Anger Jennifer T, Maliski Sally L, Krupski Tracey L, Kwan Lorna, Gore John L, Fink Arlene, Connor Sarah E, Orecklin James R, Litwin Mark S
Department of Urology, David Geffen School of Medicine and School of Public Health, Los Angeles, CA, USA.
Public Health Rep. 2007 Mar-Apr;122(2):217-23. doi: 10.1177/003335490712200211.
To improve access to prostate cancer treatment for low income uninsured men, California initiated a program called
Improving Access, Counseling and Treatment for Californians with Prostate Cancer. The program administered free treatment, case management, counseling, and educational materials to all eligible men until budget cuts led to a state-mandated suspension of enrollment and the establishment of a temporary waitlist in February 2005. To assess the effect of suspension of enrollment on patient outcomes, the authors compared health-related quality of life (HRQOL) in waitlisted and enrolled men.
Eighty-three men in each group were matched on disease stage, age, and race. HRQOL was captured with the UCLA Prostate Cancer Index short form (PCI-SF), the Medical Outcomes Study Short Form-12 (SF-12), and McCorkle and Young's Symptoms and Degrees of Distress in Patients with Cancer Scale (SDS). Self-efficacy was measured with the Perceived Efficacy in Patient-Physician Interactions (PEPPI) Questionnaire.
At intake, waitlisted men demonstrated significantly more symptom-related distress (2.9; p=0.04) and less perceived self-efficacy (2.5; p=0.005) compared to enrollees. Waitlisted men were significantly less likely to have access to a doctor or nurse case manager, treatment medications, nutrition information, or counseling services (p<0.0001).
Men denied enrollment into the IMPACT program exhibited significantly worse symptom distress and self-efficacy compared to enrolled men at initial assessment. The multivariate model suggests that HRQOL in the waitlisted men may be related to their lack of access to medical services. This data illustrates the importance of ongoing public assistance for low income men with prostate cancer.
为了改善低收入未参保男性获得前列腺癌治疗的机会，加利福尼亚州启动了一项名为“IMPACT：改善加利福尼亚州前列腺癌患者的就医机会、咨询与治疗”的项目。该项目为所有符合条件的男性提供免费治疗、病例管理、咨询及教育材料，直至2005年2月预算削减导致该州强制暂停登记并设立临时等候名单。为评估暂停登记对患者结局的影响，作者比较了等候名单上的男性和已登记男性的健康相关生活质量（HRQOL）。
每组83名男性在疾病分期、年龄和种族方面进行匹配。使用加州大学洛杉矶分校前列腺癌指数简表（PCI-SF）、医学结局研究简表-12（SF-12）以及麦科克尔和扬的癌症患者症状与痛苦程度量表（SDS）来获取HRQOL。使用患者-医生互动中的感知效能（PEPPI）问卷来测量自我效能感。
在入组时，与已登记男性相比，等候名单上的男性表现出明显更多的症状相关痛苦（2.9；p = 0.04）和更低的自我效能感（2.5；p = 0.005）。等候名单上的男性获得医生或护士病例管理员、治疗药物、营养信息或咨询服务的可能性显著更低（p < 0.0001）。
在初始评估时，被拒绝纳入IMPACT项目的男性与已登记男性相比，表现出明显更差的症状痛苦和自我效能感。多变量模型表明，等候名单上男性的HRQOL可能与其无法获得医疗服务有关。这些数据说明了持续的公共援助对低收入前列腺癌男性的重要性。
