Malin Jennifer L, Schuster Mark A, Kahn Katherine A, Brook Robert H
Department of Medicine, Jonsson Comprehensive Cancer Center, University of California Los Angeles, 90095-1736, USA.
J Clin Oncol. 2002 Nov 1;20(21):4381-93. doi: 10.1200/JCO.2002.04.020.
To critically review studies that describe patterns of care for breast cancer patients and to examine the data sources used for case identification and determining patterns of care.
We searched the MEDLINE database (National Library of Medicine, Bethesda, MD) in August 2001 for studies of breast cancer care published from January 1985 to June 2001. Thirty-eight articles, describing 32 studies, met the inclusion criteria for this review.
According to the patterns of care literature, approximately 10% of women do not have an axillary lymph node dissection, 11% to 26% do not have their hormone receptor status reported, 20% do not receive radiation after breast-conserving surgery, and 30% to 70% of women with lymph node-positive breast cancer are not prescribed tamoxifen. Twenty-five (78%) of the studies relied on cancer registries for case identification. Cancer registries (47%) and the medical record (38%) were the most frequent sources of data on process of care. Twenty percent of the articles reported using more than one data source to determine patterns of care.
Although more patterns of care research has taken place in breast cancer than in any other oncologic condition, we found the available data had many limitations. These limitations highlight the challenges of quality-of-care research. To track changes in the quality of cancer care that may result from our rapidly transforming health care system, we need reliable data on the quality of current practice.
严格审查描述乳腺癌患者护理模式的研究，并检查用于病例识别和确定护理模式的数据源。
我们于2001年8月在MEDLINE数据库（美国国立医学图书馆，马里兰州贝塞斯达）中搜索了1985年1月至2001年6月发表的乳腺癌护理研究。38篇文章，描述了32项研究，符合本综述的纳入标准。
根据护理模式文献，约10%的女性未进行腋窝淋巴结清扫，11%至26%的女性未报告其激素受体状态，20%的女性在保乳手术后未接受放疗，30%至70%的淋巴结阳性乳腺癌女性未服用他莫昔芬。25项（78%）研究依靠癌症登记处进行病例识别。癌症登记处（47%）和病历（38%）是护理过程数据最常见的来源。20%的文章报告使用了不止一个数据源来确定护理模式。
尽管乳腺癌护理模式的研究比其他任何肿瘤疾病都多，但我们发现现有数据存在许多局限性。这些局限性凸显了护理质量研究的挑战。为了追踪我们快速变革的医疗保健系统可能导致的癌症护理质量变化，我们需要关于当前实践质量的可靠数据。
