Earle Craig C, Schrag Deborah, Neville Bridget A, Yabroff K Robin, Topor Marie, Fahey Angela, Trimble Edward L, Bodurka Diane C, Bristow Robert E, Carney Michael, Warren Joan L
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
J Natl Cancer Inst. 2006 Feb 1;98(3):172-80. doi: 10.1093/jnci/djj019.
For many diseases, specialized care (i.e., care rendered by a specialist) has been associated with superior-quality care (i.e., better outcomes). We examined associations between physician specialty and outcomes in a population-based cohort of elderly ovarian cancer surgery patients.
We analyzed the Medicare claims, by physician specialty, of all women aged 65 years or older who underwent surgery for pathologically confirmed invasive epithelial ovarian cancer between January 1, 1992, and December 31, 1999, while living in an area monitored by the Surveillance, Epidemiology, and End Results (SEER) program to assess important care processes (i.e., the appropriate extent of surgery and use of adjuvant chemotherapy) and outcomes (i.e., surgical complications, ostomy rates, and survival). All statistical tests were two-sided.
Among 3067 ovarian cancer patients who underwent surgery, 1017 patients (33%) were treated by a gynecologic oncologist, 1377 patients (45%) by a general gynecologist, and 673 patients (22%) by a general surgeon. Among patients with stage I or II disease, those treated by a gynecologic oncologist (60%) were more likely to undergo lymph node dissection than those treated by a general gynecologist (36%) or a general surgeon (16%). Patients with stage III or IV disease were more likely to undergo a debulking procedure if the initial surgery was performed by a gynecologic oncologist (58%) than by a general gynecologist (51%) or a general surgeon (40%; P < .001) and were more likely to receive postoperative chemotherapy when operated on by a gynecologic oncologist (79%) or a general gynecologist (76%) than by a general surgeon (62%, P < .001). Survival among patients operated on by gynecologic oncologists (hazard ratio [HR] of death from any cause = 0.85, 95% confidence interval [CI] = 0.76 to 0.95) or general gynecologists (HR = 0.86, 95% CI = 0.78 to 0.96) was better than that among patients operated on by general surgeons.
Ovarian cancer patients treated by gynecologic oncologists had marginally better outcomes than those treated by general gynecologists and clearly superior outcomes compared with patients treated by general surgeons.
对于许多疾病，专科护理（即由专科医生提供的护理）与优质护理（即更好的治疗结果）相关。我们在一个基于人群的老年卵巢癌手术患者队列中研究了医生专业与治疗结果之间的关联。
我们分析了1992年1月1日至1999年12月31日期间，居住在监测、流行病学和最终结果（SEER）项目监测区域内，所有65岁及以上经病理确诊为浸润性上皮性卵巢癌并接受手术的女性的医疗保险理赔记录，以评估重要的护理过程（即手术的适当范围和辅助化疗的使用）和治疗结果（即手术并发症、造口率和生存率）。所有统计检验均为双侧检验。
在3067例接受手术的卵巢癌患者中，1017例（33%）由妇科肿瘤学家治疗，1377例（45%）由普通妇科医生治疗，673例（22%）由普通外科医生治疗。在I期或II期疾病患者中，由妇科肿瘤学家治疗的患者（60%）比由普通妇科医生（36%）或普通外科医生（16%）治疗的患者更有可能接受淋巴结清扫。如果初次手术由妇科肿瘤学家进行（58%），III期或IV期疾病患者比由普通妇科医生（51%）或普通外科医生（40%；P <.001）进行更有可能接受减瘤手术，并且由妇科肿瘤学家（79%）或普通妇科医生（76%）进行手术时比由普通外科医生（62%，P <.001）进行更有可能接受术后化疗。由妇科肿瘤学家（任何原因导致死亡的风险比[HR] = 0.85，95%置信区间[CI] = 0.76至0.95）或普通妇科医生（HR = 0.86，95%CI = 0.78至0.96）进行手术的患者的生存率优于由普通外科医生进行手术的患者。
由妇科肿瘤学家治疗的卵巢癌患者的治疗结果略优于由普通妇科医生治疗的患者，与由普通外科医生治疗的患者相比明显更好。
