Incidence and predictors of low dose-intensity in adjuvant XXXX chemotherapy: a nationwide study of community practices.

@entity1 @entity632 @entity0 @entity786 @entity1398 @entity1213 @entity1499 @entity2841 @entity1487
PURPOSE: This retrospective study was undertaken to assess practice patterns in adjuvant chemotherapy for @entity0 ( @entity0 ) and to define the incidence and predictive factors of reduced @entity1213 ( @entity1213 ). @entity1 AND METHODS: A nationwide survey of 1,243 community oncology practices was conducted, with data extracted from records of 20,799 @entity0 @entity1 treated with adjuvant chemotherapy. Assessments included demographic and clinical characteristics, chemotherapy dose modifications, incidence of @entity1398 , and patterns of use of @entity2841 ( @entity2841 ). Dose-intensity was compared with published reference standard regimens. RESULTS: Dose reductions > or =15% occurred in 36.5% of @entity1 , and there were treatment delays > or =7 days in 24.9% of @entity1 , resulting in 55.5% of @entity1 receiving @entity1213 less than 85%. Nearly two thirds of @entity1 received @entity1213 less than 85% when adjusted for differences in regimen dose-intensity. Multivariate analysis identified several independent predictors for reduced @entity1213 , including increased age; chemotherapy with @entity786 , @entity1499 , and @entity1487 , or @entity786 , @entity632 , and @entity1487 ; a 28-day schedule; body-surface area greater than 2 m2; and no primary @entity2841 prophylaxis. @entity2841 was often initiated late in the chemotherapy cycle. CONCLUSION: @entity1 with @entity0 are at substantial risk for reduced @entity1213 when treated with adjuvant chemotherapy. @entity1 at greatest risk include older @entity1 , overweight @entity1 , and those receiving three-drug combinations or 28-day schedules. Predictive models based on such risk factors should enable the selective application of supportive measures in an effort to deliver full dose-intensity chemotherapy.
