Timeliness of care in veterans with non-small cell lung cancer
Timeliness of care in veterans with non-small cell lung cancer
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DOI：
10.1378/chest.07-2654
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发表时间：
2008-05-01
期刊：
影响因子：
9.6
通讯作者：
Schultz, Ellen M.
中科院分区：
文献类型：
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作者：
Gould, Michael K.;Ghaus, Sharfun J.;Schultz, Ellen M.
背景：及时性是肺癌患者护理质量的一个重要方面。方法：我们回顾了2002年1月1日至2003年12月31日在退伍军人事务部帕洛阿尔托卫生保健系统连续确诊的非小细胞肺癌(NSCLC)患者的记录。结果：我们确定了129名退伍军人非小细胞肺癌患者(平均年龄67岁；男性占98%；白人占83%)，其中大多数人患有腺癌(51%)或鳞癌(30%)。少数患者(18%)出现孤立性肺结节(SPN)。从最初怀疑癌症到治疗的中位数为84天(四分位数范围为38到153天)。在84天内接受治疗的独立预测因素包括：7天内住院(优势比[OR]，8.2；95%可信区间[CI]，2.9~23)，肿瘤大小<GT；3.0厘米(OR，4.8；95%CI，1.8~12.4)，是否有其他胸部影像异常(OR，3.0；95%CI，1.1~8.5)，以及出现一种或多种提示转移的症状(OR，2.6；95%CI，1.1~6.2)。更及时的护理与更长的生存时间无关(调整后的危险比为1.6；95%可信区间为1.3至1.9)。然而，在SPN患者中，当治疗时间为84天时，有一种更好的生存时间的趋势。结论：NSCLC患者的治疗时间往往比推荐的时间长。有较大肿瘤、症状和其他胸部X光异常的患者得到更及时的治疗。在恶性SPN患者中，如果及时开始治疗，存活率可能会更高。
Background: Timeliness is an important dimension of quality of care for patients with lung cancer.Methods: We reviewed the records of consecutive patients in whom non-small cell lung cancer (NSCLC) had been diagnosed between January 1, 2002, and December 31, 2003, at the Veterans Affairs Palo Alto Health Care System. We used multivariable statistical methods to identify independent predictors of timely care and examined the effect of timeliness on survival.Results: We identified 129 veterans with NSCLC (mean age, 67 years; 98% men; 83% white), most of whom had adenocarcinoma (51%) or squamous cell carcinoma (30%). A minority of patients (18%) presented with a solitary pulmonary nodule (SPN). The median Lime from the initial suspicion of cancer to treatment was 84 days (interquartile range, 38 to 153 days). Independent predictors of treatment,within 84 days included hospitalization within 7 days (odds ratio [OR], 8.2; 95% confidence interval [CI], 2.9 to 23), tumor size of > 3.0 cm (OR, 4.8; 95% CI, 1.8 to 12.4), the presence of additional chest radiographic abnormalities (OR, 3.0; 95% CI, 1.1 to 8.5), and the presence of one or more symptoms suggesting metastasis (OR, 2.6; 95% CI, 1.1 to 6.2). More timely care was not associated with better survival time (adjusted hazard ratio, 1.6; 95% CI, 1.3 to 1.9). However, in patients with SPNs, there was a trend toward better survival time when the time to treatment was < 84 days.Conclusions: The time to treatment for patients with NSCLC was often longer than recommended. Patients with larger tumors, symptoms, and other chest radiographic abnormalities receive more timely care. In patients with malignant SPNs, survival may be better when treatment is initiated promptly.