Surgical decisions for early stage, non-small cell lung cancer: Which racially sensitive perceptions of cancer are likely to explain racial variation in surgery?
Surgical decisions for early stage, non-small cell lung cancer: Which racially sensitive perceptions of cancer are likely to explain racial variation in surgery?
复制标题
DOI：
10.1177/0272989x03251244
复制
发表时间：
2003-03-01
影响因子：
3.6
通讯作者：
Phifer, N
中科院分区：
文献类型：
--
作者：
Cykert, S;Phifer, N
目标。患有早期非小细胞肺癌的23%的白人和36%的非洲裔美国人没有接受可能治愈的手术。提出了一个简单的决策模型来探索手术决策的要素，可以解释肺癌手术的决定和这些决定中的种族差异。方法。对181个不同个体进行了调查，以测量与肺癌手术相关的健康效用得分。这些分数被插入到一个简单的模型中，该模型计算与癌症手术决定相关的质量调整生存率。结果。根据一项使用标准赌博方法的调查，非裔美国人的健康效用评分（HUS）几乎是白人的两倍（0.32比0.18）。然而，在纳入非裔美国人效用数据的模型中，与不手术相比，肺癌手术仍然受到极大的青睐（2.32 vs 0.48质量调整生命年）。敏感性分析表明，在没有手术干预的情况下，导致癌症“治愈”的因素比溶血性尿毒综合征的变化在指导模型结果远离手术方面更重要。结论。该分析表明，通过溶血性尿毒测定的进展性肺癌的生活质量评分存在种族差异，但可能不能像患者护理的其他因素那样解释反对手术的决定。
Objectives. Twenty-three percent of white and 36% of African American patients who suffer from early stage non-small cell lung cancer do not undergo potentially curative surgery. A simple decision model is presented to probe for elements of surgical decision making that could explain decisions against lung cancer surgery and racial variation in these decisions. Methods. A survey of 181 diverse individuals to measure health utility scores for conditions relevant to lung cancer surgery was performed. These scores were inserted into a simple model that calculates quality-adjusted survival related to decisions for and against cancer surgery. Results. The health utility score (HUS) for progressive lung cancer, as determined by a survey using the standard gamble approach, is nearly twice as high in African Americans as whites (0.32 v. 0.18). However, in a model incorporating African American utility data, lung cancer surgery remains heavily favored compared to the no-surgery decision (2.32 v. 0.48 quality-adjusted life years). Sensitivity analysis shows that factors that lead to a belief of cancer "cure" in the absence of surgical intervention are much more important than variations of HUS in directing model results away from surgery. Conclusion. This analysis illustrates that racial differences in quality-of-life ratings of progressive lung cancer as measured by HUS exist but may not explain decisions against surgery as much as other elements of patient care.