Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016
Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016
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DOI：
10.1186/s12885-020-06979-y
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发表时间：
2020-05-30
期刊：
影响因子：
3.8
通讯作者：
Moller, Bjorn
中科院分区：
文献类型：
--
作者：
Nilssen, Yngvar;Brustugun, Odd Terje;Moller, Bjorn
癌症患者路径（CPP）于2015年实施，以减少等待时间，等待时间的区域差异，并提高患者癌症护理的可预测性。本研究的目的是观察是否达到了将70%的癌症患者纳入CPP的国家目标，并确定与CPP纳入相关的因素。方法2015-2016年期间在挪威癌症登记处登记的结直肠癌、肺癌、乳腺癌或前列腺癌诊断的所有患者均与挪威患者登记处的CPP信息和挪威统计局的社会人口变量相关联。多变量logistic回归分析未纳入CPP的几率是否与诊断年份、年龄、性别、肿瘤分期、婚姻状况、教育、收入、居住地区和合并症相关。从2015年到2016年，30，747名患者被诊断患有结直肠癌，肺癌，乳腺癌或前列腺癌，其中24，429名（79.5%）被纳入CPP。结肠直肠癌（79.1 - 86.2%）、肺癌（79.0 - 87.3%）、乳腺癌（91.5 - 97.2%）和前列腺癌（62.2 - 76.2%）患者纳入CPP的概率显著增加（p < 0.001）。年龄的增加与肺癌（p < 0.001）和前列腺癌（p < 0.001）患者未被纳入CPP的几率增加相关。< 50岁的结直肠癌患者未被纳入CPP的几率增加了2倍（OR = 2.23，95%CI：1.70-2.91）。低收入结直肠癌患者（OR = 1.24，95%CI：1.00-1.54）和肺癌患者（OR = 1.52，95%CI：1.16-1.99）未纳入CPP的几率显著增加。居住地区与CPP入选显著相关（p < 0.001），根据病例组合调整后的概率范围从西部地区前列腺癌患者的62.4%到北部地区乳腺癌患者的97.6%。结论在挪威实施CPP的1年内达到了70%的国家目标。虽然所有患者都应该平等地获得CPP，但前列腺癌诊断、年龄较大、合并症水平高或收入低与不包括在CPP中的几率增加显著相关。
Background Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion. Methods All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015-2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity. Results From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70-2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00-1.54) and lung (OR = 1.52, 95%CI: 1.16-1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients. Conclusions The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.