Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States.
Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States.
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DOI：
10.3390/ijerph18116040
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发表时间：
2021-06-04
影响因子：
--
通讯作者：
Akinyemiju T
中科院分区：
文献类型：
--
作者：
Islam JY;Saraiya V;Previs RA;Akinyemiju T
姑息治疗可以提高生活质量并延长生存期，但在美国妇科癌症患者中并未得到充分利用。我们的目标是评估美国妇科癌症患者整体和按种族/族裔的医疗保健获取 (HCA) 措施与姑息治疗利用之间的关联。我们使用了美国国家癌症数据库 2004-2016 年的数据，纳入了转移性（诊断时为 III-IV 期）卵巢癌、宫颈癌和子宫癌患者 (n = 176,899)。姑息治疗被定义为非治愈性治疗，可能包括手术、放疗、化疗和疼痛管理或任何组合。 HCA 指标包括保险类型、地区级社会经济指标、护理距离和癌症治疗设施类型。我们使用多变量逻辑回归评估了 HCA 指标与总体姑息治疗使用之间的关联，并按种族/民族进行了评估。我们的人口大部分是非西班牙裔白人 (72%)，患有卵巢癌 (72%)，24% 的存活时间不到 6 个月。百分之五的转移性妇科癌症患者接受姑息治疗。与拥有私人保险的患者相比，未参保的卵巢癌（aOR：1.80，95% CI：1.53–2.12）和宫颈癌（aOR：1.45，95% CI：1.26–1.67）患者更有可能使用姑息治疗。与居住在距离医疗服务提供者 45 英里以上的卵巢癌（aOR：0.58，95% CI：0.48–0.70）或宫颈癌（aOR：0.74，95% CI：0.60–0.88）患者相比，居住在距其提供者不到 2 英里的患者中，采用姑息治疗的可能性较小。与在社区癌症项目中接受治疗的卵巢癌患者相比，在学术/研究项目中接受治疗的卵巢癌患者采用姑息治疗的可能性较小（aOR：0.70，95%CI：0.58-0.84）。 HCA 措施与姑息治疗利用之间的关联在美国不同种族群体中基本一致。保险类型、癌症治疗设施类型和护理距离可能会影响美国转移性妇科癌症患者对姑息治疗的使用。
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.
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