Bhatt Vijaya Raj, Dhakal Prajwal, Dahal Sumit, Giri Smith, Pathak Ranjan, Bociek R Gregory, Silberstein Peter T, Armitage James O
Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, USA.
Department of Medicine, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
Ther Adv Hematol. 2015 Oct;6(5):223-7. doi: 10.1177/2040620715592568.
Cancer therapy and outcomes are known to be affected by various demographic features and hospital types. We aimed to identify the characteristics of non-Hodgkin's lymphoma (NHL) patients associated with receipt of care at academic centers.
This is a retrospective study of all patients diagnosed with nodal NHL between 2000 and 2011 in the National Cancer Database (NCDB), who received the diagnosis, and all or part of their initial therapy in the reporting hospital (n = 243,436). Characteristics of patients receiving care in academic versus nonacademic centers were compared using the Chi-square test.
Approximately 27% received care in academic centers. Patients receiving care in nonacademic centers, compared with academic centers, were more likely to be ⩾60 years (69% versus 58%, p < .0001), White (89% versus 80%, p < .0001) and have lower educational attainment (>12% without high school diploma: 72% versus 69%, p < .0001) and economic status (household income <$49,000: 66% versus 61%, p < 0.0001). Patients receiving care in nonacademic centers were less likely to travel ⩾25 miles (21% versus 26%, p < 0.0001). White patients, compared with non-Whites, were more likely to be ⩾60 years (70% versus <50%, p < 0.0001), which probably explains less care in academic centers.
Patients ⩾60 years and those with poorer educational attainment and economic status were less likely to receive care in academic centers. Care in academic centers required a longer commute. Elderly patients frequently have inferior outcomes and may benefit from clinical trials with novel agents and expertise at academic centers.
癌症治疗及治疗效果已知会受到多种人口统计学特征及医院类型的影响。我们旨在确定与在学术中心接受治疗相关的非霍奇金淋巴瘤（NHL）患者的特征。
这是一项对2000年至2011年期间在国家癌症数据库（NCDB）中被诊断为淋巴结NHL且在报告医院接受诊断及全部或部分初始治疗的所有患者进行的回顾性研究（n = 243,436）。使用卡方检验比较在学术中心与非学术中心接受治疗的患者的特征。
约27%的患者在学术中心接受治疗。与学术中心相比，在非学术中心接受治疗的患者更可能年龄≥60岁（69%对58%，p <.0001）、为白人（89%对80%，p <.0001），且教育程度较低（>12%没有高中文凭：72%对69%，p <.0001）以及经济状况较差（家庭收入<$49,000：66%对61%，p < 0.0001）。在非学术中心接受治疗的患者出行≥25英里的可能性较小（21%对26%，p < 0.0001）。与非白人患者相比，白人患者更可能年龄≥60岁（70%对<50%，p < 0.0001），这可能解释了在学术中心接受治疗的患者较少的原因。
年龄≥60岁以及教育程度和经济状况较差的患者在学术中心接受治疗的可能性较小。在学术中心接受治疗需要更长的通勤距离。老年患者的治疗效果往往较差，可能会从学术中心开展的使用新型药物和专业技术的临床试验中受益。
