Adoption of immunotherapy in the community for patients diagnosed with metastatic melanoma
Adoption of immunotherapy in the community for patients diagnosed with metastatic melanoma
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DOI：
10.1186/s40425-019-0782-y
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发表时间：
2019-11-07
影响因子：
10.9
通讯作者：
Trinh, Quoc-Dien
中科院分区：
文献类型：
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作者：
Krimphove, Marieke J.;Tully, Karl H.;Trinh, Quoc-Dien
背景：免疫检查点抑制剂的引入使晚期黑色素瘤患者的生存受益；然而，关于社区采用免疫治疗的数据很少。方法利用国家癌症数据库，我们确定了2011年至2015年间美国4725名年龄为20岁的转移性黑色素瘤患者。使用多项回归来确定与在低免疫疗法处方医院与高免疫疗法处方医院接受治疗相关的因素，该医院根据其治疗转移性黑色素瘤患者的免疫疗法的比例定义为最低和最高五分之一的医院。结果我们确定了246家治疗转移性黑色素瘤患者的独特医院。2011至2015年间，至少20%的黑色素瘤患者在确诊后90天内接受免疫治疗的医院比例从14.5%上升到37.7%。低处方医院和高处方医院接受免疫治疗的患者比例分别为7.8%(95%可信区间7.47~8.08)和50.9%(95%可信区间47.6~54.3)。在低处方医院接受护理的预测因素包括保险不足(无保险：相对风险比2.44，95%-CI1.28-4.67，p=0.007；医疗补助：相对风险比2.10，95%-CI1.12-3.92，p=0.020)，在城市地区接受护理(RR2.58，95%-CI1.34-4.96，p=0.005)和在非学术机构接受护理(RR5.18，95%CI1.69-15.88，p=0.004)。结论：虽然转移性黑色素瘤的免疫疗法的使用率随着时间的推移而增加，但不同医院的采用情况差别很大。保险不足的患者更有可能在低免疫疗法处方医院接受治疗。这种差异表明，在获得这些潜在的救命药物方面存在不平等。
Background The introduction of immune checkpoint inhibitors has led to a survival benefit in patients with advanced melanoma; however data on the adoption of immunotherapy in the community are scarce. Methods Using the National Cancer Database, we identified 4725 patients aged >= 20 diagnosed with metastatic melanoma in the United States between 2011 and 2015. Multinomial regression was used to identify factors associated with the receipt of treatment at a low vs. high immunotherapy prescribing hospital, defined as the bottom and top quintile of hospitals according to their proportion of treating metastatic melanoma patients with immunotherapy. Results We identified 246 unique hospitals treating patients with metastatic melanoma. Between 2011 and 2015, the proportion of hospitals treating at least 20% of melanoma patients with immunotherapy within 90 days of diagnosis increased from 14.5 to 37.7%. The mean proportion of patients receiving immunotherapy was 7.8% (95% Confidence Interval [CI] 7.47-8.08) and 50.9% (95%-CI 47.6-54.3) in low and high prescribing hospitals, respectively. Predictors of receiving care in a low prescribing hospital included underinsurance (no insurance: relative risk ratio [RRR] 2.44, 95%-CI 1.28-4.67, p = 0.007; Medicaid: RRR 2.10, 95%-CI 1.12-3.92, p = 0.020), care in urban areas (RRR 2.58, 95%-CI 1.34-4.96, p = 0.005) and care at non-academic facilities (RRR 5.18, 95%CI 1.69-15.88, p = 0.004). Conclusion While the use of immunotherapy for metastatic melanoma has increased over time, adoption varies widely across hospitals. Underinsured patients were more likely to receive treatment at low immunotherapy prescribing hospitals. The variation suggests inequity in access to these potentially life-saving drugs.