Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
BMC Health Serv Res. 2009 Dec 15;9:231. doi: 10.1186/1472-6963-9-231.
Previous evidence indicates potential variation in the quality of care of cancer patients. We aimed to examine whether recent changes in the treatment of oesophagogastric cancers have been distributed equally among different patient subgroups.
We analysed population-based cancer registry data about the treatment patterning of oesophagogastric cancer (other than oesophageal squamous cell carcinoma) during 1995-2006.
There were 14,077 patients aged > or =40 years (69% men). There was only limited information on stage, and no information on co-morbidity status. During successive triennia, curative surgery use decreased from 28% to 20% (p < 0.001) whilst chemotherapy use increased from 9% to 30% (p < 0.001). Use of palliative surgery and of radiotherapy increased significantly but modestly (7% to 10%, and 9% to 11%, respectively). In multivariable logistic regression adjusting for age group, gender, diagnosis period and tumour type, curative surgery and chemotherapy were used less frequently in more deprived patients [per increasing deprivation group Odds Ratio (OR) = 0.96, 95% Confidence Interval (CI) 0.93-0.99, and OR = 0.90, 95%CI 0.87-0.93, respectively, p < 0.001 for both)]. Chemotherapy was also used less frequently in women (OR = 0.76, p < 0.001).
During the study period, curative surgery decreased by a third and chemotherapy use increased by more than three-fold, reflecting improvements in the appropriateness and quality of management, but chemotherapy use, in particular, was unequal, both by socioeconomic status and gender.
以往的证据表明，癌症患者的护理质量可能存在差异。我们旨在研究在过去 15 年间，胃食管癌症（不包括食管鳞状细胞癌）的治疗模式是否在不同的患者亚组中得到了平等的分布。
我们分析了 1995 年至 2006 年期间人群癌症登记处关于胃食管癌症（不包括食管鳞状细胞癌）治疗模式的数据。
共有 14077 名年龄≥40 岁的患者（69%为男性）。仅有有限的关于分期的信息，没有关于合并症状态的信息。在连续的三个三年期内，根治性手术的使用率从 28%下降到 20%（p<0.001），而化疗的使用率从 9%增加到 30%（p<0.001）。姑息性手术和放疗的使用率显著增加，但幅度较小（分别从 7%增加到 10%，从 9%增加到 11%）。在多变量逻辑回归中，根据年龄组、性别、诊断期和肿瘤类型进行调整后，在更贫困的患者中，根治性手术和化疗的使用率较低[每个递增的贫困组比值比（OR）分别为 0.96（95%置信区间（CI）为 0.93-0.99）和 0.90（95%CI 为 0.87-0.93），均<0.001]。化疗在女性中的使用率也较低（OR=0.76，p<0.001）。
在研究期间，根治性手术减少了三分之一，化疗的使用率增加了三倍以上，这反映了治疗的适当性和质量的提高，但特别是化疗的使用率存在不平等，既存在于社会经济地位方面，也存在于性别方面。
