SOCIAL AND ECONOMIC-FACTORS IN THE CHOICE OF LUNG-CANCER TREATMENT - A POPULATION-BASED STUDY IN 2 RURAL STATES
SOCIAL AND ECONOMIC-FACTORS IN THE CHOICE OF LUNG-CANCER TREATMENT - A POPULATION-BASED STUDY IN 2 RURAL STATES
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DOI：
10.1056/nejm198803103181006
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发表时间：
1988-03-10
影响因子：
158.5
通讯作者：
KORSON, R
中科院分区：
文献类型：
--
作者：
GREENBERG, ER;CHUTE, CG;KORSON, R
我们查阅了1808份医院病历，这些病历代表了1973年至1976年间新罕布夏州和佛蒙特州几乎所有被诊断为非小细胞肺癌的患者，发现患者的治疗因他们的婚姻状况、医疗保险覆盖范围以及离癌症治疗中心的距离而异。如果患者已婚(赔率比1.67；95%可信区间1.08至2.57)或拥有私人医疗保险(1.52；1.03至2.26)，则更有可能接受手术治疗。在没有接受手术的患者中，那些有私人保险的患者更有可能接受另一种形式的抗癌治疗-要么是放射治疗，要么是化疗(1.57；1.18到2.09)。居住在离癌症治疗中心越远的地方，接受手术的机会就越大。75岁及以上的患者不太可能接受手术(0.16；0.08至0.35)或任何其他肿瘤导向治疗(0.32；0.19至0.54)。治疗类型和患者特征之间的关系不是基于肿瘤分期或功能状态的明显差异，尽管这两个因素也都强烈地预测了治疗类型。尽管私人保险和已婚患者接受了更积极的治疗，但他们在确诊后存活时间并不长。我们得出结论，对于非小细胞肺癌，社会经济和医学因素决定了治疗。(N Engl J Med 1988；318：612-7)
We reviewed 1808 hospital charts representing virtually all patients given a diagnosis of non-small-cell lung cancer in New Hampshire and Vermont between 1973 and 1976 and found that the treatment of patients varied according to their marital status, medical insurance coverage, and proximity to a cancer-treatment center. Patients were more likely to be treated with surgery if they were married (odds ratio, 1.67; 95 percent confidence interval, 1.08 to 2.57) or had private medical insurance (1.52; 1.03 to 2.26). Among patients who did not have surgery, those with private insurance were more likely to receive another form of anticancer therapy — either radiation or chemotherapy (1.57; 1.18 to 2.09). Residing farther from a cancer-treatment center was associated with a greater chance of having surgery. Patients 75 years of age and older were less likely to have surgery (0.16; 0.08 to 0.35) or any other tumor-directed therapy (0.32; 0.19 to 0.54). The relation between the type of treatment and a patient's characteristics was not based on apparent differences in tumor stage or functional status, although both these factors were also strongly predictive of the type of treatment. Despite the fact that privately insured and married patients were more aggressively treated, they did not survive longer after diagnosis.We conclude that for non-small-cell lung cancer, socioeconomic as well as medical factors determine treatment. (N Engl J Med 1988; 318:612–7.)