Absence of cancer diagnosis and treatment in elderly medicaid-insured nursing home residents
Absence of cancer diagnosis and treatment in elderly medicaid-insured nursing home residents
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DOI：
10.1093/jnci/djm271
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发表时间：
2008-01-02
影响因子：
10.3
通讯作者：
Lin, Chunchieh
中科院分区：
文献类型：
--
作者：
Bradley, Cathy J.;Clement, Jan P.;Lin, Chunchieh
背景鲜为人知的是，癌症对疗养院患者的生活和护理质量，包括姑息治疗，delivered to them.Methods使用全州范围内的人口为基础的数据集从密歇根州肿瘤登记处和医疗记录，我们确定了1907年老年人医疗保险养老院居民被诊断为癌症在1997年和2000年之间。根据年龄、种族、性别、收入、合并症和诊断时晚期或未分期癌症的癌症部位、诊断后3个月内死亡、接受临终关怀以及诊断为早期乳腺癌、结直肠癌、肺癌或前列腺癌的患者接受癌症定向手术的可能性，使用Logistic回归模型估计比值比（OR）和相对风险（RR）。所有的统计检验都是双侧的。结果被诊断为癌症的疗养院居民有优势的晚期或未分期的疾病（62%），高死亡率在3个月内的诊断（48%），和低临终关怀的使用，如果他们有远程阶段的癌症（28%）。只有22%的患者接受了癌症导向手术，其中61%仅限于乳腺癌患者，只有6%的患者接受了化疗和/或放疗。年龄较大与晚期或未分期癌症以及诊断后3个月内死亡呈正相关。71-75岁的患者比86岁及以上的患者更有可能接受癌症定向手术（OR = 2.83，95%置信区间[CI] = 1.26 - 6.32; RR = 1.37，95% CI = 1.08 - 1.75）。与白色患者相比，非裔美国患者接受手术的可能性较低（OR = 0.51，95% CI = 0.26 - 0.99; RR = 0.80，95% CI = 0.62 - 1.03）。其他的人口统计学特征和共病的条件几乎没有预测价值，癌症治疗或临终关怀使用nursing home patients.Conclusions很少癌症服务提供给医疗补助保险的疗养院患者，尽管事实上，这些患者中的许多人可能经历了癌症相关的症状和显着的身体下降之前的诊断和死亡。需要在被视为指导性治疗做法和显然缺乏诊断和治疗之间找到一个中间立场。
Background Little is known about the effect cancer has on the lives of nursing home patients and the quality of care, including palliative care, delivered to them.Methods Using a statewide population-based dataset assembled from the Michigan Tumor Registry and Medicare records, we identified 1907 elderly Medicaid-insured nursing home residents who were diagnosed with cancer between 1997 and 2000. Logistic regression models were used to estimate odds ratios (ORs) and relative risks (RRs) according to age, race, sex, income, comorbidity, and cancer site for late or unstaged cancer at diagnosis, death within 3 months of diagnosis, receipt of hospice care, and-for patients diagnosed with early-stage breast, colorectal, lung, or prostate cancer-the likelihood of cancer-directed surgery. All statistical tests were two-sided.Results Nursing home residents diagnosed with cancer had a preponderance of late or unstaged disease (62%), high mortality within 3 months of diagnosis (48%), and low hospice use if they had distant-stage cancer (28%). Only 22% received cancer-directed surgery, 61% of which was confined to breast cancer patients, and only 6% of patients received chemotherapy and/or radiation. Older age was positively associated with late or unstaged cancer and with death within 3 months of diagnosis. Patients aged 71-75 years were more likely to have cancer-directed surgery than patients aged 86 years and older (OR = 2.83, 95% confidence interval [Cl] = 1.26 to 6.32; RR = 1.37, 95% Cl = 1.08 to 1.75). African American patients were less likely to receive surgery (OR = 0.51, 95% Cl = 0.26 to 0.99; RR = 0.80, 95% Cl = 0.62 to 1.03) than white patients. Other demographic characteristics and comorbid conditions had little predictive value with regard to cancer treatment or hospice use in nursing home patients.Conclusions Very few cancer services are provided to Medicaid-insured nursing home patients, despite the fact that many of these patients likely experienced cancer-related symptoms and marked physical decline before diagnosis and death. A middle ground between what would be considered guideline treatment practices and the apparent absence of diagnosis and treatment is needed.