Variations in breast cancer treatment by patient and provider characteristics
Variations in breast cancer treatment by patient and provider characteristics
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DOI：
10.1007/bf01806003
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发表时间：
1996-01-01
影响因子：
3.8
通讯作者：
Guadagnoli, E
中科院分区：
文献类型：
--
作者：
Ayanian, JZ;Guadagnoli, E
在过去的15年里，乳腺癌的最佳治疗指南已经公布，但美国的临床实践仍然存在很大差异。本文回顾了文献的变化，在局部和全身治疗乳腺癌的患者和供应商的characteristics.Studies的局部治疗一直表明，老年妇女是不太可能比年轻妇女接受保乳手术后放射治疗。一些研究指出，黑人女性比白色女性更不可能接受保乳手术，也不太可能在保乳手术后接受放射治疗。保乳手术的比率在地理区域之间以及教学医院和非教学医院之间相差三倍。小医院的病人似乎不太可能接受放射治疗。系统治疗的模式还没有得到很好的描述。75岁以上的女性可能没有接受足够的激素治疗，但最近的数据不可用。有限的数据表明，全身治疗的比率并没有因种族或西班牙裔种族而发生实质性变化，但没有健康保险的女性可能不会接受适当的化疗。关于医院和医生的特点与系统治疗的使用之间的关系的研究很少，而且没有结论，为了增加接受乳腺癌最佳治疗的妇女的比例，并确保更大的公平性，需要对临床实践中的差异有更深入的了解。这些差异可能是由于医生对指南的了解不足或不同意，医生和患者之间的沟通不足以及患者的个人偏好或临床属性。未来的研究将需要探索妇女和医生之间的对话，导致对乳腺癌治疗的决定。
Guidelines for the optimal treatment of breast cancer have been publicized over the past 15 years, yet clinical practices continue to vary substantially in the United States. This article reviews the literature on variations in local and systemic treatment of breast cancer by patient and provider characteristics.Studies of local therapy have consistently demonstrated that older women are less likely than younger women to receive radiation therapy after breast-conserving surgery. Some studies have noted that black women are less likely than white women to receive breast-conserving surgery and less likely to receive radiation therapy after breast-conserving surgery. Rates of breast-conserving surgery vary three-fold among geographic regions and between teaching and non-teaching hospitals. Patients at smaller hospitals appear less likely to receive indicated radiation therapy.Patterns of systemic therapy have not been well described. Women over age 75 may not be receiving adequate hormonal therapy, but recent data are not available. Limited data suggest that rates of systemic therapy do not vary substantially by race or Hispanic ethnicity, but women without health insurance may not be receiving appropriate chemotherapy. Studies relating hospital and physician characteristics to the use of systemic therapy are sparse and inconclusive.In order to increase the proportion of women who receive optimal treatment for breast cancer and ensure greater equity, a more sophisticated understanding of variations in clinical practice will be required. These variations may arise from insufficient knowledge of or disagreement with guidelines among physicians, inadequate communication between physicians and patients, and individual preferences or clinical attributes of patients. Future studies will need to explore the dialogue between women and their physicians that leads to decisions about treatment of breast cancer.