Moores Comprehensive Cancer Center, University of California, La Jolla, CA, USA.
Cancer. 2010 Mar 1;116(5):1378-84. doi: 10.1002/cncr.24856.
The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program.
This was a cohort study of 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT). Multinomial regression was used to compare types of treatments patients received from different providers.
Between 2001 and 2006, 315 (56%) participants received treatment from county hospitals and 244 (44%) from private providers. There were no significant between-group differences with respect to age (P = .22), enrollment year (P = .49), Charlson comorbidity index (P = .47), Gleason sum (P = .33), clinical T stage (P = .36), prostate-specific antigen (P = .39), or D'Amico risk criteria (P = .45). Participants treated by private providers were more likely than those treated in county hospitals to be white (35% vs 10%, P < .01) and less likely to undergo surgery (29% vs 54%, P < .01). Multinomial regression analyses showed that participants treated by private providers were nearly 2(1/2) times more likely than those treated by public providers to receive radiotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.37-4.07) and >4(1/2) times more likely to receive primary androgen deprivation (OR, 4.71; 95% CI, 2.15-10.36) than surgery.
In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers. These data reveal substantial variations in treatment patterns between different types of healthcare institutions that-given the implications for health policy and quality of care-merit further scrutiny.
作者比较了前列腺癌患者在州县医院和私人医疗机构接受的治疗类型，这是全州公共援助计划的一部分。
这是一项对 559 名参加加利福尼亚州前列腺癌患者改善获得途径、咨询和治疗计划（IMPACT）的低收入患者州资助计划的队列研究。使用多项逻辑回归比较患者从不同提供者处接受的治疗类型。
2001 年至 2006 年，315 名（56%）参与者在州县医院接受治疗，244 名（44%）在私人提供者处接受治疗。两组在年龄（P=0.22）、登记年份（P=0.49）、Charlson 合并症指数（P=0.47）、Gleason 总和（P=0.33）、临床 T 分期（P=0.36）、前列腺特异性抗原（P=0.39）或 D'Amico 风险标准（P=0.45）方面没有显著差异。与在州县医院接受治疗的患者相比，私人提供者治疗的患者更有可能是白人（35%比 10%，P<0.01），而不太可能接受手术（29%比 54%，P<0.01）。多项逻辑回归分析显示，与公共提供者治疗的患者相比，私人提供者治疗的患者接受放疗的可能性几乎高出 2 倍（优势比[OR]，2.36；95%置信区间[CI]，1.37-4.07），接受主要雄激素剥夺的可能性高出 4 倍以上（OR，4.71；95%CI，2.15-10.36）。
在这个经济处于不利地位的队列中，州县医院和私人医疗机构之间的前列腺癌治疗方法存在显著差异。这些数据揭示了不同类型医疗机构之间治疗模式的显著差异，考虑到对卫生政策和护理质量的影响，值得进一步审查。
