Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, 10 Stuart Street, Kingston, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2011 Feb;23(1):19-28. doi: 10.1016/j.clon.2010.08.027. Epub 2010 Sep 9.
We conducted a population-based study of practice patterns and outcome across the regional cancer centres providing care to patients with laryngeal cancer in the Province of Ontario, Canada.
: This was a retrospective cohort study of 1547 patients with cancers of the glottic or supraglottic larynx diagnosed between 1982 and 1995. Data were collected via chart review, including: patient and disease characteristics, treatment, waiting times and treatment volumes. Vital status was obtained from the Ontario Cancer Registry. Variations across the nine regional cancer centres are described and their effect on outcome explored. All analyses were stratified by stage I and II separately from stage III and IV.
Treatments differed across centres (P<0.0001); for instance, in the stage I and II group, use of a daily dose of >2.54Gy varied from 0 to 87.6% and in the stage III and IV group, total laryngectomy rates varied from a low of 6% to a high of 53%. The percentage of patients waiting more than 6 weeks from diagnosis to first treatment varied from 17 to 49% (P<0.0001). Multivariate analysis revealed cause-specific survival differences that were not explained by control for case mix, treatment or waiting times. Differences ranged from an 82% risk reduction in one centre compared with the reference (stage I and II group, P=0.008) to a 153% increase in risk (stage III and IV group, P=0.02). Centre case volumes were not associated with cause-specific survival.
This study quantifies the degree of variation that can occur in the treatment and outcome of people with cancer. We cannot properly assess whether care delivery is of high quality until we have a better understanding of the factors that drive such variations.
我们对加拿大安大略省提供喉癌治疗的九个区域癌症中心进行了一项基于人群的实践模式和结果研究。
这是一项回顾性队列研究，纳入了 1982 年至 1995 年间诊断为声门或声门上型喉癌的 1547 例患者。通过病历回顾收集数据，包括：患者和疾病特征、治疗方法、等待时间和治疗量。通过安大略癌症登记处获取患者的生存状态。描述了九个区域癌症中心之间的差异，并探讨了其对结果的影响。所有分析均按 I 期和 II 期以及 III 期和 IV 期分别分层。
各中心的治疗方法不同（P<0.0001）；例如，在 I 期和 II 期组中，每日剂量>2.54Gy 的使用率从 0 到 87.6%不等，而在 III 期和 IV 期组中，全喉切除术的比例从低的 6%到高的 53%不等。从诊断到首次治疗的等待时间超过 6 周的患者比例从 17%到 49%不等（P<0.0001）。多变量分析显示，特异性生存差异不能用病例组合、治疗或等待时间的控制来解释。差异范围从一个中心的 82%风险降低（与参考中心相比，I 期和 II 期组，P=0.008）到风险增加 153%（III 期和 IV 期组，P=0.02）。中心的病例量与特异性生存无关。
本研究量化了癌症患者治疗和结果中可能出现的变化程度。在我们更好地了解驱动这种变化的因素之前，我们无法正确评估护理的提供是否具有高质量。
