Veenstra Christine M, Epstein Andrew J, Liao Kaijun, Griggs Jennifer J, Pollack Craig E, Armstrong Katrina
University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA.
J Oncol Pract. 2015 May;11(3):e304-12. doi: 10.1200/JOP.2014.003137. Epub 2015 Apr 21.
The relationship between oncologic hospital academic status and the value of care for stage II and III colon cancer is unknown.
Retrospective SEER-Medicare analysis of patients age ≥ 66 years with stage II or III colon cancer and seen by medical oncology. Eligible patients were diagnosed 2000 to 2009 and followed through December 31, 2010. Hospitals reporting a major medical school affiliation in the NCI Hospital File were classified as academic medical centers. The association between hospital academic status and survival was assessed using Kaplan-Meier curves and Cox proportional hazards models. The association with mean cost of care was estimated using generalized linear models with log link and gamma family and with cost of care at various quantiles using quantile regression models.
Of 24,563 eligible patients, 5,707 (23%) received care from academic hospitals. There were no significant differences in unadjusted disease-specific median survival or adjusted risk of colon cancer death by hospital academic status (stage II hazard ratio = 1.12; 95% CI, 0.98 to 1.28; P = .103; stage III hazard ratio = 0.99; 95% CI, 0.90 to 1.08; P = .763). Excepting patients at the upper limits of the cost distribution, there was no significant difference in adjusted cost by hospital academic status.
We found no survival differences for elderly patients with stage II or III colon cancer, treated by a medical oncologist, between academic and nonacademic hospitals. Furthermore, cost of care was similar across virtually the full range of the cost distribution.
肿瘤医院学术地位与II期和III期结肠癌治疗价值之间的关系尚不清楚。
对年龄≥66岁的II期或III期结肠癌且接受肿瘤内科治疗的患者进行回顾性SEER - 医疗保险分析。符合条件的患者于2000年至2009年被诊断，并随访至2010年12月31日。在NCI医院档案中报告隶属于主要医学院的医院被归类为学术医疗中心。使用Kaplan - Meier曲线和Cox比例风险模型评估医院学术地位与生存率之间的关联。使用对数链接和伽马族的广义线性模型估计与平均护理成本的关联，并使用分位数回归模型估计不同分位数下的护理成本。
在24,563名符合条件的患者中，5,707名（23%）在学术医院接受治疗。按医院学术地位划分，未经调整的疾病特异性中位生存期或调整后的结肠癌死亡风险无显著差异（II期风险比 = 1.12；95%可信区间，0.98至1.28；P = 0.103；III期风险比 = 0.99；95%可信区间，0.90至1.08；P = 0.763）。除成本分布上限的患者外，按医院学术地位划分的调整后成本无显著差异。
我们发现，对于接受肿瘤内科治疗的II期或III期结肠癌老年患者，学术医院和非学术医院之间在生存率上没有差异。此外，几乎在整个成本分布范围内，护理成本相似。
