Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina.
Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina.
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DOI：
10.1002/cncr.28004
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发表时间：
2013-06-15
期刊：
影响因子：
6.2
通讯作者：
Bensen, Jeannette T.
中科院分区：
文献类型：
--
作者：
Ellis, Shellie D.;Blackard, Bonny;Carpenter, William R.;Mishel, Merle;Chen, Ronald C.;Godley, Paul A.;Mohler, James L.;Bensen, Jeannette T.
关键词：
与高加索美国人相比，非裔美国人前列腺癌的发病率更高，预后更差。护理方面的种族差异是有据可查的。然而，很少有研究根据前列腺癌风险类别来描述患者，这需要区分适当和不适当的指南应用。对北卡罗来纳州777名新诊断为前列腺癌的男性的人群样本的医疗记录进行了研究，以评估患者种族、临床因素和国家综合癌症网络(NCCN)指南一致的前列腺癌护理之间的关系。非洲裔美国人的格里森评分(p=0.025)和前列腺特异性抗原水平(p=0.008)显著高于高加索裔美国人。然而，当同时考虑临床T分期时，总体风险类别的差异仅接近统计学意义(p=0.055)。在风险类别中，与高加索美国人相比，非裔美国人接受手术的可能性较小(58.1%对68.0%，p=0.004)，而有辐射的可能性更大(39.0%对27.4%，p=0.001)。然而，83.5%的男性在诊断后一年内接受了符合指南的治疗，在多变量分析中，这没有种族差异(OR 0.83；95%CI 0.54-1.25)。患者感觉更容易获得护理与接受与指南一致的护理的几率更大(OR 1.06；95%CI 1.01-1.12)。在控制了NCCN风险类别后，在接受指南一致性护理方面没有种族差异。改善前列腺癌治疗结果的努力应侧重于改善获得医疗保健系统的机会。
African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared to Caucasian Americans. Racial differences in care are well documented. However, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application. The medical records of a population-based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors and National Comprehensive Cancer Network (NCCN) guideline-concordant prostate cancer care. African Americans presented with significantly higher Gleason scores (p=0.025) and prostate specific-antigen levels (p=0.008) than Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance (p=0.055). Across risk categories, African Americans were less likely to have surgery (58.1% vs. 68.0%, p=0.004) and more likely to have radiation (39.0% vs. 27.4%, p=0.001) compared to Caucasian Americans. However, 83.5% of men received guideline-concordant care within one year of diagnosis, which did not differ by race in multivariable analysis (OR 0.83; 95% CI 0.54–1.25). Greater patient-perceived access to care was associated with greater odds of receiving guideline-concordant care (OR 1.06; 95% CI 1.01–1.12). After controlling for NCCN risk category, there were no racial differences in receipt of guideline-concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system.
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DOI：
10.1016/j.ijrobp.2011.11.024
发表时间：
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影响因子：
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作者：
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