我院2016年度乳腺癌术后辅助化疗方案的合理性评价分析

Rationality Analysis of Postoperative Adjuvant Chemotherapy Scheme for Breast Cancer Patients in Our Hospital in 2016

目的从乳腺癌术后辅助化疗方案、剂量、疗程、不良反应等角度分析我院肿瘤内科与非肿瘤内科乳腺癌术后辅助治疗方案的合理性,并分析不规范治疗方案原因,为乳腺癌术后规范诊疗与管理提供参考。方法以诊断"乳腺癌"为关键词提取2016年全年于我院就诊并行乳腺癌根治性手术的患者362例。参照《NCCN乳腺癌临床实践指南(2016版)》和《中国乳腺癌诊疗规范(2015版)》,分别从术后辅助化疗方案选择、化疗药物剂量是否合理、疗程是否足够、不良反应发生情况、不同科室治疗方案比较等方面进行统计分析,在此基础上对乳腺癌术后辅助治疗方案的合理性进行综合评价,对不规范诊疗的原因进行总结分析。结果化疗方案选择符合指南推荐首选方案163例,化疗给药剂量符合指南推荐标准剂量125例,完成指南推荐化疗周期136例。对肿瘤内科及非肿瘤内科的患者进行对比,方案规范率分别为77.0%、46.0%,给药剂量合理率分别为42.2%、23.5%,治疗疗程合理率分别为64.6%、39.6%,6个月内完成既定周期化疗比例分别为54.9%、19.5%,差异均具有统计学意义(P<0.01)。结论目前,乳腺癌术后辅助化疗不规范现象发生率较高,特别是非肿瘤内科,应加强肿瘤规范化诊疗培训,推进抗肿瘤药物分级管理及临床药师参与化疗方案的制定。

Objective Rationality analysis of postoperative adjuvant therapy for breast cancer patients from non-tumor Internal Medicine department compared with that of patients from Medical Oncology on the perspective of postoperative adjuvant chemotherapy regimen,dosage,course of treatment,adverse reactions of breast cancer,and analyze the reasons for non-standard treatment.It will provide reference for the standardized diagnosis,treatment,and management after surgery for breast cancer patients.Methods362patients were selected by searching key word“breast cancer”in our hospital in2016,the data was analyzed retrospectively.Evaluation analysis was conducted from postoperative adjuvant chemotherapy options,the dose of chemotherapy drugs,the course of treatment,the incidence of adverse reactions,different departments of the treatment program comparison and other aspects according to NCCN Clinical Practice Guidelines in Oncology:Breast Cancer(2016version)and Chinese breast cancer diagnosis and treatment specifications(2015version)respectively.Then,we did comprehensive evaluation of the rationality of postoperative adjuvant therapy for breast cancer patients in our hospital,furthermore we summarized the reasons for those who did not make standardized treatment.Results163patients with breast cancer were reasonable and consistent with the Chemotherapy options of recommended guidelines.125cases with the chemotherapy dose,136cases with the completed chemotherapy cycle.The schema specification rates were77.0%and46.0%in tumor internal medicine department and non-tumor internal medical department,the reasonable dose administration rates were42.2%and23.5%,the rational treatment rates were64.6%and39.6%,the completed the6-month scheduled chemotherapy cycle rates were54.9%and19.5%,respectively in the two departments.The differences were statistically significant(P<0.01).Conclusion At present,the occurrence rate of non-standard postoperative adjuvant chemotherapy phenomenon for breast cancer is high,especially in non-tumor medical internal department.The standardization of anti-tumor diagnosis and treatment training should be strengthened to promote the management of anti-tumor drug classification and clinical pharmacists involved in the development of chemotherapy programs.