title: Patterns of prescribing radiotherapy and bevacizumab in nationwide practice - analysis of 101 designated cancer care hospitals in Japan.
abstract: Radiotherapy and bevacizumab are each effective in treating patients with advanced cancer, but their concurrent use may cause serious adverse events (SAEs). Whereas sequential administration can theoretically reduce the risk of SAEs while maintaining the anticancer effects, this hypothesis remains unconfirmed, leading to variations in practice. To elucidate current practices, the patterns of care received by patients in Japan with regard to these two therapies were assessed in a large database of a hospital-based cancer registry linked with insurance claims. This database contained information on 106 057 patients diagnosed with seven major cancers in 2011 and the care they received up to the end of 2012. In total, 335 patients from 101 hospitals in the database were treated with both radiotherapy and bevacizumab. Of these patients, 50.8% had lung cancer, and 51.3% had Stage IV cancer. Of the 335 patients, 75 (22.4%) received these therapies concurrently. In patients treated sequentially, the time from the last dose of bevacizumab to the start of radiotherapy was most frequently 4-5 weeks (12.4%), whereas the time from the end of radiotherapy to the start of bevacizumab was most frequently 1-2 weeks (10.6%). The cumulative proportions of patients in these two groups receiving sequential therapies within 3 weeks were 19.0% and 26.1%, respectively. Many practices appeared to avoid the concurrent use of bevacizumab and radiation, but some provided concurrent therapy. Additional data are required to determine whether the avoidance of concurrent use should become a standard of care.
authors.affiliation: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan yotsukad@ncc.go.jp.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Tsukada
authors.affiliation: Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Iwamoto
authors.affiliation: Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
authors.affiliation: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higashi
mesh_terms: D000368:Aged; D000068258:Bevacizumab / Q000627:therapeutic use*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000706:statistics & numerical data*
chemical_list: D000068258:Bevacizumab
keywords: Vascular Endothelial Growth Factor A; adverse effects; bevacizumab; radiation-sensitizing agents; radiotherapy