Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy
Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy
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DOI：
10.1002/cncr.27658
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发表时间：
2012-12-01
期刊：
影响因子：
6.2
通讯作者：
Galsky, Matthew D.
中科院分区：
文献类型：
--
作者：
Small, Alexander C.;Tsao, Che-Kai;Galsky, Matthew D.
背景：一部分患有转移性实体瘤的患者从未接受过抗癌治疗。原因可能包括功能状态不佳、合并症和患者偏好。据作者所知，此前尚未描述过该人群的患病率和特征。方法：查询国家癌症数据库，查找诊断患有转移性（根据美国癌症联合委员会的 IV 期）实体瘤（包括乳腺癌、宫颈癌、结肠癌和肾癌；小细胞和非小细胞肺癌 [NSCLC]；以及前列腺、直肠和子宫肿瘤）且既未接受放疗也未接受全身治疗的患者。对数二项式回归分析用于估计未经治疗的 IV 期癌症患者与已治疗的 IV 期癌症患者的百分比患病率 (PR)。结果：2000 年至 2008 年间，共鉴定出 773,233 名 IV 期癌症患者，其中 159,284 名患者（20.6%；95% 置信区间，20.5%-20.7%）未接受抗癌治疗。 NSCLC 患者占未接受治疗人群的 55%。肾癌和肺癌患者的未治疗率最高，分别为 25.5% 和 24.0%，而前列腺癌患者的未治疗率最低，为 11.1%。在所有癌症类型中，年龄较大（PR 范围，1.37-1.49；所有 P < .001）、黑人种族（PR 范围，1.05-1.32；所有 P < .001）、缺乏医疗保险（PR 范围，1.47-2.46；所有 P < .001）和收入较低（子宫癌除外；PR 范围，每种癌症 0.91-0.98）收入增加 10,000 美元[所有 P < .001]）与缺乏治疗有关。结论：大约 20% 的 IV 期实体瘤患者没有接受抗癌治疗。尽管缺乏治疗可能有多种原因，包括适当的适应症，但这些发现对医疗保健政策和获得医疗服务具有潜在影响。癌症 2012。(c) 2012 年美国癌症协会。
BACKGROUND: A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS: The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS: Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%-20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37-1.49; all P < .001), black race (PR range, 1.05-1.32; all P < .001), lack of medical insurance (PR range, 1.47-2.46; all P < .001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P < .001]) were associated with a lack of treatment. CONCLUSIONS: Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care. Cancer 2012.(c) 2012 American Cancer Society.