Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status
Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status
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DOI：
10.1016/j.ygyno.2014.03.561
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发表时间：
2014-07-01
影响因子：
4.7
通讯作者：
Vieira, Veronica M.
中科院分区：
文献类型：
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作者：
Bristow, Robert E.;Chang, Jenny;Vieira, Veronica M.
Objective.确定地理位置对晚期卵巢癌护理依从性的影响，以国家综合癌症网络（NCCN）与种族和社会经济地位（SES）方法相关的指南。从加州癌症登记处确定诊断为IIIC/IV期上皮性卵巢癌的患者（1996年1月1日至2006年12月31日）。建立广义加性模型，以评估地理位置的空间分布、与高容量医院（>= 20例/年）的接近度、接受护理的距离、种族和SES对NCCN指南依从性的影响，同时平滑地理位置并调整混杂变量。采用x（2）检验分析治疗依从性的地理预测因素的差异。在确定的11，770例患者中，45.4%根据NCCN指南进行治疗。黑人种族（OR = 1.49，95%CI = 1.21-1.83），低SES（OR = 1.46，95%CI = 1.24-1.72），且地理位置距离大容量医院>= 80 km/50 mi（OR = 1.88，95%CI = 1.61-2.19）与非依从性治疗风险增加独立相关，而大量住院治疗（OR = 0.59，95%CI = 0.53-0.66）和接受护理的距离>= 32 km/20 mi（OR = 0.80，95%CI = 0.69-0.92）是独立的保护因素。SES与距离大容量医院的公里/50英里呈负相关，范围从6.3%（高SES）到33.0%（低SES）（p < 0.0001）。与黑人（14.4%）、西班牙裔（15.9%）和亚洲/太平洋岛民（15.5%）相比，白色患者（21.8%）更可能旅行≥ 32 km/20 mi以接受治疗（p < 0.0001）。地理上接近高容量医院和接受治疗的旅行距离与晚期卵巢癌的NCCN指南依从性护理独立相关。标准卵巢癌治疗的地理障碍不成比例地影响少数民族和低社会经济地位的妇女。(C)2014爱思唯尔公司All rights reserved.
Objective. To determine the impact of geographic location on advanced-stage ovarian cancer care adherence to the National Comprehensive Cancer Network (NCCN) guidelines in relation to race and socioeconomic status (SES)Methods. Patients diagnosed with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Generalized additive models were created to assess the effect of spatial distributions of geographic location, proximity to a high-volume hospital (>= 20) cases/year), distance traveled to receive care, race, and SES on adherence to NCCN guidelines, with simultaneous smoothing of geographic location and adjustment for confounding variables. Disparities in geographic predictors of treatment adherence were analyzed with the x(2) test for equality of proportions.Results. Of the 11,770 patients identified, 45.4% were treated according to NCCN guidelines. Black race (OR = 1.49, 95%CI = 1.21-1.83), low-SES (OR = 1.46, 95%CI = 1.24-1.72), and geographic location >= 80 km/50 mi from a high-volume hospital (OR = 1.88, 95%CI = 1.61-2.19) were independently associated with an increased risk of non-adherent care, while high-volume hospital treatment (OR = 0.59, 95%CI = 0.53-0.66) and travel distance to receive care >= 32 km/20 mi (OR = 0.80, 95%CI = 0.69-0.92) were independently protective. SES was inversely associated with location km/50 mi from a high-volume hospital, ranging from 6.3% (high-SES) to 33.0% (low-SES) (p < 0.0001). White patients were significantly more likely to travel >= 32 km/20 mi to receive care (21.8%) compared to Blacks (14.4%), Hispanics (15.9%), and Asian/Pacific Islanders (15.5%) (p < 0.0001).Conclusion. Geographic proximity to a high-volume hospital and travel distance to receive treatment are independently associated with NCCN guideline adherent care for advanced-stage ovarian cancer. Geographic barriers to standard ovarian cancer treatment disproportionately affect racial minorities and women of low-SES. (C) 2014 Elsevier Inc. All rights reserved.