泾县医院2015年结肠癌术后辅助化疗方案合理性评价分析
|
摘要
目的分析泾县医院结肠癌术后治疗方案的合理性,为进一步规范结肠癌的术后治疗方案提供有益参考。方法筛选164例就诊于泾县医院并行结肠癌术后辅助化疗的病例,分别从化疗方案选择合理性、化疗药物剂量准确性、疗程是否足够、不良反应发生率、不同科室治疗差异性等方面进行归纳统计,在此基础上对结肠癌术后辅助治疗方案合理性进行综合评价,对导致不合理治疗的原因进行总结分析。结果化疗方案选择符合指南推荐125例(76.22%),给药剂量符合指南推荐77例(46.95%),化疗疗程符合指南推荐95例(57.93%),6个月完成既定化疗周期81例(49.39%)。肿瘤化疗科在化疗方案选择合理率、治疗疗程合理率、6个月完成既定化疗周期比例三个统计指标上合理率明显高于非肿瘤化疗科(P<0.01)。表明结肠癌术后辅助化疗不规范现象较为严重,还存在巨大的改进空间。结论结肠癌术后辅助化疗方案应该遵从大规模临床试验结果及相关指南推荐,严格掌握药物剂量、具体用法,足疗程给予化疗、积极预防和治疗化疗相关不良反应、及时评价疗效,避免治疗过度或治疗不足等。尤其在非肿瘤化疗科,医生更应在以上方面加以严格规范,从多方面确保结肠癌术后辅助化疗的安全、有效实施。
Objective To analyze the rationality of postoperative treatment plan of colon cancer in Jingxian Hospital,and provide beneficial reference for further standardizing the postoperative treatment plan of colon cancer.Methods Screening of 164 cases of colon cancer in Jingxian Hospital with postoperative adjuvant chemotherapy,summarized the chemotherapy scheme selection,dose accuracy,treatment sufficiency,the incidence of adverse reactions,different departments treatment comparison,aspects of statistics,on the basis of the comprehensive evaluation of the rationality of adjuvant therapy after colon cancer surgery,the causes of unreasonable treatment were summarized and analyzed. Result 125 cases(76.22%)of chemotherapy scheme selection conforms to the guidelines recommend,77 cases(46.95%)of the dosage in accordance with guidelines recommended,95 cases(57.93%) of chemotherapy treatment course in accordance with guidelines recommend,81 cases(49.39%)finished the cycle of chemotherapy in six months. In the oncology department,the rational rate of chemotherapy plan,the reasonable rate of treatment course,and the completion period chemotherapy were completed in 6 months. The reasonable rate of three statistical indicators was significantly higher than that of the non-oncology department(P < 0.01). It shows that the non-standard adjuvant chemotherapy after colon cancer surgery is more serious,and there is still a huge space for improvement. Conclusions Colon cancer postoperative adjuvant chemotherapy scheme should follow large-scale clinical trials and related guidelines recommend,strict control of drug dosage,concrete usage,full course chemotherapy,active prevention and treatment of adverse drug reactions associated with chemotherapy,timely evaluation of curative effect,avoid excessive or insufficient treatment etc. Especially in non-oncology departments,doctors should be strictly standardized in the above aspects,safety and effective implementation of adjuvant chemotherapy for colon cancer patients from multiple perspectives.
Objective To analyze the rationality of postoperative treatment plan of colon cancer in Jingxian Hospital,and provide beneficial reference for further standardizing the postoperative treatment plan of colon cancer.Methods Screening of 164 cases of colon cancer in Jingxian Hospital with postoperative adjuvant chemotherapy,summarized the chemotherapy scheme selection,dose accuracy,treatment sufficiency,the incidence of adverse reactions,different departments treatment comparison,aspects of statistics,on the basis of the comprehensive evaluation of the rationality of adjuvant therapy after colon cancer surgery,the causes of unreasonable treatment were summarized and analyzed. Result 125 cases(76.22%)of chemotherapy scheme selection conforms to the guidelines recommend,77 cases(46.95%)of the dosage in accordance with guidelines recommended,95 cases(57.93%) of chemotherapy treatment course in accordance with guidelines recommend,81 cases(49.39%)finished the cycle of chemotherapy in six months. In the oncology department,the rational rate of chemotherapy plan,the reasonable rate of treatment course,and the completion period chemotherapy were completed in 6 months. The reasonable rate of three statistical indicators was significantly higher than that of the non-oncology department(P < 0.01). It shows that the non-standard adjuvant chemotherapy after colon cancer surgery is more serious,and there is still a huge space for improvement. Conclusions Colon cancer postoperative adjuvant chemotherapy scheme should follow large-scale clinical trials and related guidelines recommend,strict control of drug dosage,concrete usage,full course chemotherapy,active prevention and treatment of adverse drug reactions associated with chemotherapy,timely evaluation of curative effect,avoid excessive or insufficient treatment etc. Especially in non-oncology departments,doctors should be strictly standardized in the above aspects,safety and effective implementation of adjuvant chemotherapy for colon cancer patients from multiple perspectives.
引文
[1]国家卫生和计划生育委员会.关于加强肿瘤规范化诊疗管理工作的通知[S].国卫办医发(2016)7号.2016-03-22.
[2]National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology:Colon cancer(2018.V1)[EB/OL].https://www.nccn.org/
[3]国家卫生计生委医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017版)[J].中华胃肠外科杂志,2018,21(1):92-106.
[4]蒲兵,谢法东,孙波,等.抗肿瘤合理用药评价体系的建立[J].中国医院药学杂志,2014,34(2):143-146.
[5]OCONNELL J B,MAGGARD M A,KO C Y.Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging[J].J NatI Cancer Inst,2004,96(19):1420-1425.
[6]ANDRéT,BONI C,MOUNEDJI-BOUDIAF L,et al.Oxaliplatin,Fluorouracil,and Leucovorin as adjuvant treatment for colon cancer[J].N Engl J Med,2004,350(23):2343-2351.
[7]de GRAMONT A,BONI C,NAVARRO M,et al.Oxaliplatin/5FU/LV in adjuvant colon cancer:Updated efficacy results of the MOSAIC trial,including survival,with a median follow-up of six years[J].J Clin Oncol,2007,25(18 S):4007.
[8]ANDRéT,BONI C,NAVARRO M,et al.Improved overall survival with Oxaliplatin,Fluorouracil,and Leucovorin as adjuvant treatment in stageⅡorⅢcolon cancer in the MOSAICtrial[J].J Clin Oncol,2009,27(19):3109-3116.
[9]COMPTON C C,FIELDING L P,BURGART L J,et al.Prognostic factors in colorectal cancer.College of American Pathologists Consensus Statement 1999[J].Arch Pathol Lab Med,2000,124(7):979-994.
[10]BENSON A B,SCHRAG D,SOMERFIELD M R,et al.American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stageⅡcolon cancer[J].J Clin Oncol,2004,22(16):3408-3419.
[11]SARGENT D J,MARSONI S,MONGES G,et al.Defective mismatch repair as a predictive marker for lack of efficacy of Fluorouracil-based adjuvant therapy in colon cancer[J].J Clin Oncol,2010,28(20):3219-3226.
[12]ROTH A D,DELORENZI M,TEJPAR S,et al.Integrated analysis of molecular and clinicalprognostic factors in stageⅡ/Ⅲcolon cancer[J].J Natl Cancer Inst,2012,104(21):1635-1646.
[13]秦琼.Ⅱ、Ⅲ期结肠癌根治术后复发转移多因素分析及DNA错配修复(MMR)蛋白状态对预后和疗效预测的影响[D].北京协和医学院,2013.
[14]邰宵辉,张玲芳,张旭霞,等.我院2011-2014年结直肠癌患者化疗用药分析[J].中国药房,2015,26(32):4485-4487.
[15]BIAGI J J,RAPHAEL M J,MACKILLOP W J,et al.Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer:A systematic review and metaanalysis[J].JAMA,2011,305(22):2335-2342.
[16]国家卫生计生委合理用药专家委员会.消化道恶性肿瘤合理用药指南[J].中国合理用药探索杂志,2017,14(9):5-54.2018-03-29
[2]National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology:Colon cancer(2018.V1)[EB/OL].https://www.nccn.org/
[3]国家卫生计生委医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017版)[J].中华胃肠外科杂志,2018,21(1):92-106.
[4]蒲兵,谢法东,孙波,等.抗肿瘤合理用药评价体系的建立[J].中国医院药学杂志,2014,34(2):143-146.
[5]OCONNELL J B,MAGGARD M A,KO C Y.Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging[J].J NatI Cancer Inst,2004,96(19):1420-1425.
[6]ANDRéT,BONI C,MOUNEDJI-BOUDIAF L,et al.Oxaliplatin,Fluorouracil,and Leucovorin as adjuvant treatment for colon cancer[J].N Engl J Med,2004,350(23):2343-2351.
[7]de GRAMONT A,BONI C,NAVARRO M,et al.Oxaliplatin/5FU/LV in adjuvant colon cancer:Updated efficacy results of the MOSAIC trial,including survival,with a median follow-up of six years[J].J Clin Oncol,2007,25(18 S):4007.
[8]ANDRéT,BONI C,NAVARRO M,et al.Improved overall survival with Oxaliplatin,Fluorouracil,and Leucovorin as adjuvant treatment in stageⅡorⅢcolon cancer in the MOSAICtrial[J].J Clin Oncol,2009,27(19):3109-3116.
[9]COMPTON C C,FIELDING L P,BURGART L J,et al.Prognostic factors in colorectal cancer.College of American Pathologists Consensus Statement 1999[J].Arch Pathol Lab Med,2000,124(7):979-994.
[10]BENSON A B,SCHRAG D,SOMERFIELD M R,et al.American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stageⅡcolon cancer[J].J Clin Oncol,2004,22(16):3408-3419.
[11]SARGENT D J,MARSONI S,MONGES G,et al.Defective mismatch repair as a predictive marker for lack of efficacy of Fluorouracil-based adjuvant therapy in colon cancer[J].J Clin Oncol,2010,28(20):3219-3226.
[12]ROTH A D,DELORENZI M,TEJPAR S,et al.Integrated analysis of molecular and clinicalprognostic factors in stageⅡ/Ⅲcolon cancer[J].J Natl Cancer Inst,2012,104(21):1635-1646.
[13]秦琼.Ⅱ、Ⅲ期结肠癌根治术后复发转移多因素分析及DNA错配修复(MMR)蛋白状态对预后和疗效预测的影响[D].北京协和医学院,2013.
[14]邰宵辉,张玲芳,张旭霞,等.我院2011-2014年结直肠癌患者化疗用药分析[J].中国药房,2015,26(32):4485-4487.
[15]BIAGI J J,RAPHAEL M J,MACKILLOP W J,et al.Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer:A systematic review and metaanalysis[J].JAMA,2011,305(22):2335-2342.
[16]国家卫生计生委合理用药专家委员会.消化道恶性肿瘤合理用药指南[J].中国合理用药探索杂志,2017,14(9):5-54.2018-03-29