1 Department of Healthcare Policy and Research, Virginia Commonwealth University, College of Medicine, Richmond, VA 23298, USA ; 2 College of Medicine, University of Virginia, Charlottesville, VA, USA ; 3 College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
Ann Transl Med. 2015 Apr;3(5):72. doi: 10.3978/j.issn.2305-5839.2015.03.52.
Few studies have examined the management of comorbidities in cancer patients. This study used population-based data to estimate the guideline concordance rates for diabetes management before and after cancer diagnosis and examined if diabetes management services among cancer patients was associated with characteristics of the hospital where the patient was treated.
We linked 2005-2009 Medicare claims data to information on 2,707 breast and colorectal cancers patients in state cancer registry files. Multivariate logistic regression models examined hospital characteristics associated with receipt of diabetes management care after cancer diagnosis.
The rates of HbAlc testing, LDL-C testing, and retinal eye exam decreased from 72.7%, 79.6%, and 57.9% before cancer diagnosis to 58.3%, 69.5%, and 55.8% after diagnosis. The pre- and post-diagnosis diabetes management care was not significantly different by hospital characteristics in the bivariate analysis except for that the distance between residence and hospital was negatively related to retinal eye exam after diagnosis (P<0.05). The multivariate analysis did not identify any significant differences in diabetes management care after cancer diagnosis by hospital characteristics.
Cancer patients received fewer diabetes management care after diagnosis than prior to diagnosis, even for those who were treated in large comprehensive centers. This may reflect a missed opportunity to connect diabetic cancer patients to diabetes care. This study provides benchmarks to measure improvements in comorbidity management among cancer patients.
很少有研究探讨癌症患者合并症的管理。本研究使用基于人群的数据，估计癌症诊断前后糖尿病管理的指南符合率，并探讨癌症患者的糖尿病管理服务是否与患者接受治疗的医院的特征有关。
我们将 2005-2009 年医疗保险索赔数据与州癌症登记处文件中 2707 例乳腺癌和结直肠癌患者的信息进行了关联。多变量逻辑回归模型检查了与癌症诊断后接受糖尿病管理护理相关的医院特征。
在癌症诊断之前，HbAlc 检测、LDL-C 检测和视网膜眼部检查的比率从 72.7%、79.6%和 57.9%下降到诊断后的 58.3%、69.5%和 55.8%。在单变量分析中，除了居住地和医院之间的距离与诊断后的视网膜眼部检查呈负相关（P<0.05）外，医院特征与糖尿病管理护理的前后差异并不显著。多变量分析未发现癌症诊断后糖尿病管理护理与医院特征之间存在任何显著差异。
癌症患者在诊断后接受的糖尿病管理护理比诊断前少，即使他们在大型综合中心接受治疗也是如此。这可能反映了将糖尿病癌症患者与糖尿病护理联系起来的机会被错失了。本研究为衡量癌症患者合并症管理的改善提供了基准。
