Disparities in Receiving Guideline-Concordant Treatment for Lung Cancer in the United States
Disparities in Receiving Guideline-Concordant Treatment for Lung Cancer in the United States
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DOI：
10.1513/annalsats.201901-094oc
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发表时间：
2020-02-01
影响因子：
8.3
通讯作者：
de Koning, Harry J.
中科院分区：
文献类型：
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作者：
Blom, Erik F.;ten Haaf, Kevin;de Koning, Harry J.
理由：美国对肺癌治疗指南的遵守程度尚不清楚。此外，尚不清楚之前发现的种族或民族以及年龄差异是否在所有临床亚组中都存在。目的：评估美国国家综合癌症网络指南(指南符合治疗)推荐的最低限度肺癌治疗的遵守程度，并评估所有临床亚组按种族或民族以及年龄差异的持续性。方法：我们评估了国家癌症数据库中2010至2014年间诊断的441,812例肺癌病例是否接受了指南一致的治疗。使用Logistic回归模型评估在所有临床亚组中接受指南一致性治疗的种族或民族和年龄的可能差异，以及在调整患者、肿瘤和医疗保健提供者的特征后这种差异是否持续。结果：总体而言，62.1%的受试者接受了指南一致性治疗(临床亚组之间的范围为50.4-76.3%)。然而，21.6%的患者没有接受治疗(范围为10.3-31.4%)，16.3%的患者接受的治疗强度低于建议的水平(范围为6.4-21.6%)。在所有亚组中，最常见的低强度治疗是“仅常规分割放射治疗”(范围=2.5-16.0%)，非转移亚组的“仅化疗”(范围=1.2-13.7%)，以及局部非小细胞肺癌的“常规分割放疗和化疗”(5.9%)。尽管调整了相关的协变量(与80岁相比，年龄=80岁)，但随着年龄的增长，符合指南的治疗的可能性降低
Rationale: The level of adherence to lung cancer treatment guidelines in the United States is unclear. In addition, it is unclear whether previously identified disparities by racial or ethnic group and by age persist across all clinical subgroups.Objectives: To assess the level of adherence to the minimal lung cancer treatment recommended by the National Comprehensive Cancer Network guidelines (guideline-concordant treatment) in the United States, and to assess the persistence of disparities by racial or ethnic group and by age across all clinical subgroups.Methods: We evaluated whether 441,812 lung cancer cases in the National Cancer Database diagnosed between 2010 and 2014 received guideline-concordant treatment. Logistic regression models were used to assess possible disparities in receiving guideline-concordant treatment by racial or ethnic group and by age across all clinical subgroups, and whether these persist after adjusting for patient, tumor, and health care provider characteristics.Results: Overall, 62.1% of subjects received guideline-concordant treatment (range across clinical subgroups = 50.4-76.3%). However, 21.6% received no treatment (range = 10.3-31.4%) and 16.3% received less intensive treatment than recommended (range = 6.4-21.6%). Among the most common less intensive treatments for all subgroups was "conventionally fractionated radiotherapy only" (range = 2.5-16.0%), as was "chemotherapy only" for nonmetastatic subgroups (range = 1.2-13.7%), and "conventionally fractionated radiotherapy and chemotherapy" for localized non-small-cell lung cancer (5.9%). Guideline-concordant treatment was less likely with increasing age, despite adjusting for relevant covariates (age >= 80 yr compared with