Johns Hopkins School of Medicine, 624 N. Broadway, Room 657, Baltimore, MD 21205, USA.
J Clin Oncol. 2013 Mar 20;31(9):1140-8. doi: 10.1200/JCO.2012.43.0272. Epub 2013 Feb 11.
Building on previous research documenting differences in preventive care quality between cancer survivors and noncancer controls, this study examines comorbid condition care.
Using data from the Surveillance, Epidemiology, and End Results (SEER) -Medicare database, we examined comorbid condition quality of care in patients with locoregional breast, prostate, or colorectal cancer diagnosed in 2004 who were age ≥ 66 years at diagnosis, who had survived ≥ 3 years, and who were enrolled in fee-for-service Medicare. Controls were frequency matched to cases on age, sex, race, and region. Quality of care was assessed from day 366 through day 1,095 postdiagnosis using published indicators of chronic (n = 10) and acute (n = 19) condition care. The proportion of eligible cancer survivors and controls who received recommended care was compared by using Fisher's exact tests. The chronic and acute indicators, respectively, were then combined into single logistic regression models for each cancer type to compare survivors' care receipt to that of controls, adjusting for clinical and sociodemographic variables and controlling for within-patient variation.
The sample matched 8,661 cancer survivors to 17,322 controls (mean age, 75 years; 65% male; 85% white). Colorectal cancer survivors were less likely than controls to receive appropriate care on both the chronic (odds ratio [OR], 0.88; 95% CI, 0.81 to 0.95) and acute (OR, 0.72; 95% CI, 0.61 to 0.85) indicators. Prostate cancer survivors were more likely to receive appropriate chronic care (OR, 1.28; 95% CI, 1.19 to 1.38) but less likely to receive quality acute care (OR, 0.75; 95% CI, 0.65 to 0.87). Breast cancer survivors received care equivalent to controls on both the chronic (OR, 1.06; 95% CI, 0.96 to 1.17) and acute (OR, 0.92; 95% CI, 0.76 to 1.13) indicators.
Because we found differences by cancer type, research exploring factors associated with these differences in care quality is needed.
基于先前研究记录癌症幸存者和非癌症对照之间在预防保健质量方面的差异，本研究检查了合并症的护理情况。
利用来自监测、流行病学和最终结果（SEER）-医疗保险数据库的数据，我们检查了 2004 年诊断为局部区域乳腺癌、前列腺癌或结直肠癌且诊断时年龄≥66 岁、存活≥3 年且参加按服务收费医疗保险的患者的合并症护理质量。对照与病例按年龄、性别、种族和地区进行频数匹配。使用已发表的慢性（n=10）和急性（n=19）疾病护理指标，在诊断后第 366 天至第 1095 天评估护理质量。采用 Fisher 确切检验比较符合条件的癌症幸存者和对照者接受推荐护理的比例。然后，将慢性和急性指标分别纳入每个癌症类型的单一逻辑回归模型，以比较幸存者的护理接受情况与对照者的护理接受情况，同时调整临床和社会人口统计学变量，并控制患者内变异。
该样本匹配了 8661 例癌症幸存者和 17322 例对照者（平均年龄 75 岁；65%为男性；85%为白人）。结直肠癌幸存者在慢性（比值比 [OR]，0.88；95%置信区间 [CI]，0.81 至 0.95）和急性（OR，0.72；95% CI，0.61 至 0.85）指标上接受适当护理的可能性均低于对照者。前列腺癌幸存者更有可能接受适当的慢性护理（OR，1.28；95% CI，1.19 至 1.38），但接受高质量急性护理的可能性较小（OR，0.75；95% CI，0.65 至 0.87）。乳腺癌幸存者在慢性（OR，1.06；95% CI，0.96 至 1.17）和急性（OR，0.92；95% CI，0.76 至 1.13）指标上接受的护理与对照者相当。
由于我们发现了不同癌症类型之间的差异，因此需要研究探索与这些护理质量差异相关的因素。
