Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance
Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance
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DOI：
10.1200/jco.2015.61.1558
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发表时间：
2015-10-01
影响因子：
45.3
通讯作者：
Hershman, Dawn I.
中科院分区：
文献类型：
--
作者：
Lin, Chun Chieh;Bruinooge, Suanna S.;Hershman, Dawn I.
目的获得护理的地理位置可能与接受化疗有关，但尚未得到充分的检查。这项研究试图评估肿瘤学家的密度与结肠癌切除后90天内旅行距离和接受辅助化疗的相关性。患者和方法选择国家癌症数据库中2007-2010年间诊断为III期结肠癌的患者，年龄在18-80岁之间。结果在34,694名患者中，75.7%的患者在结肠切除术后90天内接受辅助化疗。与旅行距离小于12.5英里相比，旅行50至249英里(优势比[OR]为0.87；P=0.009)或250英里(优势比为0.36；P<；0.001)的患者接受辅助化疗的可能性较低。肿瘤学家的密度水平与接受辅助化疗没有统计学关系(低密度与高密度：OR为0.98；P=0.77)。当按保险状况分层分析时，居住在肿瘤学家密度较低地区的非私人保险患者接受辅助化疗的可能性较小(OR，0.85；P=0.03)。结论无论保险状况如何，旅行负担的增加都与接受辅助化疗的可能性降低有关。居住在低密度肿瘤学家地区的非私人保险患者接受辅助化疗的可能性较小。如果这些发现被前瞻性地证实，减少地理障碍的干预措施可能会改善结肠癌治疗的及时性和质量。(C)2015年度美国临床肿瘤学会
PurposeGeographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy.Patients and MethodsPatients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics.ResultsOf 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P = .009) or 250 miles (OR, 0.36; P < .001) had decreased likelihood of receiving adjuvant chemotherapy. Density level of oncologists was not statistically associated with receipt of adjuvant chemotherapy (low v high density: OR, 0.98; P = .77). When stratifying analyses by insurance status, non-privately insured patients who resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy (OR, 0.85; P = .03).ConclusionIncreased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment. (C) 2015 by American Society of Clinical Oncology