Yoon Jean, Malin Jennifer L, Tisnado Diana M, Tao May Lin, Adams John L, Timmer Martha J, Ganz Patricia A, Kahn Katherine L
School of Public Health, Health Services Department, University of California at Los Angeles, Los Angeles, CA 90095-1772, USA.
Breast Cancer Res Treat. 2008 Mar;108(1):69-77. doi: 10.1007/s10549-007-9580-1. Epub 2007 Jul 19.
With improved patient survival from breast cancer, more interest has evolved regarding the symptoms women experience in association with breast cancer treatments. We studied the extent to which symptoms for women with incident breast cancer are addressed by their physicians and how symptom management varies with patient characteristics.
As part of the Los Angeles Women's (LAW) Study, we categorized women from a population-based study of incident breast cancer (n = 1,219) as having an unmet need if she had at least one severe symptom (any of the following: nausea/vomiting, arm problems, hot flashes, vaginal dryness, difficulty sleeping) for which she did not receive the help she wanted. Multivariable analyses predicted having any unmet need as a function of patient demographic and health characteristics.
The prevalence of unmet need varied by the type of symptom with the highest proportion of women receiving help for nausea and vomiting (0.91) and the lowest for vaginal dryness (0.48). Black women (OR = 3.61, 95% CI: [1.57, 8.31]), and Spanish-speaking Hispanic women (OR = 2.69, 95% CI: [1.22, 5.94]) were significantly more likely than white women to report an unmet need. More black and Hispanic women compared to white women cited the doctor not thinking treatment would benefit her (P = 0.02), not appreciating how much the problem bothered her (P = 0.03), not knowing about treatments (P < 0.0001), or insurance/cost barriers (P = 0.009) as reasons for her unmet need.
These results show the persistence of racial disparities in the receipt of appropriate care within the health care system.
随着乳腺癌患者生存率的提高，人们对女性在乳腺癌治疗过程中所经历的症状越来越感兴趣。我们研究了初诊乳腺癌女性的症状在多大程度上得到医生的关注，以及症状管理如何随患者特征而变化。
作为洛杉矶女性（LAW）研究的一部分，我们将一项基于人群的初诊乳腺癌研究（n = 1219）中的女性进行分类，如果她至少有一种严重症状（以下任何一种：恶心/呕吐、手臂问题、潮热、阴道干燥、睡眠困难）且未得到她想要的帮助，就将其归类为有未满足的需求。多变量分析预测了有任何未满足需求与患者人口统计学和健康特征之间的关系。
未满足需求的患病率因症状类型而异，接受恶心和呕吐帮助的女性比例最高（0.91），阴道干燥的比例最低（0.48）。黑人女性（OR = 3.61，95% CI：[1.57, 8.31]）和说西班牙语的西班牙裔女性（OR = 2.69，95% CI：[1.22, 5.94]）比白人女性更有可能报告未满足的需求。与白人女性相比，更多的黑人和西班牙裔女性提到医生认为治疗对她没有益处（P = 0.02）、不理解问题对她的困扰程度（P = 0.03）、不了解治疗方法（P < 0.0001）或保险/费用障碍（P = 0.009）是其未满足需求的原因。
这些结果表明，在医疗保健系统中接受适当护理方面，种族差异依然存在。
