Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer.
Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer.
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DOI：
10.1001/jama.2010.793
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发表时间：
2010-06-16
影响因子：
120.7
通讯作者：
Bunton, Audrina Jones
中科院分区：
文献类型：
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作者：
Cykert, Samuel;Dilworth-Anderson, Peggye;Monroe, Michael H.;Walker, Paul;McGuire, Franklin R.;Corbie-Smith, Giselle;Edwards, Lloyd J.;Bunton, Audrina Jones
肺癌是美国癌症死亡的主要原因。 I 期或 II 期非小细胞癌的手术切除仍然是唯一可靠的治愈方法。不接受手术的患者的中位生存期不到 1 年。尽管存在生存劣势，但许多早期疾病患者没有接受手术治疗，黑人患者的手术率甚至更低。旨在确定新诊断出的早期肺癌患者接受手术的潜在可改变因素，并探讨为什么黑人接受手术的频率低于白人。通过研究转诊或计算机断层扫描审查方案，对 5 个社区的肺科、肿瘤科、胸外科和全科实践所确定的患者进行前瞻性队列研究。 2005年12月至2008年12月期间，共有437名经活检证实或可能患有早期肺癌的患者入组。在制定治疗计划之前，对患者进行了一项调查，包括有关信任、医患沟通、对癌症的态度和功能状态等问题。有关合并症的信息是通过图表审核获得的。诊断后 4 个月内进行肺癌手术。共有 386 名患者符合肺切除手术的全部资格标准。中位年龄为 66 岁（范围为 26-90 岁），29% 的患者是黑人。白人患者的手术率为 66% (n=179/273)，而黑人患者的手术率为 55% (n=62/113；P=.05)。对医患沟通的负面认知表现为 25 点沟通量表上 5 点递减（比值比 [OR]，0.42；95% 置信区间 [CI]，0.32-0.74）和对术后 1 年预后的负面认知（OR，0.27；95% CI，0.14-0.50；绝对风险，34%）与决策相关反对手术。当黑人患有 2 种或更多合并症时（<2 种合并症为 13% vs 62%；OR，0.04 [95% CI，0.01–0.25]；绝对风险，49%）以及当黑人缺乏常规护理来源时（没有定期护理为 42%，定期护理为 57%；OR，0.20 [95% CI， 0.10–0.43]；绝对风险，15%）。新诊断出肺癌的患者决定不接受手术与沟通和预后、年龄、多种合并症和黑人种族的看法独立相关。优化手术的干预措施应考虑这些因素。
Lung cancer is the leading cause of cancer death in the United States. Surgical resection for stage I or II non–small cell cancer remains the only reliable treatment for cure. Patients who do not undergo surgery have a median survival of less than 1 year. Despite the survival disadvantage, many patients with early-stage disease do not receive surgical care and rates are even lower for black patients. To identify potentially modifiable factors regarding surgery in patients newly diagnosed with early-stage lung cancer and to explore why blacks undergo surgery less often than whites. Prospective cohort study with patients identified by pulmonary, oncology, thoracic surgery, and generalist practices in 5 communities through study referral or computerized tomography review protocol. A total of 437 patients with biopsy-proven or probable early-stage lung cancer were enrolled between December 2005 and December 2008. Before establishment of treatment plans, patients were administered a survey including questions about trust, patient-physician communication, attitudes toward cancer, and functional status. Information about comorbid illnesses was obtained through chart audits. Lung cancer surgery within 4 months of diagnosis. A total of 386 patients met full eligibility criteria for lung resection surgery. The median age was 66 years (range, 26–90 years) and 29% of patients were black. The surgical rate was 66% for white patients (n=179/273) compared with 55% for black patients (n=62/113; P=.05). Negative perceptions of patient-physician communication manifested by a 5-point decrement on a 25-point communication scale (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.32–0.74) and negative perception of 1-year prognosis postsurgery (OR, 0.27; 95% CI, 0.14–0.50; absolute risk, 34%) were associated with decisions against surgery. Surgical rates for blacks were particularly low when they had 2 or more comorbid illnesses (13% vs 62% for <2 comorbidities; OR, 0.04 [95% CI, 0.01–0.25]; absolute risk, 49%) and when blacks lacked a regular source of care (42% with no regular care vs 57% with regular care; OR, 0.20 [95% CI, 0.10–0.43]; absolute risk, 15%). A decision not to undergo surgery by patients with newly diagnosed lung cancer was independently associated with perceptions of communication and prognosis, older age, multiple comorbidities, and black race. Interventions to optimize surgery should consider these factors.
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影响因子：
--
作者：
Farjah, Farhood;Wood, Douglas E.;Flum, David R.
通讯作者：
Flum, David R.
影响因子：
4.6
作者：
Esnaola, Nestor F.;Gebregziabher, Mulugeta;Ford, Marvella E.
通讯作者：
Ford, Marvella E.
影响因子：
7.6
作者：
Greenwald, AG;McGhee, DE;Schwartz, JLK
通讯作者：
Schwartz, JLK
影响因子：
158.5
作者：
Bach, PB;Cramer, LD;Begg, CB
通讯作者：
Begg, CB
影响因子：
9.6
作者：
Dewan, NA;Shehan, CJ;Ryschon, K
通讯作者：
Ryschon, K