Gupta Digant, Patel Kamal, Lis Christopher G
Cancer Treatment Centers of America® (CTCA), 500 Remington Road, Schaumburg, IL, 60173, USA.
Health Qual Life Outcomes. 2015 Sep 4;13:137. doi: 10.1186/s12955-015-0334-1.
We have previously reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we argued that patients with greater satisfaction might be the ones with better self-rated health (SRH), a recognized predictor of cancer survival. We therefore investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer.
Nine hundred seventeen prostate cancer treated at four Cancer Treatment Centers of America(®) hospitals between July 2011 and March 2013. PS was measured on a 7-point scale ranging from "completely dissatisfied" to "completely satisfied". SRH was measured on a 7-point scale ranging from "very poor" to "excellent". Both were dichotomized into two categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between PS and survival controlling for covariates.
The response rate for this study was 72%. Majority of patients (n = 517) had stage II disease. Seven hundred eighty-seven (85.8%) patients were "completely satisfied". Three hundred nineteen (34.8%) patients had "excellent" SRH. There was a weak but significant correlation between satisfaction and SRH (Kendall's tau b = 0.18; p < 0.001). On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality (HR = 0.46; 95% CI: 0.25-0.85; p = 0.01). Similarly, patients with "excellent" SRH had a significantly lower risk of mortality (HR = 0.25; 95% CI: 0.11-0.58; p = 0.001). On multivariate analysis, SRH was found to be a significant predictor of survival (HR = 0.31; 95% CI: 0.12-0.79; p = 0.01) while patient satisfaction was not (HR = 0.76; 95% CI: 0.40-1.5; p = 0.40).
SRH supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer. SRH should be used as a control variable in analyses involving patient satisfaction as a predictor of clinical cancer outcomes.
我们之前曾报道，患者对服务质量的满意度较高与多种癌症的良好生存结局相关。然而，我们认为满意度较高的患者可能是那些自我健康评价（SRH）较好的患者，而自我健康评价是癌症生存的一个公认预测指标。因此，我们研究了在前列腺癌中，自我健康评价是否能取代患者满意度作为生存的预测指标。
2011年7月至2013年3月期间，在美国癌症治疗中心（®）的四家医院接受治疗的917例前列腺癌患者。患者满意度采用7分制进行测量，范围从“完全不满意”到“完全满意”。自我健康评价也采用7分制进行测量，范围从“非常差”到“优秀”。两者均被分为两类：最高评分（7分）与其他评分（1 - 6分）。患者生存是主要终点。采用Cox回归评估患者满意度与生存之间的关联，并对协变量进行控制。
本研究的应答率为72%。大多数患者（n = 517）处于II期疾病。787例（85.8%）患者“完全满意”。319例（34.8%）患者自我健康评价为“优秀”。满意度与自我健康评价之间存在微弱但显著的相关性（肯德尔等级相关系数tau b = 0.18；p < 0.001）。单因素分析显示，“完全满意”的患者死亡风险显著较低（风险比[HR] = 0.46；95%置信区间[CI]：0.25 - 0.85；p = 0.01）。同样，自我健康评价为“优秀”的患者死亡风险也显著较低（HR = 0.25；95% CI：0.11 - 0.58；p = 0.001）。多因素分析发现，自我健康评价是生存的显著预测指标（HR = 0.31；95% CI：0.12 - 0.79；p = 0.01），而患者满意度则不是（HR = 0.76；95% CI：0.40 - 1.5；p = 0.40）。
在前列腺癌中，自我健康评价取代了患者对服务质量的满意度作为生存的预测指标。在涉及患者满意度作为临床癌症结局预测指标的分析中，自我健康评价应作为一个控制变量。
