Health Services Research Department, American Cancer Society, National Home Office, Atlanta, GA, USA.
J Am Coll Surg. 2011 Nov;213(5):633-43. doi: 10.1016/j.jamcollsurg.2011.07.014. Epub 2011 Sep 8.
Black patients are less likely to undergo surgery for early-stage non-small cell lung cancer (NSCLC) compared with white patients, and are more likely to undergo resection at low-volume hospitals. However, little is known about the relationship between hospital safety-net burden and the likelihood of curative-intent surgery for black and white patients. This study analyzes whether hospital safety-net burden is associated with curative-intent surgery among adult early-stage NSCLC patients treated at facilities accredited by the American College of Surgeons Commission on Cancer.
Adult patients diagnosed with invasive initial primary early-stage (TNM I-II) NSCLC during 2003-2005 were obtained from the National Cancer Data Base. Curative-intent surgery included anatomic resection, wedge resection, and segmentectomy. Hospital safety-net burden was defined as the percent of cancer patients per facility that were Medicaid-insured or uninsured. Generalized estimating equations and linear mixed models were used to control for clustering by facility.
Of 52,853 evaluable patients, those treated at high safety-net burden facilities were significantly less likely (unadjusted p < 0.0001) to undergo curative-intent surgery than patients treated at low safety-net burden facilities. Controlling for patient and other facility characteristics, high safety-net burden remained significantly associated (p < 0.0001) with reduced likelihood of curative-intent surgery overall (odds ratio = 0.69; 95% CI, 0.62-0.77) and in black- and white-only models (odds ratio = 0.59, 95% CI, 0.48-0.73; odds ratio = 0.71; 95% CI, 0.63-0.80, respectively).
Both black and white adult patients treated for early-stage NSCLC at high safety-net burden facilities are less likely to undergo curative-intent surgery than those treated at low safety-net burden facilities. Innovative solutions are needed to ensure quality cancer care at high safety-net burden facilities.
与白人患者相比，黑人患者接受早期非小细胞肺癌（NSCLC）手术的可能性较低，并且更有可能在低容量医院进行切除术。然而，对于医院安全网负担与黑人和白人患者接受治愈性手术的可能性之间的关系，知之甚少。本研究分析了在接受美国外科医师学院癌症委员会认证的医疗机构治疗的成人早期 NSCLC 患者中，医院安全网负担是否与治愈性手术相关。
从国家癌症数据库中获取了 2003 年至 2005 年间诊断为侵袭性初始原发性早期（TNM I-II）NSCLC 的成年患者。治愈性手术包括解剖性切除术、楔形切除术和节段切除术。医院安全网负担定义为每所医疗机构中接受医疗补助保险或无保险的癌症患者的百分比。使用广义估计方程和线性混合模型来控制设施聚类。
在 52853 例可评估患者中，与低安全网负担设施相比，在高安全网负担设施接受治疗的患者进行治愈性手术的可能性明显较低（未调整的 p <0.0001）。在控制患者和其他设施特征后，高安全网负担与总体上降低治愈性手术的可能性仍显著相关（比值比=0.69；95%置信区间，0.62-0.77），并且在黑人患者和白人患者的模型中也是如此（比值比=0.59，95%置信区间，0.48-0.73；比值比=0.71；95%置信区间，0.63-0.80）。
在高安全网负担设施接受治疗的黑人和白人成年早期 NSCLC 患者接受治愈性手术的可能性均低于在低安全网负担设施接受治疗的患者。需要创新的解决方案来确保高安全网负担设施提供高质量的癌症护理。
