Ramondetta Lois M, Sun Charlotte, Hollier Lisa, Jarrett Latasha, Folloder Jody, Tortolero-Luna Guillermo, Hughes Alycia, Jhingran Anuja, Brown Jubilee
Department of Obstetrics and Gynecology, The University of Texas Lyndon Baines Johnson General Hospital, Houston, TX 77230, USA.
Gynecol Oncol. 2006 Nov;103(2):547-53. doi: 10.1016/j.ygyno.2006.03.054. Epub 2006 May 30.
To document obstacles to completing outpatient treatment faced by indigent patients with cervical cancer and compare treatment costs.
A retrospective pilot case series study assessed all indigent Harris County residents referred from Lyndon Baines Johnson Hospital (LBJ) to The University of Texas M. D. Anderson Cancer Center (M. D. Anderson) for advanced cervical cancer treatment between February 2001 and April 2004. Twenty-seven patients required hospital admission during the expected course of outpatient treatment and were identified as the study group. Nine patients, drawn from the same cohort but able to successfully complete the expected course of treatment as outpatients, were selected as the control group.
The median total treatment costs per patient in the study group (n = 27) was 28,892 US dollar more than the median treatment costs for the patients in the control group (n = 9) (P = 0.01). Median number of inpatient days in the study group was 19.6. Social factors identified as significantly different between the study and control groups included transportation difficulties (P = 0.006) and lack of social support (P = 0.08). Additional factors identified in the study group may have social significance such as accessible local housing (11% vs. 0%, P = 0.56) and noncompliance with treatment (37% vs. 11%, P = 0.22).
A combination of the lack of adequate methods of transportation and social support may contribute to the high cost of treating indigent patients with cervical cancer in Harris County, Texas.
记录贫困宫颈癌患者在完成门诊治疗时面临的障碍，并比较治疗费用。
一项回顾性试点病例系列研究评估了2001年2月至2004年4月期间从林登·贝恩斯·约翰逊医院（LBJ）转诊至德克萨斯大学MD安德森癌症中心（MD安德森）接受晚期宫颈癌治疗的所有哈里斯县贫困居民。27名患者在预期的门诊治疗过程中需要住院，并被确定为研究组。从同一队列中选取9名能够成功完成预期门诊治疗过程的患者作为对照组。
研究组（n = 27）每位患者的总治疗费用中位数比对照组（n = 9）患者的治疗费用中位数多28,892美元（P = 0.01）。研究组的住院天数中位数为19.6天。研究组和对照组之间被确定为有显著差异的社会因素包括交通困难（P = 0.006）和缺乏社会支持（P = 0.08）。研究组中确定的其他因素可能具有社会意义，如可获得当地住房（11%对0%，P = 0.56）和不遵守治疗（37%对11%，P = 0.22）。
缺乏足够的交通方式和社会支持可能共同导致德克萨斯州哈里斯县贫困宫颈癌患者的治疗费用高昂。
