School of Public Health, University of Alberta, Alberta, Canada.
Clin Oncol (R Coll Radiol). 2012 Feb;24(1):e9-17. doi: 10.1016/j.clon.2011.07.005. Epub 2011 Jul 30.
Evidence suggests that pre- and/or postoperative treatment benefits patients with stage II/III rectal cancer. This study aimed to quantify treatment patterns and adherence to treatment guidelines, and to identify barriers to having a consultation with an oncologist and barriers to receiving treatment in stage II/III rectal cancer, in a publicly funded medical care system.
Patients with surgically treated stage II/III rectal adenocarcinoma, diagnosed from 2002 to 2005 in Alberta, a Canadian province with a population of 3 million, were included. Demographic and treatment information from the Alberta Cancer Registry were linked to data from electronic medical records, hospital discharge data and the 2001 Canadian Census. The study outcomes were 'not having an oncologist consultation' and 'not receiving guideline-based treatment'. The relative risks of the two outcomes in association with patient characteristics were estimated using multivariable log-binomial regression.
Of a total of 910 surgically treated stage II/III rectal adenocarcinoma patients, 748 (82%) had a consultation with an oncologist and 414 (45.5%) received treatment. Pre-/post-surgical treatment modalities and timing varied; 96 (10.5%) received neoadjuvant treatment only, 389 (42.7%) received adjuvant treatment only, 119 (13.1%) received both, and 306 (33.6%) had surgery alone. Factors related to not having a consultation with an oncologist included older age, co-morbidities, cancer stage II and region of residence. Older age was the most significantly associated factor with not receiving treatment (relative risk=2.23; 95% confidence interval: 1.89, 2.64).
Disparities exist in the receipt of treatment in stage II/III rectal cancer. Factors such as age, region of residence and stage should not be barriers to consulting an oncologist to discuss or receive treatment. The reasons for these disparities need to be identified and addressed.
有证据表明，II/III 期直肠癌患者的术前和/或术后治疗获益。本研究旨在量化治疗模式和对治疗指南的遵循情况，并确定在公共资助的医疗保健系统中，II/III 期直肠癌患者与肿瘤医生进行咨询以及接受治疗的障碍。
纳入了 2002 年至 2005 年在加拿大阿尔伯塔省诊断为 II/III 期直肠腺癌且接受手术治疗的患者。从阿尔伯塔癌症登记处获取人口统计学和治疗信息，并与电子病历、医院出院数据和 2001 年加拿大人口普查数据进行关联。研究结果为“未与肿瘤医生进行咨询”和“未接受基于指南的治疗”。使用多变量对数二项式回归估计这两个结果与患者特征的关联的相对风险。
总共 910 名接受手术治疗的 II/III 期直肠腺癌患者中，748 名（82%）与肿瘤医生进行了咨询，414 名（45.5%）接受了治疗。术前/术后治疗方式和时间有所不同；96 名（10.5%）仅接受新辅助治疗，389 名（42.7%）仅接受辅助治疗，119 名（13.1%）同时接受两种治疗，306 名（33.6%）仅接受手术治疗。未与肿瘤医生进行咨询的相关因素包括年龄较大、合并症、癌症分期为 II 期和居住地。年龄较大是与未接受治疗最显著相关的因素（相对风险=2.23；95%置信区间：1.89，2.64）。
在 II/III 期直肠癌的治疗中存在差异。年龄、居住地和癌症分期等因素不应成为与肿瘤医生咨询或接受治疗的障碍。需要确定和解决这些差异的原因。
