Gynecologic Cancer Outcomes in the Elderly Poor: A Population-Based Study
Gynecologic Cancer Outcomes in the Elderly Poor: A Population-Based Study
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DOI：
10.1002/cncr.29541
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发表时间：
2015-10-15
期刊：
影响因子：
6.2
通讯作者：
Meyer, Anne-Marie
中科院分区：
文献类型：
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作者：
Doll, Kemi M.;Meng, Ke;Meyer, Anne-Marie
背景：同时参加联邦医疗保险和医疗补助的65岁成年人是医疗保健领域的高危群体。然而，就作者所知，这一人群中患有妇科癌症的妇女的结局尚不清楚。方法：目前的研究是一项基于人群的队列研究，研究对象是北卡罗来纳州的子宫癌、卵巢癌、宫颈癌和外阴/阴道癌登记病例(2003-2009年)，并与联邦医疗保险和州医疗补助挂钩。使用多变量分析和生存曲线分析了全因死亡率和诊断时疾病阶段的结果作为登记状态的函数。结果：在4522例65岁女性中，子宫癌2286例(51%)，卵巢癌1587例(35%)，宫颈癌302例(7%)，外阴/阴道癌347例(8%)。双重登记的人增加了全因死亡率(调整后的风险比[AHR]，1.34；95%可信区间[95%CI]，1.19-1.49)，以及每个癌症部位(子宫：AHR，1.22[95%CI，1.02-1.47]；卵巢：AHR，1.25[95%CI，1.05-1.49]；宫颈：AHR，1.34[95%CI，0.96-1.87]；外阴/阴道：AHR，1.93[95%CI，1.36~2.72])。在双重登记的患者中，诊断时晚期疾病的几率增加仅在子宫癌患者中存在(调整后的优势比，1.38；95%可信区间，1.06-1.79)。分层生存曲线显示早期子宫癌和早期外阴/阴道癌妇女之间的差异最大。结论：与未参加双重保险的65岁女性相比，同时参加联邦医疗保险和医疗补助的65岁女性在被诊断为妇科癌症后，全因死亡率总体上增加了34%。患有早期子宫癌和外阴癌/阴道癌的女性似乎具有最不同的结果。由于这些恶性肿瘤通常是可以治愈的，它们最有可能从有针对性的干预中受益。(C)2015年美国癌症协会。
BACKGROUND: Adults aged >= 65 years who are dually enrolled in Medicare and Medicaid are an at-risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown. METHODS: The current study was a population-based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar/vaginal cancers (2003-2009), with linked enrollment in Medicare and state Medicaid. Outcomes of all-cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves. RESULTS: Of 4522 women aged >= 65 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar/vaginal (8%) cancers. Dual enrollees had increased all-cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19-1.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02-1.47]; ovarian: aHR, 1.25 [95% CI, 1.05-1.49]; cervical: aHR, 1.34 [95% CI, 0.96-1.87]; and vulvar/vaginal: aHR, 1.93 [95% CI, 1.36-2.72]). Increased odds of advanced-stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06-1.79). Stratified survival curves demonstrated the strongest disparities among women with early-stage uterine and early-stage vulvar/vaginal cancers. CONCLUSIONS: Women aged >= 65 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all-cause mortality after diagnosis with a gynecologic cancer compared with the non-dually enrolled Medicare population. Women with early-stage uterine and vulvar/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions. (c) 2015 American Cancer Society.