Ho Vivian, Ku-Goto Meei-Hsiang, Zhao Hui, Hoffman Karen E, Smith Benjamin D, Giordano Sharon H
Rice University's Baker Institute for Public Policy, Rice University, 6100 Main Street MS-40, Houston, TX, 77005, USA.
Department of Economics, Rice University, 6100 Main Street MS-40, Houston, TX, 77005, USA.
BMC Health Serv Res. 2016 Jul 15;16:262. doi: 10.1186/s12913-016-1534-z.
Little is known about regional variation in cancer treatment and its determinants. We compare rates of adherence to treatment guidelines for elderly patients across Texas and whether local specialist supply is an important determinant of treatment variation.
Previous literature reviewed indicated 7 recommended courses of treatment for colorectal, pancreatic, and prostate cancer. We analyzed Texas Cancer Registry data linked with Medicare claims for the years 2004 to 2007 to study patients with these cancers. We tested for unadjusted and adjusted differences in treatment rates across 22 hospital referral regions (HRR). We tested whether variation in the local supply of specialists treating each cancer was an important determinant of treatment.
We found significant differences in adjusted treatment rates across regions. For removal and examination of 12+ lymph nodes with colon cancer resection, 13 of 22 HRRs had rates significantly different from the median region. For adjuvant chemotherapy for regional colon cancer, five HRRs significantly differed from the median. For prostate cancer treatment with a favorable diagnosis, nine HRRs differed from the median HRR. Of the 7 treatments, only the local availability of surgeons was an important determinant for excision of lymph nodes for colon cancer patients.
There are significant variations across Texas for seven recommended cancer treatments. No one region has consistently higher or lower treatments than other regions, and local specialist supply is not an important predictor of treatment. Different factors may be determining regional variation in treatment rates across cancer types and treatment options.
关于癌症治疗的地区差异及其决定因素，人们了解甚少。我们比较了德克萨斯州老年患者对治疗指南的遵循率，以及当地专科医生的供给是否是治疗差异的重要决定因素。
以往文献综述指出了结直肠癌、胰腺癌和前列腺癌的7种推荐治疗方案。我们分析了2004年至2007年与医疗保险理赔数据相关联的德克萨斯癌症登记数据，以研究患有这些癌症的患者。我们测试了22个医院转诊地区（HRR）治疗率的未经调整和调整后的差异。我们测试了治疗每种癌症的当地专科医生供给差异是否是治疗的重要决定因素。
我们发现各地区调整后的治疗率存在显著差异。对于结肠癌切除术中切除并检查12个及以上淋巴结的情况，22个HRR中有13个地区的比率与中位数地区有显著差异。对于局部结肠癌的辅助化疗，5个HRR与中位数有显著差异。对于诊断良好的前列腺癌治疗，9个HRR与中位数HRR不同。在这7种治疗中，只有外科医生的当地可获得性是结肠癌患者淋巴结切除的重要决定因素。
德克萨斯州在7种推荐的癌症治疗方面存在显著差异。没有一个地区的治疗率始终高于或低于其他地区，而且当地专科医生的供给不是治疗的重要预测指标。不同的因素可能决定了不同癌症类型和治疗方案的治疗率地区差异。
