Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study.
Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study.
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DOI：
10.1016/j.jamcollsurg.2013.07.007
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发表时间：
2013-11
影响因子：
5.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Hyder, Omar;Dodson, Rebecca M.;Nathan, Hari;Herman, Joseph M.;Cosgrove, David;Kamel, Ihab;Geschwind, Jean-Francois H.;Pawlik, Timothy M.
对于肝细胞癌 (HCC) 患者，专科医生的护理模式可能有所不同。人们对差异背后的原因知之甚少。差异的来源之一可能是向专家转诊的比例不同，从而导致针对癌症的治疗方法存在差异。查询了与监测、流行病学和最终结果 (SEER) 相关的 Medicare 数据库，查找 1998 年至 2007 年间诊断出的 HCC 患者，这些患者在诊断后咨询了 1 名或多名医生。就诊和手术记录是从医疗保险账单记录中提取的。检查了与专家咨询和后续治疗相关的因素。已确定 6,752 名 HCC 患者； 1,379 名 (20%) 患者患有早期疾病。中位年龄为 73 岁；大多数是男性（66%）、白人（60%）和来自西部地区（56%）。诊断后，转诊至专科医生的情况差异很大（肝病学/胃肠病学，60%；内科肿瘤学，62%；外科手术，56%；介入放射学 [IR]，33%；放射肿瘤学，9%）。 22% 的患者去看了 1 名专科医生； 39% 的人会见 3 名或更多专家。诊断和就诊之间的时间各不相同（手术，37 天，IR，55 天；p = 0.04）。与转诊至专科医生相关的因素包括年龄较小（优势比 [OR] 2.16）、亚洲种族（OR 1.49）、地理区域（东北 OR 2.10）和早期疾病的存在（OR 2.21）（所有 p < 0.05）。在早期疾病患者中，77% 的人去看了外科医生，50% 的人咨询了肿瘤内科医生。早期疾病患者接受治疗的情况各不相同（未治疗，30%；手术，39%；IR，9%；化疗，23%）。与接受治疗相关的因素包括年龄较小（OR 2.48）和早期疾病（OR 2.20）。 HCC 诊断后，转诊至专科医生的情况差异很大。临床和非临床因素均与咨询相关。需要更好地了解转诊至专科医生和后续治疗方面的差异，以确保所有 HCC 患者得到适当的护理。
Patterns of care of physician specialists may differ for patients with hepatocellular carcinoma (HCC). Reasons underlying variations are poorly understood. One source of variation may be disparate referral rates to specialists, leading to differences in cancer-directed treatments. Surveillance, Epidemiology, and End Results (SEER)-linked Medicare database was queried for patients with HCC, diagnosed between 1998 and 2007, who consulted 1 or more physicians after diagnosis. Visit and procedure records were abstracted from Medicare billing records. Factors associated with specialist consult and subsequent treatment were examined. There were 6,752 patients with HCC identified; 1,379 (20%) patients had early-stage disease. Median age was 73 years; the majority were male (66%), white (60%), and from the West region (56%). After diagnosis, referral to a specialist varied considerably (hepatology/ gastroenterology, 60%; medical oncology, 62%; surgery, 56%; interventional radiology [IR], 33%; radiation oncology, 9%). Twenty-two percent of patients saw 1 specialist; 39% saw 3 or more specialists. Time between diagnosis and visitation with a specialist varied (surgery, 37 days vs IR, 55 days; p = 0.04). Factors associated with referral to a specialist included younger age (odds ratio [OR] 2.16), Asian race (OR 1.49), geographic region (Northeast OR 2.10), and presence of early-stage disease (OR 2.21) (all p < 0.05). Among patients with early-stage disease, 77% saw a surgeon, while 50% had a consultation with medical oncologist. Receipt of therapy among patients with early-stage disease varied (no therapy, 30%; surgery, 39%; IR, 9%; chemotherapy, 23%). Factors associated with receipt of therapy included younger age (OR 2.48) and early-stage disease (OR 2.20). After HCC diagnosis, referral to a specialist varied considerably. Both clinical and nonclinical factors were associated with consultation. Disparities in referral to a specialist and subsequent therapy need to be better understood to ensure all HCC patients receive appropriate care.
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影响因子：
29.4
作者：
El-Serag HB
通讯作者：
El-Serag HB
DOI：
10.1016/j.jamcollsurg.2011.04.013
发表时间：
2011-07-01
影响因子：
5.2
作者：
Steele, Scott R.;Chen, Steven L.;Bilchik, Anton
通讯作者：
Bilchik, Anton
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
DOI：
10.1200/jco.2010.30.8650
发表时间：
2011-02-20
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Nathan H;Bridges JF;Schulick RD;Cameron AM;Hirose K;Edil BH;Wolfgang CL;Segev DL;Choti MA;Pawlik TM
通讯作者：
Pawlik TM
影响因子：
7.2
作者：
Howell, EA;Chen, YT;Concato, J
通讯作者：
Concato, J