Millas Stefanos G, Alawadi Zeinab M, Wray Curtis J, Silberfein Eric J, Escamilla Richard J, Karanjawala Burzeen E, Ko Tien C, Kao Lillian S
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
J Surg Res. 2015 Oct;198(2):311-6. doi: 10.1016/j.jss.2015.03.078. Epub 2015 Apr 1.
Disparities in colon cancer survival have been reported to result from advanced stage at diagnosis and delayed therapy. We hypothesized that delays in treatment among medically underserved patients occur as a result of system-level barriers in a safety-net hospital system.
Retrospective review and analysis of colon cancer patients treated in a large safety-net hospital system between May 2008 and May 2012. Data were collected on demographics, stage at diagnosis, time to surgery, time to adjuvant chemotherapy, and vital status. Regression analyses were performed to determine predictors of delays and failure to receive therapy.
Of 248 patients treated for colon cancer, 56% (n = 140) had advanced disease at the time of presentation; furthermore, 29.1% of all colectomies for colon cancer were performed on an urgent or emergent basis. Thirty-six patients with stage III and IV disease did not receive chemotherapy (26%). Race, age, gender, and hospice care did not predict receipt of chemotherapy or delays to treatment. Patients with stage I colon cancer had a significantly longer interval between diagnosis and elective surgery when compared with patients with stage II, III, and IV colon cancer, with only 10% (n = 3) undergoing resection sooner than 6 wk after diagnosis.
One in three patients diagnosed with colon cancer in a large safety-net hospital system require urgent or emergent surgery, and one in two present with advanced disease. Reducing disparities should focus on earlier diagnosis of colon cancer and improving access to surgical specialists.
据报道，结肠癌生存率的差异是由诊断时的晚期阶段和治疗延迟导致的。我们推测，医疗服务不足患者的治疗延迟是安全网医院系统中系统层面障碍的结果。
对2008年5月至2012年5月在大型安全网医院系统接受治疗的结肠癌患者进行回顾性审查和分析。收集了人口统计学、诊断阶段、手术时间、辅助化疗时间和生命状态的数据。进行回归分析以确定延迟和未接受治疗的预测因素。
在248例接受结肠癌治疗的患者中，56%（n = 140）在就诊时患有晚期疾病；此外，所有结肠癌结肠切除术中有29.1%是在紧急或急诊情况下进行的。36例III期和IV期疾病患者未接受化疗（26%）。种族、年龄、性别和临终关怀并不能预测化疗的接受情况或治疗延迟。与II期、III期和IV期结肠癌患者相比，I期结肠癌患者在诊断和择期手术之间的间隔明显更长，只有10%（n = 3）在诊断后6周内接受了切除手术。
在大型安全网医院系统中，每三名被诊断患有结肠癌的患者中就有一名需要紧急或急诊手术，每两名患者中就有一名患有晚期疾病。减少差异应侧重于早期诊断结肠癌并改善获得外科专家的机会。
