Diagnostic route is associated with care satisfaction independently of tumour stage: Evidence from linked English Cancer Patient Experience Survey and cancer registration data
Diagnostic route is associated with care satisfaction independently of tumour stage: Evidence from linked English Cancer Patient Experience Survey and cancer registration data
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DOI：
10.1016/j.canep.2019.04.011
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发表时间：
2019-08-01
影响因子：
2.6
通讯作者：
Lyratzopoulos, Georgios
中科院分区：
文献类型：
--
作者：
Tra My Pham;Gomez-Cano, Mayam;Lyratzopoulos, Georgios
背景：诊断途径(如急诊)是否与癌症护理经验独立于肿瘤阶段相关尚不清楚。方法：我们分析了18590名乳腺癌、前列腺癌、结肠癌、肺癌和直肠癌患者的数据，这些患者回答了2014年英国癌症患者体验调查，并与诊断途径和诊断时肿瘤阶段的癌症登记数据联系起来。我们根据肿瘤分期和诊断路径(根据患者特征和癌症部位变量进行粗略调整)估计了报告总体癌症护理负面体验的优势比(OR)，并检查了它们与癌症部位的交互作用。结果：调整后，急诊报告者报告负面体验的可能性最高，而筛查发现的乳腺癌、结肠癌和直肠癌患者的负面体验报告的可能性最低(OR与两周等待1.51，95%可信区间[CI]1.24-1.83；0.88，95%CI 0.75-1.03)。最晚期的患者更有可能报告负面经历(OR IV期与I期1.37，95%可信区间1.15~1.62)，在分期和路线之间几乎没有混淆，没有证据表明癌症分期或癌症路线相互作用。结论：尽管疾病的程度与整体癌症护理的评分密切相关，但诊断途径(特别是急诊或筛查检测)发挥着重要的独立作用。
Background: Whether diagnostic route (e.g. emergency presentation) is associated with cancer care experience independently of tumour stage is unknown.Methods: We analysed data on 18 590 patients with breast, prostate, colon, lung, and rectal cancers who responded to the 2014 English Cancer Patient Experience Survey, linked to cancer registration data on diagnostic route and tumour stage at diagnosis. We estimated odds ratios (OR) of reporting a negative experience of overall cancer care by tumour stage and diagnostic route (crude and adjusted for patient characteristic and cancer site variables) and examined their interactions with cancer site.Results: After adjustment, the likelihood of reporting a negative experience was highest for emergency presenters and lowest for screening-detected patients with breast, colon, and rectal cancers (OR versus two-week-wait 1.51, 95% confidence interval [CI] 1.24-1.83; 0.88, 95% CI 0.75-1.03, respectively). Patients with the most advanced stage were more likely to report a negative experience (OR stage IV versus I 1.37, 95% CI 1.15-1.62) with little confounding between stage and route, and no evidence for cancer-stage or cancer-route interactions.Conclusions: Though the extent of disease is strongly associated with ratings of overall cancer care, diagnostic route (particularly emergency presentation or screening detection) exerts important independent effects.