Johnston G M, Boyd C J, Joseph P, MacIntyre M
Nova Scotia Cancer Registry and Nova Scotia Cancer Centre of Queen Elizabeth II Health Sciences Centre, and School of Health Services Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
J Clin Oncol. 2001 Jul 15;19(14):3323-32. doi: 10.1200/JCO.2001.19.14.3323.
To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer.
The Nova Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obtained from the provincial treatment database. Multivariate analysis identified factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an RT consultation with a radiation oncologist and, given a consultation, likelihood of being treated with palliative RT.
The likelihood of having a consultation decreased with age (20 to 59 years v. 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v. < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the cancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased between 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relative to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic: OR, 0.35 [0.27 to 0.44]), and was greater for those who had prior RT (OR, 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception: prior RT was associated with a lower likelihood of receiving palliative RT (OR, 0.48 [0.40 to 0.58]).
Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, palliative radiation consultation and treatment.
研究与为癌症临终患者提供姑息性放疗（RT）相关的社会人口统计学和临床变量。
利用新斯科舍省癌症登记处来识别1994年至1998年期间在加拿大新斯科舍省死于癌症的9978名成年人。1992年4月至1998年12月期间的放疗记录来自省级治疗数据库。多变量分析确定了与在生命最后9个月决定是否提供姑息性放疗的两个连续决策相关的因素：接受放射肿瘤学家放疗咨询的可能性，以及在接受咨询后接受姑息性放疗的可能性。
接受咨询的可能性随年龄增长而降低（20至59岁与80岁以上：优势比[OR]，4.43[95%置信区间，3.80至5.15]），随社区家庭收入中位数增加而增加（>50,000美元与<20,000美元：OR，1.31[1.02至1.70]），距离癌症中心较近的居民可能性更高（<25公里与200公里以上：OR，2.47[2.16至2.83]），在1994年至1998年期间有所增加（OR，1.34[1.16至1.56]），因死亡原因而异（相对于胸段癌症，头颈部：OR，1.75[1.31至2.33]；妇科：OR，0.35[0.27至0.44]），并且曾接受过放疗的患者可能性更大（OR，2.20[1.89至2.56]）。当结果是在接受咨询后提供姑息性放疗时，观察到类似的关联，但有一个显著例外：曾接受过放疗与接受姑息性放疗的可能性较低相关（OR，0.48[0.40至0.58]）。
姑息性放疗实施过程中观察到的差异应促使进一步调查获得临床适当的姑息性放疗咨询和治疗的公平性。
