Breast-conserving therapy versus modified radical mastectomy: Socioeconomic status determines who receives what-Results from case-control study in Tianjin, China
Breast-conserving therapy versus modified radical mastectomy: Socioeconomic status determines who receives what-Results from case-control study in Tianjin, China
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DOI：
10.1016/j.canep.2011.04.005
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发表时间：
2012-02-01
影响因子：
2.6
通讯作者：
Zhang, Jin
中科院分区：
文献类型：
--
作者：
Liu, Jing-Jing;Zhang, Sheng;Zhang, Jin
背景：尽管有轶事证据表明中国乳腺癌患者的社会经济状况与手术治疗的选择有关，但尚未进行科学评估。本研究的目的是评估影响乳腺癌患者在接受保乳治疗(BCT)和改良根治术(MRM)之间的治疗选择的患者因素。方法：对天津市肿瘤医院2005-01/2007-01接受BCT治疗的268例I-II期乳腺癌患者与随机选择的200例接受MRM治疗的乳腺癌患者(对照组)进行比较。使用个人健康问卷(PHQ)评估可能影响手术决策的因素。采用卡方检验和多因素Logistic回归分析BCT的相关因素。结果：BCT患者年龄较小，更倾向于居住在城市，有医疗保险，受教育程度较高，家庭收入较高。在控制了其他潜在的混杂因素后，有医疗保险的患者接受BCT的可能性大约是没有医疗保险的患者的6倍。家庭收入方面也观察到了类似的结果。观察到的差异不能用他们的疾病的临床方面来解释，如肿瘤分期、雌激素受体和淋巴转移。结论：决定乳腺癌患者是否接受BCT的主要因素是乳腺癌患者的社会经济状况，而不是他们的临床状况。这些结果提供了一个快照，说明社会经济状况如何影响中国的癌症护理服务。今后应努力减少因社会阶层和社会经济地位而导致的癌症患者治疗选择的差异。(C)2011爱思唯尔有限公司。保留所有权利。
Background: Despite anecdotal evidence linking socioeconomic status and choices on surgical management in breast cancer patients in China, no scientific evaluations have ever been conducted. The objective of this study was to evaluate patient factors that influence patients' treatment options between breast cancer patients receiving breast-conserving therapy (BCT) and modified radical mastectomy (MRM). Methods: A total of 268 stage I-II breast cancer patients treated with BCT in Tianjin Cancer Hospital, from January 2005 to January 2007, were compared with 200 randomly selected breast cancer patients (controls) treated with MRM. A personal health questionnaire (PHQ) was used to assess the factors that may affect the surgical decision making. Chi-squared test and multiple logistic regressions were used to examine factors associated with BCT. Results: BCT patients who were younger and were more likely to live in urban areas had medical insurance, higher levels of education and family income. Patients with medical insurance coverage were approximately six times more likely to receive BCT than patients without medical insurance after controlling for other potentially confounding factors. Similar results were also observed for family income. The observed differences cannot be explained by clinical aspects of their disease, such as tumor stage, estrogen receptor, and lymph node involvement. Conclusion: Breast cancer patients' socioeconomic status, rather than their clinical condition, is the predominant factor in determining whether a breast cancer patient receives BCT or not. These results provide a snapshot on how socioeconomic status influences cancer care provision in China. Future efforts should be made towards reducing discrepancies in treatment options for cancer patients caused by social class and socioeconomic status. (C) 2011 Elsevier Ltd. All rights reserved.