Department of Medicine, and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, School of Public Health, Columbia University Medical Center, 722 W 168th Street, New York, NY 10032, USA.
Breast J. 2012 May-Jun;18(3):203-13. doi: 10.1111/j.1524-4741.2012.01240.x. Epub 2012 Apr 5.
In oncology, quality of care is a major issue for patients and providers. Significant variations in care, including nonreceipt of adjuvant systemic therapy, nonadherence to therapy, and/or early discontinuation of therapy, occur frequently and may impact survival. Reasons for these variations are not well understood, but may play a role in the prominent disparity in breast cancer survival between blacks and whites. Since May 2006, the Breast Cancer Quality of Care Study (BQUAL) has recruited 1158 women with nonmetastatic breast cancer from several centers across the country, with completed data on 1057 participants to date. Detailed information on demographic, behavioral, biomedical, and emotional factors related to chemotherapy use was collected on each participant at baseline and at two follow-up interviews during the first 6 months. In addition, for women with ER+ tumors, further questionnaires were completed every 6 months regarding hormonal therapy use. Each participant was also asked to provide a DNA sample, and to allow medical record review. We surveyed physicians providing care to the study participants regarding attitudes toward adjuvant treatment. The mean age of participants was 58 years (SD 11.6), and 15% (n = 160) were black. The majority had an annual household income <$90,000 (n = 683), had college education or higher (n = 802), 55.9% were married, and 57.9% were not currently employed. Seventy-six percent had hormone-receptor-positive tumors, 49.9% initiated chemotherapy and 82.7% started hormonal therapy. Blacks were more likely to have lower annual household income (p < 0001), less education (p = 0.0005), ER negative tumor status (p = 0.02), and poorly differentiated cancer (p = 0.0002). The main endpoints of the study are noninitiation of chemotherapy or hormonal therapy, nonadherence to therapy and early discontinuation of therapy. Treatment and outcomes will be compared on the 15% of participants who are black versus other participants. The BQUAL Study will be a rich ongoing source of information regarding reasons for differences in receipt of both adjuvant chemotherapy and hormonal therapy. This information may be useful in planning interventions to improve quality of care.
在肿瘤学领域，医疗质量是患者和医疗服务提供者的一个主要问题。在护理中经常出现显著的差异，包括未接受辅助系统治疗、不遵守治疗方案和/或过早停止治疗，这些差异可能会影响生存。这些差异的原因尚不清楚，但可能在黑人和白人之间乳腺癌存活率的显著差异中起作用。自 2006 年 5 月以来，乳腺癌护理质量研究（BQUAL）从全国多个中心招募了 1158 名患有非转移性乳腺癌的女性，迄今为止，已有 1057 名参与者完成了数据。在基线和首次 6 个月的两次随访访谈中，详细收集了与化疗使用相关的人口统计学、行为学、生物医学和情感因素的信息。此外，对于雌激素受体阳性肿瘤的女性，每 6 个月完成进一步的问卷调查，了解激素治疗的使用情况。每位参与者还被要求提供 DNA 样本，并允许查阅病历。我们调查了为研究参与者提供护理的医生对辅助治疗的态度。参与者的平均年龄为 58 岁（标准差 11.6），15%（n=160）为黑人。大多数人年收入<90000 美元（n=683），接受过大学教育或更高学历（n=802），55.9%已婚，57.9%未就业。76%的患者肿瘤具有激素受体阳性，49.9%开始化疗，82.7%开始激素治疗。黑人更有可能年收入较低（p<0.0001）、受教育程度较低（p=0.0005）、雌激素受体阴性肿瘤状态（p=0.02）和分化不良的癌症（p=0.0002）。该研究的主要终点是非化疗或激素治疗的起始、治疗不依从和治疗过早终止。将比较黑人参与者和其他参与者在化疗和激素治疗方面的差异。BQUAL 研究将是一个关于接受辅助化疗和激素治疗差异的原因的丰富的持续信息来源。这些信息可能有助于计划改善护理质量的干预措施。
