国家健康基金政策对牙买加前列腺癌激素治疗的影响。

Impact of the National Health Fund policy on hormone treatment for prostate cancer in Jamaica.

机构信息

Department of Surgery, University of the West Indies, Kingston, Jamaica.

出版信息

Rev Panam Salud Publica. 2011 Jun;29(6):404-8. doi: 10.1590/s1020-49892011000600004.

DOI:10.1590/s1020-49892011000600004

PMID:21829963

Abstract

OBJECTIVE

To compare the proportion of patients choosing surgical versus medical castration to treat prostate cancer, before and after the National Health Fund (NHF) of Jamaica began to subsidize hormone therapy.

METHODS

A retrospective review was performed at the University Hospital of the West Indies (UHWI), Jamaica. The pathology database at UHWI was searched to identify patients who had prostate biopsies between January 2000 and December 2007. These were combined with records of biopsies at external institutions. Medical records of all patients with positive prostate biopsies were reviewed to determine if they had received androgen deprivation therapy (ADT). Patients were classified as having had surgical castration (bilateral orchiectomy) or medical castration. Chi-square statistics were used to determine the difference in proportions between those choosing medical versus surgical castration before and after March 2005, when the NHF began offering subsidies for ADT drugs.

RESULTS

Of the 1,529 prostate biopsies performed during the study period, 680 (44.0%) cases of prostate cancer were diagnosed. Of these, 458 patients underwent ADT and had complete records available for analysis. The mean patient age was 72 years. During the entire study period, surgical castration was performed in 265 patients (58.0%) and medical castration in 193 (42.0%). A greater proportion of orchiectomies were performed before March 2005, rather than after (P < 0.001). Estrogens were the most common method of medical castration used before the NHF subsidy became available (62.0%); while luteinizing hormone-releasing hormone analogues (38.0%) and antiandrogens (36.5%) were most often chosen afterwards.

CONCLUSIONS

Surgical castration was more common than medical castration before March 2005. After the NHF began to subsidize the cost of drugs for hormone therapy, medical castration was chosen more often. Increased access to drugs for hormone therapy has changed treatment patterns in Jamaica.

摘要

目的

比较在牙买加国家健康基金（NHF）开始补贴激素治疗之前和之后，选择手术去势或药物去势治疗前列腺癌的患者比例。

方法

在牙买加西印度群岛大学医院（UHWI）进行了回顾性研究。在 UHWI 的病理数据库中搜索了 2000 年 1 月至 2007 年 12 月之间进行前列腺活检的患者。这些患者与外部机构的活检记录相结合。回顾所有前列腺活检阳性患者的病历，以确定他们是否接受了雄激素剥夺疗法（ADT）。将患者分为接受手术去势（双侧睾丸切除术）或药物去势的患者。使用卡方检验来确定在 2005 年 3 月 NHF 开始提供 ADT 药物补贴之前和之后，选择药物去势与手术去势的患者比例之间的差异。

结果

在研究期间进行的 1529 次前列腺活检中，诊断出 680 例（44.0%）前列腺癌病例。其中，458 名患者接受了 ADT，并且有完整的记录可供分析。患者的平均年龄为 72 岁。在整个研究期间，265 名患者（58.0%）接受了手术去势，193 名患者（42.0%）接受了药物去势。在 2005 年 3 月之前进行的睾丸切除术比例大于之后（P<0.001）。在 NHF 补贴可用之前，雌激素是最常用的药物去势方法（62.0%）；而在 NHF 补贴可用之后，黄体生成素释放激素类似物（38.0%）和抗雄激素（36.5%）则是最常选择的方法。