Treatment choice and quality of care for men with localized prostate cancer
Treatment choice and quality of care for men with localized prostate cancer
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DOI：
10.1097/01.mlr.0000255261.81220.29
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发表时间：
2007-05-01
期刊：
影响因子：
3
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Miller, David C.;Spencer, Benjamin A.;Litwin, Mark S.
背景：护理模式和治疗结果的差异表明接受局限性前列腺癌治疗的男性的护理质量存在差异。目的：我们试图比较接受根治性前列腺切除术或体外放射治疗的男性对前列腺癌护理质量指标的依从性。研究设计和对象：我们从向国家癌症数据库报告的 984 个机构中抽取了 2000 年或 2001 年诊断为早期前列腺癌的 5230 名男性。我们的分析队列包括接受根治性前列腺切除术或体外放射治疗的 2604 名男性（来自 770 个机构）。 主要结果指标：受试者水平符合兰德公司局部前列腺癌护理质量指标，按治疗分层。我们应用抽样权重来获得国家对质量指标依从性的估计。结果：加权样本分别代表接受根治性前列腺切除术或外照射放射治疗的 24,547 名和 27,125 名男性。两个治疗组对多项质量指标的遵守率均接近 100%；然而，注意到治疗特异性的差异。与接受手术的男性相比，接受放射治疗的男性在由委员会认证的泌尿科医生的机构接受治疗的可能性较小（比值比 [OR] = 0.4，95% 置信区间 [95% CI] = 0.2-0.8）。放射受试者对护理过程指标的依从性明显较高，包括临床分期记录（OR = 7.5，95% CI = 4.8-11.9）、治疗前泌尿功能评估（OR = 2.8，95% CI = 1.9-4.2）和性功能（OR = 1.6，95% CI = 1.2-2.2），以及治疗方案的讨论（OR = 1.8， 95% CI = 1.1-2.9）。结论：与手术治疗相比，接受外照射治疗的局限性前列腺癌男性对护理质量指标过程的依从性似乎更好。
Background: Variations in patterns of care and treatment outcomes suggest differences in the quality of care for men treated for localized prostate cancer.Objective: We sought to compare adherence with quality indicators for prostate cancer care among men treated with radical prostatectomy or external beam radiation therapy.Research Design and Subjects: We sampled 5230 men diagnosed in 2000 or 2001 with early-stage prostate cancer from 984 facilities reporting to the National Cancer Data Base. Our analytic cohort includes 2604 men (from 770 facilities) treated with radical prostatectomy or external beam radiation.Main Outcome Measure: Subject-level compliance with the RAND quality indicators for localized prostate cancer care, stratified by treatment. We applied sampling weights to obtain national estimates of quality indicator adherence.Results: The weighted samples represent 24,547 and 27,125 men treated with radical prostatectomy or external beam radiation therapy, respectively. Compliance with several quality indicators approached 100% in both treatment groups; however treatment-specific variations were noted. Men receiving radiation were less likely than those undergoing surgery to be treated in facilities with a board-certified urologist (odds ratio [OR] = 0.4, 95% confidence interval [95% CI] = 0.2-0.8). Adherence with process of care indicators was appreciably higher among radiation subjects, including documentation of clinical stage (OR = 7.5, 95% CI = 4.8-11.9), pretherapy assessment of urinary (OR = 2.8, 95% Cl = 1.9-4.2) and sexual (OR = 1.6, 95% CI = 1.2-2.2) function, and discussion of treatment options (OR = 1.8, 95% CI = 1.1-2.9).Conclusions: Documented compliance with process of care quality indicators among men with localized prostate cancer appears superior for those treated with external beam radiation compared with those treated surgically.