Cancer stage at presentation for incarcerated patients at a single urban tertiary care center
Cancer stage at presentation for incarcerated patients at a single urban tertiary care center
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DOI：
10.1371/journal.pone.0237439
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发表时间：
2020-09-15
期刊：
影响因子：
3.7
通讯作者：
Sachs, Teviah E.
中科院分区：
文献类型：
--
作者：
Sunthankar, Kathryn I.;Griffith, Kevin N.;Sachs, Teviah E.
被监禁的患者是弱势群体，与非监禁患者相比，接受常规癌症筛查的机会可能较少。因此，需要对癌症诊断分期的潜在差异进行彻底评估。我们通过对 2010 年至 2017 年在城市安全网医院新诊断出癌症的所有患者进行回顾性图表审查，试图检查非监禁患者和监禁患者在初次诊断时的癌症分期是否存在差异。监禁状况由保险状况决定。我们的主要结局是初次癌症诊断时的监禁状态。总体而言，与非监禁患者相比，监禁患者的所有癌症类型均处于较晚的癌症分期（+.14 T 分期，p = .033；+.23 N 分期，p < .001）。监禁患者在晚期被诊断为结直肠癌（+0.93 T 分期，p < .001；+.48 N 分期，p < .001）、口咽癌（+0.37 N 分期，p = .003）、肺癌（+0.60 N 分期，p = .018）、皮肤癌（+0.59 N 分期，p = 0.014）和可筛查癌症（结直肠、前列腺、肺）作为一个整体（+0.23 T 分期，p = 0.002；+0.17 N 分期，p = 0.008）。被监禁的患者可能会受益于更结构化的筛查方案，以改善某些恶性肿瘤的就诊阶段。
Patients who are incarcerated are a vulnerable patient population and may suffer from less access to routine cancer screenings compared to their non-incarcerated counterparts. Therefore, a thorough evaluation of potential differences in cancer diagnosis staging is needed. We sought to examine whether there are differences in cancer stage at initial diagnosis between non-incarcerated and incarcerated patients by pursuing a retrospective chart review from 2010-2017 for all patients who were newly diagnosed with cancer at an urban safety net hospital. Incarceration status was determined by insurance status. Our primary outcome was incarceration status at time of initial cancer diagnosis. Overall, patients who were incarcerated presented at a later cancer stage for all cancer types compared to the non-incarcerated (+.14 T stage, p = .033; +.23 N stage, p < .001). Incarcerated patients were diagnosed at later stages for colorectal (+0.93 T stage, p < .001; +.48 N stage, p < .001), oropharyngeal (+0.37 N stage, p = .003), lung (+0.60 N stage, p = .018), skin (+0.59 N stage, p = 0.014), and screenable cancers (colorectal, prostate, lung) as a whole (+0.23 T stage, p = 0.002; +0.17 N stage, p = 0.008). Incarcerated patients may benefit from more structured screening protocols in order to improve the stage at presentation for certain malignancies.