Quality of Care In Patients With Bladder Cancer A Case Report?
Quality of Care In Patients With Bladder Cancer A Case Report?
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DOI：
10.1002/cncr.26402
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发表时间：
2012-03-01
期刊：
影响因子：
6.2
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Chamie, Karim;Saigal, Christopher S.;Litwin, Mark S.
背景技术背景：虽然有I级证据证明膀胱内治疗在膀胱癌患者中的优越性，但监测策略主要基于专家意见。作者检查了对监测和治疗策略的依从性以及对高级别疾病患者生存率的影响。方法：使用相关的监测、流行病学和最终结果（SEER）-医疗保险数据，作者确定了1992年至2002年期间诊断为高度非肌肉浸润性疾病的受试者，这些受试者存活了2年，并且在此期间没有接受明确的治疗。非线性混合效应回归分析被用来检查遵守监测和治疗策略。在使用倾向评分加权法调整混杂因素后，作者确定了诊断后最初2年内的个体和综合策略是否与2年后的生存率相关。结果：在4790名受试者中，只有1名接受了所有推荐的措施。尽管1997年后大多数措施的平均利用率显著增加，但只有卡介苗（BCG）诱导疗程的依从性增加（13%至20%; P <0.001）。在多变量分析中，发现≥ 4次膀胱镜检查、≥ 4次细胞学检查和BCG滴注的依从性在老年人中较低，而在未分化肿瘤、Tis和T1肿瘤以及1997年后诊断的个体中较高。与接受< 4次膀胱镜检查、< 4次细胞学检查和未接受BCG的受试者相比，依从这些措施的受试者死亡风险较低（风险比，0.41; 95%置信区间，0.18-0.93）。结论：在接受至少一半推荐治疗的患者中，存在统计学显著的生存优势。通过系统的质量改进措施提高对这些护理过程措施的依从性是改善膀胱癌护理的主要目标。Cancer 2012; 118：1412-21. (C)2011年美国癌症协会
BACKGROUND: Although there is level I evidence demonstrating the superiority of intravesical therapy in patients with bladder cancer, surveillance strategies are primarily founded on expert opinion. The authors examined compliance with surveillance and treatment strategies and the pursuant impact on survival in patients with high-grade disease. METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the authors identified subjects with a diagnosis of high-grade, non-muscle-invasive disease between 1992 and 2002 who survived 2 years and did not undergo definitive treatment during that time. Nonlinear mixed-effects regression analyses was used to examine compliance with surveillance and treatment strategies. After adjusting for confounders using a propensity score-weighted approach, the authors determined whether individual and comprehensive strategies during the initial 2 years after diagnosis were associated with survival after 2 years. RESULTS: Of 4790 subjects, only 1 received all the recommended measures. Although mean utilization for most measures significantly increased after 1997, only compliance with an induction course of bacillus Calmette-Guerin (BCG) increased (13% to 20%; P < .001). On multivariate analysis, compliance with >= 4 cystoscopies, >= 4 cytologies, and BCG instillation was found to be lower among octogenarians and higher among those with undifferentiated, Tis, and T1 tumors, and among those individuals diagnosed after 1997. Subjects compliant with these measures had a lower hazard of mortality (hazard ratio, 0.41; 95% confidence interval, 0.18-0.93) than those who received < 4 cystoscopies, < 4 cytologies, and no BCG. CONCLUSION: There was a statistically significant survival advantage found among those who received at least half of the recommended care. Improving compliance with these process-of-care measures via systematic quality improvement initiatives serves as the primary target to meliorate bladder cancer care. Cancer 2012; 118: 1412-21. (C) 2011 American Cancer Society.