Patterns of Colorectal Cancer Care in the United States: 1990-2010
Patterns of Colorectal Cancer Care in the United States: 1990-2010
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DOI：
10.1093/jnci/djv198
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发表时间：
2015-10-01
影响因子：
10.3
通讯作者：
Geiger, Ann M.
中科院分区：
文献类型：
--
作者：
Murphy, Caitlin C.;Harlan, Linda C.;Geiger, Ann M.
背景：结直肠癌（CRC）死亡率在美国有所下降，部分原因是治疗的进步。很少有研究评估了采用的治疗和时间变化的模式care.Methods：患者年龄20岁及以上诊断为II/III期CRC随机抽样从人口为基础的监测，流行病学和最终结果（SEER）计划在1990-1991年，1995年，2000年，2005年和2010年（n = 7057）。从医疗记录和医生验证中获得治疗。我们描述了接受化疗和放疗。对数二项式回归用于检查与治疗相关的因素。结果：结肠癌患者接受化疗的比例从1990年（II期：22.5%; III期：56.3%）增加到2005年（II期：32.1%; III期：72.4%），2010年略有下降（II期：29.3%; III期：66.4%）。年龄较大（vs = 80岁：RR = 0.37，95% CI = 0.28 - 0.47）或合并症评分≥ 2（vs 0，RR = 0.56，95% CI = 0.35 - 0.87）的III期结肠癌患者接受化疗的频率较低。直肠癌患者接受放射治疗的比例从45.5%增加到66.1%。年龄的增加（与= 80岁：RR = 0.33，95%CI = 0.25至0.45）与较低的放化疗使用II/III期直肠癌patients.Conclusion：我们的研究结果表明，结肠癌和直肠癌患者的化疗和放射治疗的采用增加和治疗的年龄，合并症，诊断年的差异。在社区中增加接受这些治疗可能会进一步降低CRC死亡率。
Background: Colorectal cancer (CRC) mortality has declined in the United States, in part because of advances in treatment. Few studies have evaluated the adoption of therapies and temporal changes in patterns of care.Methods: Patients age 20 years and older diagnosed with stages II/III CRC were randomly sampled from the population-based Surveillance, Epidemiology, and End Results (SEER) program in 1990-1991, 1995, 2000, 2005, and 2010 (n = 7057). Therapy was obtained from medical records and physician verification. We described the receipt of chemotherapy and radiation therapy. Log-binomial regression was used to examine factors associated with therapy. All statistical tests were two-sided.Results: Chemotherapy receipt among colon cancer patients increased from 1990 (stage II: 22.5%; stage III: 56.3%) to 2005 (stage II: 32.1%; stage III: 72.4%) and declined slightly in 2010 (stage II: 29.3%; stage III: 66.4%). Stage III colon cancer patients who were older (vs = 80 years: RR = 0.37, 95% CI = 0.28 to 0.47) or had a comorbidity score of 2 or higher (vs 0, RR = 0.56, 95% CI = 0.35 to 0.87) received chemotherapy less often. Receipt of radiation therapy by rectal cancer patients increased across all years from 45.5% to 66.1%. Increasing age (vs = 80 years: RR = 0.33, 95% CI = 0.25 to 0.45) was associated with lower chemoradiation use among stage II/III rectal cancer patients.Conclusion: Our findings demonstrate increased adoption of chemotherapy and radiation therapy for colon and rectal cancer patients and differences in therapy by age, comorbidity, and diagnosis year. Increased receipt of these therapies in the community may further reduce CRC mortality.