Timeliness of Treatment Initiation and Associated Survival Following Diagnosis of Non-Small-Cell Lung Cancer in South Carolina.
Timeliness of Treatment Initiation and Associated Survival Following Diagnosis of Non-Small-Cell Lung Cancer in South Carolina.
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DOI：
10.14423/smj.0000000000000601
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发表时间：
2017-02
影响因子：
1.1
通讯作者：
Salloum RG
中科院分区：
文献类型：
--
作者：
Bullard JT;Eberth JM;Arrington AK;Adams SA;Cheng X;Salloum RG
非小细胞肺癌（NSCLC）患者的生存取决于许多因素，包括早期诊断和治疗的开始。NSCLC患者的标准治疗选择包括手术、放疗和化疗。本研究的目的是评价在南卡罗来纳州的一组私人保险的NSCLC患者中，及时开始治疗对患者生存率的影响。该研究的数据回顾性地从南卡罗来纳州中央癌症登记处和国家健康计划蓝十字和蓝盾索赔。患者在2005年1月1日至2010年12月31日期间被诊断为NSCLC，年龄在18岁或以上，并且在诊断前至少1年在国家健康计划下。最终研究样本包括746名患者。采用Kaplan-Meier曲线和考克斯比例风险模型分析与生存相关的因素，并按诊断时的分期分层。研究队列中的大多数（80%）接受了及时（≤6周）而不是不及时（>6周）的护理（20%）。接受及时治疗的患者的平均生存时间为36.9，27.1，和12.4个月的局部，区域和远处转移，分别为。局部、区域和远处转移患者接受分期不及时治疗的平均生存时间分别为39.4、33.8和25.2个月。在远处转移阶段的NSCLC患者中，与接受不及时治疗的患者相比，接受及时治疗的患者生存率显著降低（风险比2.2）。在6周内开始治疗与所有癌症阶段（局部、区域和远处转移）的生存时间延长无关。需要进行更多的研究，以检查其他治疗质量指标对NSCLC患者生存期的影响，不同的治疗开始时间阈值可能对NSCLC患者的生存期更有意义，以及其他地理区域和人群中NSCLC患者的及时护理。
Non–small-cell lung cancer (NSCLC) patient survival depends on a number of factors, including early diagnosis and initiation of treatment. Standard treatment options for patients with NSCLC include surgery, radiation therapy, and chemotherapy. The objective of this study was to evaluate the impact that the initiation of timely treatment has on patient survival among a cohort of privately insured patients with NSCLC in South Carolina. Data for the study were retrospectively obtained from the South Carolina Central Cancer Registry and the state health plan Blue Cross and Blue Shield claims. Patients were diagnosed as having NSCLC between January 1, 2005 and December 31, 2010, were aged 18 years or older, and were covered under the state health plan for at least 1 year before diagnosis. The final study sample included 746 patients. Kaplan-Meier curves and Cox proportional hazard modeling were conducted to examine factors associated with survival, stratified by stage at diagnosis. The majority in the study cohort (80%) received timely (≤6 weeks) rather than untimely (>6 weeks) care (20%). The mean survival time for patients receiving timely treatment by stage was 36.9, 27.1, and 12.4 months for localized, regional, and distant metastasis, respectively. The mean survival time for patients receiving untimely care by stage was 39.4, 33.8, and 25.2 months for localized, regional, and distant metastasis, respectively. Among patients with NSCLC in the distant metastasis stage, those receiving timely treatment experienced significantly decreased survival (hazard ratio 2.2) in comparison to those receiving untimely care. Initiation of treatment within 6 weeks is not associated with greater survival time across all stages of cancer (localized, regional, and distant metastasis). Additional research is needed to examine the impact of other treatment quality metrics on the survival of patients with NSCLC, different time thresholds for treatment initiation that may be more meaningful to survival among patients with NSCLC, and timely care among patients with NSCLC in other geographic areas and populations.