Onukwugha Eberechukwu, Yong Candice, Naslund Michael, Woods Corinne, Mullins C Daniel, Seal Brian, Hussain Arif
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
Urol Oncol. 2017 Apr;35(4):150.e17-150.e23. doi: 10.1016/j.urolonc.2016.11.012. Epub 2016 Dec 29.
The urologist generally manages the treatment of men immediately following the diagnosis of prostate cancer (PCa). The role of other physician specialists in this setting is less clear. We investigated whether involvement of other physician specialty types immediately following diagnosis affects initiation of cancer-directed treatment.
This is a retrospective cohort study using linked cancer registry and claims data from 1999 to 2009, excluding stage I/II PCa. A physician visit index (PVI) served as the exposure variable and captured the "dispersion of care" across specialties, that is, the extent to which patient care involved different types of physician specialties such as the primary care physician, urologist, or oncologist. The PVI score was calculated using visits occurring within 30 days postdiagnosis. This score was dichotomized to measure "low PVI" (reflects seeing multiple specialist types). Competing risk Cox proportional hazard regression models provided adjusted hazard ratios (HR) for treatment receipt associated with a low PVI.
The sample included 33,380 patients: 4,910 metastatic and 28,470 nonmetastatic groups. The top 3 visit categories within 30 days postdiagnosis were "urologist only" (59%) and "urologist plus primary care physician" (21%) and no visit (6%). The median time to receipt of cancer-directed treatment was 51 days. Overall, 29% of individuals in the metastatic group and 38% in the nonmetastatic group were categorized as low PVI. A low PVI was associated with a shorter time to treatment receipt in the nonmetastatic (HR = 1.12 [95% CI: 1.09-1.15]) and metastatic (HR = 1.21 [95% CI: 1.14-1.29]) groups.
Multispecialist involvement in the weeks following diagnosis is associated with a shorter time to treatment initiation, highlighting a role for exposure to different specialty types in the weeks following an initial diagnosis of PCa. This study provides important baseline data for future studies examining coordination of care across cancer and noncancer specialists.
泌尿科医生通常在前列腺癌（PCa）诊断后立即负责男性患者的治疗。其他内科专科医生在这种情况下的作用尚不清楚。我们调查了诊断后立即有其他内科专科类型的参与是否会影响癌症导向治疗的启动。
这是一项回顾性队列研究，使用了1999年至2009年的癌症登记链接数据和理赔数据，排除I/II期PCa。医生就诊指数（PVI）作为暴露变量，反映了各专科之间的“医疗分散程度”，即患者护理涉及不同类型内科专科医生（如初级保健医生、泌尿科医生或肿瘤内科医生）的程度。PVI评分使用诊断后30天内的就诊情况计算得出。该评分被二分法用于衡量“低PVI”（反映就诊于多种专科类型）。竞争风险Cox比例风险回归模型提供了与低PVI相关的治疗接受的调整后风险比（HR）。
样本包括33380名患者：4910名转移组患者和28470名非转移组患者。诊断后30天内就诊的前三大类别是“仅泌尿科医生”（59%）、“泌尿科医生加初级保健医生”（21%）和未就诊（6%）。接受癌症导向治疗的中位时间为51天。总体而言，转移组中29%的个体和非转移组中38%的个体被归类为低PVI。在非转移组（HR = 1.12 [95% CI：1.09 - 1.15]）和转移组（HR = 1.21 [95% CI：1.14 - 1.29]）中，低PVI与接受治疗的时间较短相关。
诊断后数周内多专科参与与治疗开始时间较短相关，突出了在PCa初步诊断后的数周内接触不同专科类型的作用。本研究为未来研究癌症和非癌症专科医生之间的医疗协调提供了重要的基线数据。
