Rylands Joseph, Lowe Derek, Rogers Simon N
Accident and Emergency Department, University Hospital Aintree, Liverpool L9 1AE, England.
Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk L39 4QP, England.
Oral Oncol. 2016 Jan;52:30-6. doi: 10.1016/j.oraloncology.2015.10.017. Epub 2015 Nov 12.
Oral cancer patients from lower socio-economic backgrounds have worse outcomes of survival and health related quality of life. The mechanism of cause is not fully understood. The purpose of the paper is to report treatment selection, survival, health related quality of life, cause and place of death in relation to deprivation status.
553 patients treated for oral cancer between 2008 and 2012 were identified from records at University hospital. Mortality was tracked via the Office of National Statistics (ONS) and health-related quality of life was measured using the University Washington quality of life questionnaire (UW-QoLv4). Postcodes of residence at diagnosis were used to obtain index of multiple deprivation (IMD) 2010 scores.
Nearly half of the sample (47%) lived in the 'most deprived' IMD 2010 quartile of residential areas in England and such patients when treated with curative intent using surgery with or without adjuvant radiotherapy had worse survival than patients living elsewhere, p=0.01 after adjusting for pathological staging and age group. There were no notable differences by IMD group in cancer being mentioned anywhere in part 1 or part 2 of the death certificate or in place of death. After adjustment for patient and clinical factors patients residing in more deprived areas had worse quality of life outcomes in regard to social-emotional functioning and overall quality of life but not in regard to physical oral function.
Addressing inequalities in health care related to deprivation is a priority for patients with oral cancer.
社会经济背景较低的口腔癌患者生存结局及与健康相关的生活质量较差。其病因机制尚未完全明确。本文旨在报告与贫困状况相关的治疗选择、生存情况、与健康相关的生活质量、死因及死亡地点。
从大学医院的记录中识别出2008年至2012年间接受口腔癌治疗的553例患者。通过国家统计局（ONS）追踪死亡率，并使用华盛顿大学生活质量问卷（UW-QoLv4）测量与健康相关的生活质量。利用诊断时的居住邮政编码获取2010年多重贫困指数（IMD）得分。
近一半的样本（47%）居住在英格兰2010年IMD最贫困四分位的居民区，这些患者在接受有或无辅助放疗的手术进行根治性治疗时，其生存率低于其他地区的患者，在调整病理分期和年龄组后，p=0.01。在死亡证明第1部分或第2部分的任何地方提及癌症或死亡地点方面，IMD组之间没有显著差异。在调整患者和临床因素后，居住在更贫困地区的患者在社会情感功能和总体生活质量方面的生活质量结局较差，但在身体口腔功能方面没有差异。
解决与贫困相关的医疗保健不平等问题是口腔癌患者的首要任务。
