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Conference Paper: Costs and benefits of dose-dense chemotherapy scheduling in Hong Kong Chinese patients with primary breast cancer

TitleCosts and benefits of dose-dense chemotherapy scheduling in Hong Kong Chinese patients with primary breast cancer
Authors
Issue Date2007
PublisherAmerican Society of Clinical Oncology. The Journal's web site is located at http://www.asco.org/ASCOv2/Meetings/ASCO+Annual+Meeting
Citation
A S C O Annual Meeting Proceedings, 2007, v. 43, p. 598 How to Cite?
AbstractBackground: Routine prophylactic administration of recombinant granulocyte colony-stimulating factor (G-CSF, filgrastim) has enabled more frequent scheduling of adjuvant cytotoxic drugs in primary breast cancer. Dose-dense chemotherapy of this kind has become popular in recent years, but few studies have compared the costs and benefits of this treatment approach. Methods: We conducted a retrospective comparison of 150 Hong Kong Chinese primary breast cancer patients treated with either conventional 3-weekly chemotherapy or G-CSF-supported 2-weekly (dose-dense) chemotherapy using similar cytotoxic regimens (four cycles of doxorubicin and cyclophosphamide, followed by four cycles of taxane) between April 2004 and May 2006 in two teaching hospitals. Assessments of treatment tolerance, toxicity, scheduling, and expense were applied to both patient cohorts. Results: Compared to conventionally treated patients (n = 117), dose-dense patients (n = 33) benefited from 52.3% fewer chemotherapy delays (21.2% vs. 44.4%; p = 0.02), 79.3% fewer hospital admissions for febrile neutropenia (3.0% vs. 14.5%; p = 0.07), and 54.8% enhancement of cytotoxic dose intensity (p < 0.001). Dose-dense patients also developed less nausea (p < 0.001) and stomatitis (p = 0.01) but more frequent bone pain (p < 0.001). After subtracting costs saved by fewer hospital admissions, dose-dense patients incurred higher total expenses approximating US$500 per cycle. Conclusion: Routine G-CSF administration to Hong Kong Chinese patients with primary breast cancer is associated with major improvements in cytotoxic drug delivery, which could plausibly translate into greater therapeutic efficacy in some patients. In addition, dose- dense treatment is shorter, safer, and more reliably scheduled, and is associated with unexpected improvements in nausea and stomatitis. The extent to which these gains justify the rise in net costs needs to be further defined in prospective randomized studies, both in different adjuvant patient subsets and in differently resourced socioeconomic contexts.
Persistent Identifierhttp://hdl.handle.net/10722/77544

 

DC FieldValueLanguage
dc.contributor.authorTsang, Jen_HK
dc.contributor.authorYau, Ten_HK
dc.contributor.authorChan, ATCen_HK
dc.contributor.authorLiang, RHSen_HK
dc.contributor.authorYeo, Wen_HK
dc.contributor.authorEpstein, Ren_HK
dc.date.accessioned2010-09-06T07:33:03Z-
dc.date.available2010-09-06T07:33:03Z-
dc.date.issued2007en_HK
dc.identifier.citationA S C O Annual Meeting Proceedings, 2007, v. 43, p. 598en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77544-
dc.description.abstractBackground: Routine prophylactic administration of recombinant granulocyte colony-stimulating factor (G-CSF, filgrastim) has enabled more frequent scheduling of adjuvant cytotoxic drugs in primary breast cancer. Dose-dense chemotherapy of this kind has become popular in recent years, but few studies have compared the costs and benefits of this treatment approach. Methods: We conducted a retrospective comparison of 150 Hong Kong Chinese primary breast cancer patients treated with either conventional 3-weekly chemotherapy or G-CSF-supported 2-weekly (dose-dense) chemotherapy using similar cytotoxic regimens (four cycles of doxorubicin and cyclophosphamide, followed by four cycles of taxane) between April 2004 and May 2006 in two teaching hospitals. Assessments of treatment tolerance, toxicity, scheduling, and expense were applied to both patient cohorts. Results: Compared to conventionally treated patients (n = 117), dose-dense patients (n = 33) benefited from 52.3% fewer chemotherapy delays (21.2% vs. 44.4%; p = 0.02), 79.3% fewer hospital admissions for febrile neutropenia (3.0% vs. 14.5%; p = 0.07), and 54.8% enhancement of cytotoxic dose intensity (p < 0.001). Dose-dense patients also developed less nausea (p < 0.001) and stomatitis (p = 0.01) but more frequent bone pain (p < 0.001). After subtracting costs saved by fewer hospital admissions, dose-dense patients incurred higher total expenses approximating US$500 per cycle. Conclusion: Routine G-CSF administration to Hong Kong Chinese patients with primary breast cancer is associated with major improvements in cytotoxic drug delivery, which could plausibly translate into greater therapeutic efficacy in some patients. In addition, dose- dense treatment is shorter, safer, and more reliably scheduled, and is associated with unexpected improvements in nausea and stomatitis. The extent to which these gains justify the rise in net costs needs to be further defined in prospective randomized studies, both in different adjuvant patient subsets and in differently resourced socioeconomic contexts.-
dc.languageengen_HK
dc.publisherAmerican Society of Clinical Oncology. The Journal's web site is located at http://www.asco.org/ASCOv2/Meetings/ASCO+Annual+Meetingen_HK
dc.relation.ispartofA S C O Annual Meeting Proceedingsen_HK
dc.titleCosts and benefits of dose-dense chemotherapy scheduling in Hong Kong Chinese patients with primary breast canceren_HK
dc.typeConference_Paperen_HK
dc.identifier.emailLiang, RHS: rliang@hku.hken_HK
dc.identifier.emailEpstein, R: repstein@hku.hken_HK
dc.identifier.authorityLiang, RHS=rp00345en_HK
dc.identifier.authorityEpstein, R=rp00501en_HK
dc.identifier.hkuros131726en_HK

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