Miller Kenneth, Mehta Rutika, Abraham Joseph, Opneja Aman, Jain Rohit K
Division of Hematology/Oncology.
Department of Internal Medicine, Sinai Hospital of Baltimore.
Am J Clin Oncol. 2017 Dec;40(6):639-643. doi: 10.1097/COC.0000000000000217.
The majority of the cancer survivors in the United States are 5 or more years beyond their diagnosis. The follow-up care of these individuals remains a major concern for survivors and for the cancer care system. The purpose of this study was to characterize long-term cancer survivors' visits at a National Cancer Institute-designated comprehensive cancer center.
We abstracted electronic medical record data for 18,882 unique patients' visits during 2010 to determine the distribution of the number of years of survival after the initial cancer diagnosis. We then reviewed 374 patient visits during a randomly selected week in April 2010 to determine whether patients were seen for treatment of a new diagnosis of cancer, a residual or recurrent cancer, for a second or secondary cancer, or for cancer survivorship care while not actively receiving treatment (other than adjuvant hormonal therapy).
In the 1-year group of 18,882 unique patients visits the percentage of patients who were <1, 1 to 5, 6 to 10, and >10 years postdiagnosis were 18.7%, 48.7%, 18.9%, and 13.8%, respectively. During the selected week, 74% of the total office visits were with patients who were being actively treated for a new cancer, relapse, or a second cancer, whereas 24% were not being seen for treatment of an active malignancy. The percentage of total office visits with patients who were <6, 6 to 10, or >10 years postdiagnosis and had completed their initial treatment were 21.4%, 3.7%, and 1%, respectively. Approximately 5% of oncology office visits were with cancer survivors who were 5 or more years postdiagnosis and not receiving treatment.
In a database of over 18,000 unique patients who were seen at a major cancer center in 2010, approximately 68% were 5 or less and 32% were 6 or more years postdiagnosis. A review of the medical oncology notes in a random sample of cases of oncology visits demonstrated that approximately 5% of office visits were with long-term cancer survivors who were >5 years postdiagnosis and not receiving active treatment.
Cancer survivors often indicate a preference to receive long-term follow-up care from their oncologist. These findings suggest that long-term cancer survivorship care represents only a small component of care at a comprehensive cancer center and also that alternative models for long-term survivorship health care need to be considered.
美国大多数癌症幸存者在确诊后已存活5年或更长时间。对这些患者的后续护理仍是幸存者和癌症护理系统的主要关注点。本研究的目的是描述在一家国立癌症研究所指定的综合癌症中心长期癌症幸存者的就诊情况。
我们提取了2010年18882例独特患者就诊的电子病历数据，以确定初次癌症诊断后的存活年数分布。然后，我们回顾了2010年4月随机选择的一周内的374例患者就诊情况，以确定患者就诊是为了治疗新诊断的癌症、残留或复发性癌症、第二种或继发性癌症，还是在未接受积极治疗（辅助激素治疗除外）时接受癌症生存护理。
在18882例独特患者就诊的1年组中，诊断后<1年、1至5年、6至10年和>10年的患者百分比分别为18.7%、48.7%、18.9%和13.8%。在选定的一周内，总门诊就诊患者中有74%正在接受新癌症、复发或第二种癌症的积极治疗，而24%并非因活动性恶性肿瘤接受治疗。诊断后<6年、6至10年或>10年且已完成初始治疗的患者在总门诊就诊患者中的百分比分别为21.4%、3.7%和1%。约5%的肿瘤门诊就诊患者为诊断后5年或更长时间且未接受治疗的癌症幸存者。
在2010年一家大型癌症中心的18000多例独特患者数据库中，约68%的患者诊断后存活5年或更短时间，32%的患者诊断后存活6年或更长时间。对随机抽取的肿瘤门诊病例的医学肿瘤学记录进行回顾显示，约5%的门诊就诊患者为诊断后>5年且未接受积极治疗的长期癌症幸存者。
癌症幸存者通常表示倾向于由他们的肿瘤学家提供长期随访护理。这些发现表明，长期癌症生存护理在综合癌症中心的护理中仅占一小部分，同时也需要考虑长期生存医疗保健的替代模式。
