heather B Neuman5, Tufia C Haddad1, Robert W Mutter6, Theresa H M Keegan7, Sarah S Mougalian8, Charles L Loprinzi1, Cary P Gross8, Nilay Shah2, Kathryn J Ruddy9. 1. Division of Medical Oncology, Mayo Clinic, Rochester, MN. 2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA. 3. Dana-Farber Cancer Institute, Boston, MA. 4. American Cancer Society, Atlanta, GA. 5. Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI. 6. Division of Radiation Oncology, Mayo Clinic, Rochester, MN. 7. Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA. 8. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, CT. 9. Division of Medical Oncology, Mayo Clinic, Rochester, MN. Electronic address: ruddy.kathryn@mayo.edu.
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.
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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