Background

Suboptimal completion of chemotherapy, which may involve reduced patient adherence, remains a serious issue and leads to reduced treatment efficacy. This study assessed the completion rates, risk factors for noncompletion, and cost impact for noncompletion in patients on capecitabine monotherapy (Cape) or capecitabine with oxaliplatin (CAPOX) for the adjuvant treatment of early-stage colon cancer.

Methods

Patients with a diagnosis of early-stage colon cancer between April 2013 and March 2017 were retrospectively identified. Treatment completion was evaluated. Multivariate logistic regressions analyses were used to assess the baseline factors associated with noncompletion. Adverse events, costs, healthcare resource utilization, and cost impact for noncompletion were investigated.

Results

A total of 673 patients met the eligibility criteria, of which 382 (57%) were treated with Cape and 291 (43%) with CAPOX. The overall completion rate for adjuvant therapy was 40% (Cape 46%; CAPOX 33%). Noncompletion was associated with CAPOX treatment and higher healthcare costs within 6 months prior to chemotherapy. The 6-month unadjusted total healthcare costs were $44,444 for Cape and $71,247 for CAPOX. The nonchemotherapy costs were 41% higher for noncompleters than completers in both treatment groups (P = .002).

Conclusions

The real-world completion rates for adjuvant capecitabine–based chemotherapy in early-stage colon cancer patients are low. Noncompletion of therapy is associated with higher baseline healthcare costs. The nonchemotherapy costs are significantly higher in noncompleters than completers, highlighting the financial burden of managing adverse events and preexisting comorbidities, which may lead to early discontinuation of therapy. Effective strategies to optimize completion of oral chemotherapy may consider adherence monitoring.

中文翻译：

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早期结肠癌患者口服辅助卡培他滨化疗的次优完成率、不良事件、成本、资源利用和未完成的成本影响

背景

可能涉及降低患者依从性的化疗的次优完成仍然是一个严重的问题，并导致治疗效果降低。本研究评估了卡培他滨单药治疗 (Cape) 或卡培他滨联合奥沙利铂 (CAPOX) 辅助治疗早期结肠癌的患者的完成率、未完成的危险因素以及未完成的成本影响。

方法

回顾性确定了 2013 年 4 月至 2017 年 3 月期间诊断为早期结肠癌的患者。评估治疗完成情况。多变量逻辑回归分析用于评估与未完成相关的基线因素。对未完成的不良事件、成本、医疗资源利用和成本影响进行了调查。

结果

共有 673 名患者符合资格标准，其中 382 名（57%）接受 Cape 治疗，291 名（43%）接受 CAPOX 治疗。辅助治疗的总体完成率为 40%（Cape 46%；CAPOX 33%）。未完成与化疗前 6 个月内的 CAPOX 治疗和更高的医疗保健费用相关。Cape 的 6 个月未经调整的总医疗保健费用为 44,444 美元，CAPOX 为 71,247 美元。在两个治疗组中，未完成者的非化疗费用比完成者高 41%（P  = .002）。

结论

在早期结肠癌患者中，基于卡培他滨的辅助化疗的实际完成率很低。未完成治疗与较高的基线医疗保健费用相关。未完成者的非化疗成本显着高于完成者，突出了管理不良事件和先前存在的合并症的经济负担，这可能导致早期停止治疗。优化口服化疗完成的有效策略可考虑依从性监测。