Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality?
Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality?
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DOI：
10.1007/s11605-020-04760-x
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发表时间：
2020-08-04
影响因子：
3.2
通讯作者：
Migaly, J.
中科院分区：
文献类型：
--
作者：
Freischlag, Kyle;Olivere, L.;Migaly, J.
目的评价II期和III期直肠癌患者的医疗保健碎片化状况。背景：多家医院之间分散的护理可能会恶化癌症患者的预后。方法查询2006 - 2015年接受局部晚期（II-III期）直肠腺癌放疗和手术治疗的成人患者的国家癌症数据库。碎片化治疗被定义为在不同的医院接受放射治疗。描述性统计对患者进行特征描述，并使用Kaplan-Meier方法和Cox比例风险模型绘制生存概率。2006年至2015年，共有37,081例II-III期直肠癌患者接受了手术和放疗（24,102例综合治疗对12,979例分散治疗）。接受碎片化护理的患者（危险比[HR] 1.105; 95% CI 1.045-1.169）死亡风险较高。在学术医院至少接受过手术的患者（HR 0.84; 95% CI 0.77-0.92）死亡风险较低。学术型医院的碎片化护理患者比例更高（38.0% vs.综合社区32.8% vs.社区33.8%,p < 0.001）。在学术医院中，碎片化护理预示着更差的生存率（综合学术80.0% vs碎片化学术76.7%,p = 0.0002）。学术医院的碎片化护理比社区医院的综合护理的生存率更高（碎片化学术医院76.7% vs.综合社区72.2%,p = 0.00039）。结论在II-III期直肠癌患者中，在学术医院接受综合治疗或至少在学术中心接受手术治疗的患者生存率更高。应尽一切努力减少护理碎片化，并应优先考虑学术中心的手术。
Objective To evaluate health care fragmentation in patients with stage II and III rectal cancers. Background Fragmentation of care among multiple hospitals may worsen outcomes for cancer patients. Methods National Cancer Database was queried for adult patients who underwent radiation and surgery for locally advanced (stage II-III) rectal adenocarcinoma from 2006 to 2015. Fragmented care was defined as receiving radiation at a different hospital from surgery. Descriptive statistics characterized patients, and survival probability was plotted using the Kaplan-Meier method and a Cox proportional hazards model. Results A total of 37,081 patients underwent surgery and radiation for stage II-III rectal cancer from 2006 to 2015 (24,102 integrated care vs. 12,979 fragmented care). Patients who received fragmented care (hazard ratio [HR] 1.105; 95% CI 1.045-1.169) had a higher risk of mortality. Patients who received at least surgery (HR 0.84; 95% CI 0.77-0.92) at academic hospitals had a lower risk of mortality. Academic hospitals had a higher proportion of patients with fragmented care (38.0 vs. comprehensive community 32.8% vs. community 33.8%,p < 0.001). Within academic hospitals, fragmented care portended worse survival (integrated academic 80.0% vs. fragmented academic 76.7%,p = 0.0002). Fragmented care at academic hospitals had increased survival over integrated care at community hospitals (fragmented academic 76.7 vs. integrated community 72.2%,p = 0.00039). Conclusions In patients with stage II-III rectal cancer, patients who have integrated care at academic hospitals or at least surgery at academic centers had better survival. All efforts should be made to reduce care fragmentation and surgery at academic centers should be prioritized.