Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Cancer Epidemiol Biomarkers Prev. 2017 Dec;26(12):1745-1752. doi: 10.1158/1055-9965.EPI-17-0479. Epub 2017 Sep 29.
Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust. Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust. Of the 2,754 participants, 30.2% ( = 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance. Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer. Interventions should test whether or not resolving institutional distrust reduces treatment discordance. .
乳腺癌手术后的辅助治疗可以降低复发率并提高生存率，但并非所有女性都接受并完成了该治疗。先前的研究表明，对医疗机构的不信任在启动辅助治疗的人群中发挥了作用，但尚未评估治疗完成情况，也未评估医生不信任的潜在中介作用。2007 年至 2009 年期间，宾夕法尼亚州和佛罗里达州癌症登记处登记的患有局部浸润性乳腺癌且发病时年龄在 65 岁以下的女性通过邮件接受了调查。调查参与者自我报告了人口统计学特征、癌症分期和治疗方法、治疗分歧（定义为不遵循外科医生或肿瘤医生的治疗建议）、医疗系统不信任和医生信任。年龄和癌症分期与癌症登记记录进行了核对。逻辑回归评估了医疗系统不信任程度最高和最低三分位数与治疗分歧这一二分类结果之间的关系，控制了人口统计学和临床治疗因素，并通过医生信任测试了中介作用。在 2754 名参与者中，有 30.2%（832 人）报告至少有一种推荐的治疗方法未被采用。平均年龄为 52 岁。在医疗系统不信任程度最高的三分位数中，有 22%的患者报告治疗分歧的可能性高于最低三分位数；医生信任并不能中介医疗系统不信任与治疗分歧之间的关联。医疗系统不信任与治疗分歧呈正相关，后者定义为在乳腺癌后未能启动或完成医生推荐的辅助治疗。干预措施应检验是否解决机构不信任可以减少治疗分歧。
