Race, Affordability and Utilization of Supportive Care in Ovarian Cancer Patients.
Race, Affordability and Utilization of Supportive Care in Ovarian Cancer Patients.
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DOI：
10.1016/j.jpainsymman.2022.08.021
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发表时间：
2022-12
影响因子：
4.7
通讯作者：
Akinyemiju, Tomi
中科院分区：
文献类型：
--
作者：
Anyanwu, Mercy C.;Ohamadike, Onyinye;Wilson, Lauren E.;Meernik, Clare;Huang, Bin;Pisu, Maria;Liang, Margaret;Previs, Rebecca A.;Joshi, Ashwini;Ward, Kevin C.;Tucker, Tom;Schymura, Maria J.;Berchuck, Andrew;Akinyemiju, Tomi
癌症患者缺乏获得支持性护理(SC)的机会已被很好地记录下来。然而，可负担性在卵巢癌(OC)患者中的这种差异中的作用仍然知之甚少。2008-2015年间的OC患者是从SEER-Medicare数据集中确定的。在联邦医疗保险D部分覆盖的患者中，在OC诊断的6个月内使用SC药物的种族差异被检查。使用多变量对数二项回归模型，在调整所有患者和晚期疾病患者之间的临床协变量后，检验种族、可负担性和SC药物的相关性。研究队列包括3697名患者：86%的非西班牙裔白人(NHW)，6%的非西班牙裔黑人(NHB)和8%的西班牙裔。在调整后的模型中，与NHW患者相比，NHB和西班牙裔患者接受抗抑郁药物的可能性较小(NHB：AOR 0.46；95%CI 0.33-0.63；西班牙裔：AOR 0.79；95%CI 0.63-0.99)。这种关联持续存在于患有晚期疾病的NHB患者(AOR 0.42；95%CI 0.28-0.62)。双重参加医疗补助的患者更有可能接受抗抑郁药物治疗(总体：AOR 1.34；95%可信区间1.17-1.53；晚期：AOR 1.29；95%可信区间1.10-1.52)。然而，居住在受教育程度较低的成年人比例较高的地区(总体：AOR 0.82；95%CI 0.70-0.97和晚期：AOR 0.82；95%CI 0.68-0.99)的患者接受抗抑郁药物的可能性较小。黑人OC患者和那些生活在教育程度较低地区的人作为SC接受抗抑郁药物的可能性较小。鉴于癌症患者初级治疗后生活质量的重要性，需要采取干预措施，以促进公平获得SC。
Lack of access to supportive care (SC) among cancer patients have been well documented. However, the role of affordability in this disparity among ovarian cancer (OC) patients remain poorly understood. Patients with OC between 2008–2015 were identified from the SEER-Medicare dataset. Racial disparities in utilization of SC medications within the 6 months of OC diagnosis among patients with Medicare Part D coverage was examined. Multivariable log-binomial regression models were used to examine the associations of race, affordability and SC medications after adjusting for clinical covariates among all patients and separately among patients with advanced-stage disease. The study cohort included 3,697 patients: 86% non-Hispanic White (NHW), 6% non-Hispanic Black (NHB), and 8% Hispanic. In adjusted models, NHB and Hispanic patients were less likely to receive antidepressants compared to NHW patients (NHB: aOR 0.46; 95% CI 0.33–0.63 and Hispanic: aOR 0.79; 95% CI 0.63–0.99). This association persisted for NHB patients with advanced-stage disease (aOR 0.42; 95% CI 0.28–0.62). Patients dual enrolled in Medicaid were more likely to receive antidepressants (overall: aOR 1.34; 95% CI 1.17–1.53 and advanced-stage: aOR 1.29; 95% CI 1.10–1.52). However, patients residing in areas with higher vs. lower proportions of lower educated adults (overall: aOR 0.82; 95% CI 0.70–0.97 and advanced-stage: aOR 0.82; 95% CI 0.68–0.99) were less likely to receive antidepressants. Black OC patients and those living in lower educated areas were less likely to receive antidepressants as SC. Given the importance of post-primary treatment quality of life for cancer patients, interventions are needed to enhance equitable access to SC.
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