Influence of Geography on Prostate Cancer Treatment.
Influence of Geography on Prostate Cancer Treatment.
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地理对前列腺癌治疗的影响。
DOI：
10.1016/j.ijrobp.2020.11.055
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发表时间：
2021-04-01
期刊：
影响因子：
--
通讯作者：
Smith BD
中科院分区：
文献类型：
--
作者：
Tang C;Lei X;Smith GL;Pan HY;Hoffman KE;Kumar R;Chapin BF;Shih YT;Frank SJ;Smith BD
前列腺癌有几种明确的治疗方案，但获得这些方案的地理范围并不统一。我们创建了地图，说明提供者与患者的实践模式，并评估了距离对接受治疗的影响。该患者队列是通过在国家医疗保险数据库中搜索 2011 年至 2014 年诊断和治疗前列腺癌的患者而创建的。提供者队列是通过查询 AMA 医师主文件来确定接受过前列腺切除术、调强放射治疗 (IMRT)、近距离放射治疗、立体定向身体放射治疗 (SBRT) 或质子治疗的医生而创建的。为每种模式创建了详细说明提供者位置的地图。使用多变量多项逻辑回归来评估患者-提供者距离与治疗概率之间的关联。队列由 5,518 名医生治疗的 89,902 名患者组成。在主要城市中心，大量提供者实践既定模式（IMRT、前列腺切除术和近距离放射治疗），而农村地区的提供者数量有所减少，尤其是近距离放射治疗。 90% 的前列腺癌患者居住在距前列腺切除术、IMRT 和近距离放射治疗医生分别 35.1、28.9 和 55.6 英里的范围内。新兴疗法（SBRT 和质子治疗）的从业者主要集中在城市地区，90% 的患者居住在 128 英里（SBRT）和 374.5 英里（质子）范围内。距离越远与治疗概率降低相关（IMRT -3.8% 每 10 英里；前列腺切除术 -2.1%；近距离放射治疗 -2%；质子治疗 -1.6%；SBRT -1.1%）。所分析的治疗方式存在地理差异，这些差异影响了治疗的实施。
Several definitive treatment options are available for prostate cancer, but geographic access to those options is not uniform. We created maps illustrating provider practice patterns relation to patients and assessed the influence of distance to treatment receipt. The patient cohort was created by searching the National Medicare Database for patients diagnosed and treated for prostate cancer in 2011–2014. The provider cohort was created by querying the AMA Physician Masterfile to identify physicians who had treated with prostatectomy, intensity-modulated radiation therapy (IMRT), brachytherapy, stereotactic body radiation therapy (SBRT), or proton therapy. Maps detailing the location of providers were created for each modality. Multivariate multinomial logistic regressions were used to assess the association between patient-provider distance and probability of treatment. Cohorts consisted of 89,902 patients treated by 5,518 physicians. Substantial numbers of providers practicing established modalities (IMRT, prostatectomy, and brachytherapy) was noted in major urban centers, whereas provider numbers were reduced in rural areas, most notably for brachytherapy. Ninety percent of prostate cancer patients lived within 35.1, 28.9, and 55.6 miles of a practitioner of prostatectomy, IMRT, and brachytherapy, respectively. Practitioners of emerging modalities (SBRT and proton therapy) were predominantly concentrated in urban locations, with 90% of patients living within 128 miles (SBRT) and 374.5 miles (proton). Greater distance was associated with decreased probability of treatment (IMRT −3.8% per 10 miles; prostatectomy −2.1%; brachytherapy −2%; proton therapy −1.6%; and SBRT −1.1%). Geographic disparities were noted for analyzed treatment modalities, and these disparities influenced delivery.
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影响因子：
6.2
作者：
Tang, Chad;Hoffman, Karen E.;Kuban, Deborah A.
通讯作者：
Kuban, Deborah A.
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
3.1
作者：
Patrikidou, Anna;Maroun, Pierre;Blanchard, Pierre
通讯作者：
Blanchard, Pierre
DOI：
10.1016/j.ijrobp.2015.12.020
发表时间：
2016-03-15
影响因子：
7
作者：
Acharya, Sahaja;Hsieh, Samantha;Perkins, Stephanie M.
通讯作者：
Perkins, Stephanie M.
影响因子：
45.3
作者：
Morgan, Scott C.;Hoffman, Karen;Sandler, Howard
通讯作者：
Sandler, Howard