Schroen Anneke T, Brenin David R, Kelly Maria D, Knaus William A, Slingluff Craig L
Department of Surgery, University of Virginia, Charlottesville, VA 22908-0709, USA.
J Clin Oncol. 2005 Oct 1;23(28):7074-80. doi: 10.1200/JCO.2005.06.032.
Treatment access underlies quality cancer care. We hypothesize that mastectomy rates in a rural state are independently influenced by distance to radiation therapy (XRT) and by changing XRT access through opening new facilities.
Early-stage breast cancer patients diagnosed from 1996 to 2000 were identified in the Virginia state registry. Distance from patient zip code to nearest XRT facility was calculated with geographical software. Distance to XRT facility (< or = 10, > 10 to 25, > 25 to 50, and > 50 miles), American Joint Committee on Cancer tumor stage, age, race, and diagnosis year were evaluated for influencing mastectomy rate. Mastectomy use within 15 miles of five new facilities was assessed before and after opening.
Among 20,094 patients, 43% underwent mastectomy, 53% underwent lumpectomy, and therapy of 4% of patients is unknown. Twenty-nine percent of patients lived more than 10 miles from XRT facility. Mastectomy increased with distance to XRT facility (43% at < or = 10 miles, 47% at > 10 to 25 miles, 53% at > 25 to 50 miles, and 58% at > 50 miles; P < .001). Among 11,597 patients with T1 (< 2 cm) tumors, mastectomy also varied by distance (31% at < or = 10 miles, 36% at > 10 to 25 miles, 41% at > 25 to 50 miles, and 49% at > 50 miles; P < .001). In multivariate analysis, mastectomy use was independently influenced by XRT distance after adjusting for age, race, T stage, and diagnosis year. Over the study period, mastectomy rates declined from 48% to 43% across Virginia, and there were similar declines in a 15-mile area around four new radiation facilities in urban settings. However, mastectomies decreased from 61% to 45% around a new XRT facility in a rural setting.
Distance to XRT facility significantly impacts mastectomy use. Opportunities for increasing breast-conservation rates through improved XRT access exist.
获得治疗是优质癌症护理的基础。我们假设，在一个乡村州，乳房切除术的比例受到与放射治疗（XRT）机构的距离以及通过开设新机构改变XRT可及性的独立影响。
从弗吉尼亚州登记处确定1996年至2000年诊断出的早期乳腺癌患者。使用地理软件计算患者邮政编码到最近XRT机构的距离。评估到XRT机构的距离（≤10英里、>10至25英里、>25至50英里以及>50英里）、美国癌症联合委员会肿瘤分期、年龄、种族和诊断年份对乳房切除术比例的影响。评估了五家新机构开业前后15英里范围内乳房切除术的使用情况。
在20094例患者中，43%接受了乳房切除术，53%接受了乳房肿瘤切除术，4%患者的治疗情况未知。29%的患者居住在距离XRT机构超过10英里的地方。乳房切除术比例随与XRT机构距离的增加而上升（≤10英里时为43%，>10至25英里时为47%，>25至50英里时为53%，>50英里时为58%；P<.001）。在11597例患有T1（<2 cm）肿瘤的患者中，乳房切除术比例也因距离而异（≤10英里时为31%，>10至25英里时为36%，>25至50英里时为41%，>50英里时为49%；P<.001）。在多变量分析中，在对年龄、种族、T分期和诊断年份进行调整后，乳房切除术的使用受到XRT距离的独立影响。在研究期间，整个弗吉尼亚州的乳房切除术比例从48%降至43%，城市地区四家新放射机构周围15英里范围内也有类似下降。然而，在乡村地区一家新的XRT机构周围，乳房切除术比例从61%降至45%。
到XRT机构的距离对乳房切除术的使用有显著影响。通过改善XRT可及性来提高保乳率存在机会。
