Regional differences in recommended cancer treatment for the elderly.
Regional differences in recommended cancer treatment for the elderly.
复制标题
DOI：
10.1186/s12913-016-1534-z
复制
发表时间：
2016-07-15
影响因子：
2.8
通讯作者：
Giordano SH
中科院分区：
文献类型：
--
作者：
Ho V;Ku-Goto MH;Zhao H;Hoffman KE;Smith BD;Giordano SH
人们对癌症治疗的区域差异及其决定因素知之甚少。我们比较了德克萨斯州各地老年患者遵守治疗指南的比率，以及当地专科医生的供应是否是治疗差异的重要决定因素。以前的文献回顾表明，7个推荐疗程治疗结直肠癌、胰腺癌和前列腺癌。我们分析了德克萨斯州癌症登记处2004年至2007年与医疗保险索赔相关的数据，以研究这些癌症患者。我们测试了22个医院转诊地区(HRR)的未调整和调整后的治疗率差异。我们测试了治疗每种癌症的当地专家供应的差异是否是治疗的一个重要决定因素。我们发现，调整后的治疗率在不同地区存在显著差异。对于结肠癌切除的12个以上淋巴结的切除和检查，22个HRR中有13个的比率与中位数区域有显著差异。对于区域性结肠癌的辅助化疗，5个HRR与中位数有显著差异。对于诊断良好的前列腺癌治疗，9个HRR与中位数HRR不同。在7种治疗方法中，只有外科医生的局部可获得性是结肠癌患者淋巴清扫的重要决定因素。德克萨斯州各地推荐的七种癌症治疗方法存在显著差异。没有一个地区的治疗水平始终高于或低于其他地区，而且当地的专科医生供应并不是治疗的重要预测指标。不同的因素可能决定了不同癌症类型和治疗方案的治疗率的地区差异。本文的在线版本(doi：10.1186/s12913-0161534-z)包含补充材料，授权用户可以使用。
Little is known about regional variation in cancer treatment and its determinants. We compare rates of adherence to treatment guidelines for elderly patients across Texas and whether local specialist supply is an important determinant of treatment variation. Previous literature reviewed indicated 7 recommended courses of treatment for colorectal, pancreatic, and prostate cancer. We analyzed Texas Cancer Registry data linked with Medicare claims for the years 2004 to 2007 to study patients with these cancers. We tested for unadjusted and adjusted differences in treatment rates across 22 hospital referral regions (HRR). We tested whether variation in the local supply of specialists treating each cancer was an important determinant of treatment. We found significant differences in adjusted treatment rates across regions. For removal and examination of 12+ lymph nodes with colon cancer resection, 13 of 22 HRRs had rates significantly different from the median region. For adjuvant chemotherapy for regional colon cancer, five HRRs significantly differed from the median. For prostate cancer treatment with a favorable diagnosis, nine HRRs differed from the median HRR. Of the 7 treatments, only the local availability of surgeons was an important determinant for excision of lymph nodes for colon cancer patients. There are significant variations across Texas for seven recommended cancer treatments. No one region has consistently higher or lower treatments than other regions, and local specialist supply is not an important predictor of treatment. Different factors may be determining regional variation in treatment rates across cancer types and treatment options. The online version of this article (doi:10.1186/s12913-016-1534-z) contains supplementary material, which is available to authorized users.