Access to pediatric cancer care by age, race, and diagnosis, and outcomes of cancer treatment in pediatric and adolescent patients in the state of Georgia
Access to pediatric cancer care by age, race, and diagnosis, and outcomes of cancer treatment in pediatric and adolescent patients in the state of Georgia
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DOI：
10.1200/jco.2006.07.6992
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发表时间：
2007-10-10
影响因子：
45.3
通讯作者：
Woods, William G.
中科院分区：
文献类型：
--
作者：
Howell, Della L.;Ward, Kevin C.;Woods, William G.
目的：儿科肿瘤学家一直担心青少年和少数民族患者无法获得足够的护理。本研究基于格鲁吉亚患者的年龄、种族和癌症类型，调查了癌症护理的可及性和生存结果。患者和方法我们对1,751名年龄在0至19岁之间的癌症患者进行了回顾性分析，这些患者在1998年至2002年之间被诊断，在格鲁吉亚综合癌症登记处，该研究确定了在治疗过程中的任何时候在五个格鲁吉亚儿科癌症中心（儿童肿瘤学小组[COG]成员）之一接受治疗的患者。数据进行了进一步分析，年龄在诊断，种族，居住县，和5年survival.Results 87%的患者年龄在0至14岁，36%的患者年龄在15至19岁的治疗在COG机构。25%的患者为非洲裔，其中75.4%的黑人与70.3%的白色患者（年龄0 - 19岁）在COG机构接受治疗（P <0.01）; 97.1%的其他少数民族在COG机构接受治疗（P <0.05）。在所有白血病中，儿童特异性癌症的5年精算生存率显著较低（75.1%比46.4%; P = 0.0015），特别是在未在COG机构治疗的急性淋巴细胞白血病患者中（86.3%比53.3%; P <0.05）。精算生存率低得多，黑人比白人在所有癌症作为一个整体（70%对82%; P < .001），并为许多特定的subtype.Conclusion青少年年龄的患者是不太可能被称为COG机构，潜在地暴露他们在某些癌症亚型的更糟糕的结果。令人欣慰的是，少数群体正在获得足够的儿科癌症护理;不幸的是，他们的生存率较低。
Purpose There have been concerns among pediatric oncologists that adolescent and minority patients are not getting adequate access to care. This study examines access to cancer care and survival outcomes based on age, race, and type of cancer in patients in Georgia.Patients and Methods We performed a retrospective review of 1,751 cancer patients aged 0 to 19 years, diagnosed between 1998 and 2002, in the Georgia Comprehensive Cancer Registry, which identified patients who were treated at one of five Georgia pediatric cancer centers (Children's Oncology Group [COG] members) at any point in their treatment. Data were further analyzed for age at diagnosis, race, county of residence, and 5-year survival.Results Eighty-seven percent of patients aged 0 to 14 years and 36% of those aged 15 to 19 years were treated at a COG institution. Twenty-five percent of all patients were of African descent, with 75.4% of black versus 70.3% of white patients (age 0 to 19 years) treated at a COG institution (P < .01); 97.1% of other minorities were treated at a COG institution (P < .05). The 5-year actuarial survival rates for more pediatric-specific cancers were significantly lower in all leukemias (75.1% v 46.4%; P = .0015), and acute lymphoblastic leukemia specifically (86.3% v 53.3%; P < .05) for patients not treated at a COG institution. Actuarial survival rates were much lower for blacks than whites in all cancers as a whole (70% v 82%; P < .001) and for many specific subtypes.Conclusion Adolescent-aged patients are less likely to be referred to a COG institution, potentially exposing them to worse outcomes in some cancer subtypes. Reassuringly, minority populations are receiving adequate access to pediatric cancer care; unfortunately their survival rates are lower.