Risk factors involved in treatment delays and differences in treatment type for patients with prostate cancer by risk category in an academic safety net hospital.
Risk factors involved in treatment delays and differences in treatment type for patients with prostate cancer by risk category in an academic safety net hospital.
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DOI：
10.1016/j.adro.2017.12.002
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发表时间：
2018-04
影响因子：
2.3
通讯作者：
Hirsch AE
中科院分区：
文献类型：
--
作者：
Kan CK;Qureshi MM;Gupta A;Agarwal A;Gignac GA;Bloch BN;Thoreson N;Hirsch AE
了解从诊断到治疗延迟的驱动因素可以阐明如何减少前列腺癌患者的治疗时间（TTT）。此外，由于许多原因，根据癌症的阶段，可用的治疗方法可能会有很大的不同。本研究调查了在安全网学术医疗中心接受外照射放射治疗（RT）、根治性前列腺切除术（RP）、雄激素剥夺治疗（ADT）或主动监测（AS）的前列腺癌患者中TTT和治疗选择与社会人口学因素的关系。对2005年1月至2013年12月期间诊断为非转移性前列腺癌的1088例患者进行了回顾性分析。收集了人口统计学数据以及TTT、初始治疗选择、美国癌症联合委员会分期和国家综合癌症网络风险类别的数据。采用方差分析和多因素Logistic回归模型分析这些因素与治疗选择和TTT的关系。年龄、种族和婚姻状况与治疗选择显著相关。非白人和60岁以上的患者不太可能接受RP。黑人患者接受RT的可能性是白色患者的3.8倍。中位TTT为75天。在年龄较大、非白人种族/民族、不讲英语、有非商业保险和未婚状态的患者中，时间延迟较长。高危患者TTT平均比低危患者长25天。接受RT的患者的平均TTT比RP患者长34天。前列腺癌患者的治疗选择和TTT受人口统计学因素（如年龄、种族、婚姻状况和保险）以及临床因素（包括疾病的阶段和风险类别）的影响。
Understanding the drivers of delays from diagnosis to treatment can elucidate how to reduce the time to treatment (TTT) in patients with prostate cancer. In addition, the available treatments depending on the stage of cancer can vary widely for many reasons. This study investigated the relationship of TTT and treatment choice with sociodemographic factors in patients with prostate cancer who underwent external beam radiation therapy (RT), radical prostatectomy (RP), androgen deprivation therapy (ADT), or active surveillance (AS) at a safety-net academic medical center. A retrospective review was performed on 1088 patients who were diagnosed with nonmetastatic prostate cancer between January 2005 and December 2013. Demographic data as well as data on TTT, initial treatment choice, American Joint Committee on Cancer stage, and National Comprehensive Cancer Network risk categories were collected. Analyses of variance and multivariable logistic regression models were performed to analyze the relationship of these factors with treatment choice and TTT. Age, race, and marital status were significantly related to treatment choice. Patients who were nonwhite and older than 60 years were less likely to undergo RP. Black patients were 3.8 times more likely to undergo RT compared with white patients. The median TTT was 75 days. Longer time delays were significant in patients of older age, nonwhite race/ethnicity, non-English speakers, those with noncommercial insurance, and those with non-married status. The average TTT of high-risk patients was 25 days longer than that of low-risk patients. Patients who underwent RT had an average TTT that was 34 days longer than that of RP patients. The treatment choice and TTT of patients with prostate cancer are affected by demographic factors such as age, race, marital status, and insurance, as well as clinical factors including stage and risk category of disease.