Adherence to surveillance among patients with superficial bladder cancer
Adherence to surveillance among patients with superficial bladder cancer
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DOI：
10.1093/jnci/95.8.588
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发表时间：
2003-04-16
期刊：
影响因子：
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通讯作者：
Begg, CB
中科院分区：
文献类型：
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作者：
Schrag, D;Hsieh, LJ;Begg, CB
背景资料：未接受全膀胱切除术的浅表性膀胱癌患者复发风险高，建议每3-6个月对此类患者进行膀胱镜检查。我们检查了膀胱癌患者接受推荐的监测程序的程度，并确定了与不遵守这些建议相关的患者和初级保健提供者特征。研究方法：我们使用从监测、流行病学和最终结果（SEER）计划-医疗保险相关数据库中获得的信息，确定了6717例年龄在65岁或以上的患者，这些患者在1992年至1996年期间被诊断为浅表性膀胱癌，并且在诊断后存活至少3年，但没有总膀胱癌。我们使用从医疗保险索赔表中获得的信息来检查这些患者在诊断后7个月至36个月的5个连续6个月间隔内进行膀胱监测检查的频率。我们检查了与低强度监测相关的患者及其医生的特征（定义为在五个可能的随访间隔中少于两个的时间内进行检查）。采用Logistic回归分析计算比值比（OR）和95%置信区间（CI）。所有统计检验均为双侧检验。结果：整个队列中只有40%的人在所有五个间隔内进行了检查; 1216名患者（18.1%）进行了低强度监测。与低强度监测独立相关的患者特征为年龄≥ 75岁（校正OR = 1.54，95% CI = 1.35 - 1.74），非白人（调整后OR = 1.94，95% CI = 1.57 - 2.40），肿瘤组织学良好（低分化与高分化肿瘤分级的校正OR = 0.59，95% CI = 0.48 - 0.72）和高合并症（调整后OR = 1.72，95% CI = 1.30 - 2.27）。居住在城市地区或人口普查区，收入中位数较低，也与低强度监测有关。结论：浅表性膀胱癌患者的实际监测实践与临床指南中推荐的标准有很大不同。
Background: Patients diagnosed with superficial bladder cancer who have not undergone total cystectomy are at high risk for recurrence, and bladder surveillance with cystoscopy is recommended for such patients every 3-6 months. We examined the degree to which bladder cancer patients undergo the recommended surveillance procedures and identified patient and primary care provider characteristics associated with nonadherence to these recommendations. Methods: We used information obtained from the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare-linked database to identify 6717 patients aged 65 years or older who were diagnosed with superficial bladder cancer from 1992 through 1996 and who survived for at least 3 years after diagnosis but did not have a total cystectomy. We used information obtained from Medicare claims forms to examine the frequency with which these patients had a surveillance examination of the bladder during each of five contiguous 6-month intervals from month 7 to month 36 following diagnosis. We examined characteristics of patients and their physicians that were associated with low-intensity surveillance (defined as having an examination during fewer than two of the five possible follow-up intervals). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: Only 40% of the entire cohort had an examination during all five intervals; 1216 patients (18.1%) had low-intensity surveillance. Patient characteristics that were independently associated with low-intensity surveillance were being age 75 years or older (adjusted OR = 1.54, 95% CI = 1.35 to 1.74), nonwhite (adjusted OR = 1.94, 95% CI = 1.57 to 2.40), and having favorable tumor histology (adjusted OR = 0.59, 95% CI = 0.48 to 0.72 for poorly differentiated versus referent well-differentiated tumor grade) and high comorbidity (adjusted OR = 1.72, 95% CI = 1.30 to 2.27). Residence in an urban area or in a census tract with low median income was also associated with low-intensity surveillance. Conclusions: The actual practice of surveillance for patients with superficial bladder cancer differs substantially from the standards recommended in clinical guidelines.