Department of Internal Medicine, Division of Oncology, Duke University Medical Center, Durham, North Carolina.
J Am Geriatr Soc. 2014 Mar;62(3):482-8. doi: 10.1111/jgs.12687. Epub 2014 Feb 10.
To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer.
Cross-sectional.
National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries.
Individuals with stage 0-III breast cancer.
Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment.
The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥ 50) and black race were associated with less guideline concordance, regardless of comorbidity level.
When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.
探讨合并症的水平和类型与早期乳腺癌规范治疗之间的关系。
横断面研究。
国家癌症登记计划（NPCR）乳腺癌和前列腺癌治疗模式研究，该研究从 7 个癌症登记处重新提取了 2004 年的病历。
患有 0-III 期乳腺癌的个体。
根据共识指南，采用多组分肿瘤大小、淋巴结状态和激素受体状态模型来模拟综合指南一致的管理。使用成人合并症评估指数（ACE-27）测量合并症情况和严重程度。多变量逻辑回归模型确定与指南一致的治疗相关的因素，包括总体 ACE-27 评分和 26 个单独的 ACE 合并症类别、年龄、种族、分期和支付来源。
研究样本包括 6439 名女性（平均年龄 58.7 岁，范围 20-99 岁；76%为白人；44%无合并症；70%雌激素或孕激素受体阳性，或两者均阳性；31%人表皮生长因子受体 2 阳性）。60%的患者接受了规范治疗。根据总体合并症负担，规范治疗的一致性有所不同（无合并症者为 70%；轻度合并症者为 61%；中度合并症者为 58%；严重合并症者为 43%；P<0.05）。多变量分析显示，高血压的存在（比值比（OR）=1.15，95%置信区间（CI）=1.01-1.30）预测了规范治疗的一致性，而痴呆（OR=0.45，95%CI=0.24-0.82）则预测了缺乏规范治疗的一致性。无论合并症水平如何，年龄较大（≥50 岁）和黑种人种族与规范治疗的一致性降低有关。
在报告患有合并症的乳腺癌患者的生存结果时，应将遵循治疗指南作为协变量之一。
