Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy.
Umbria Cancer Registry, Perugia, Italy.
Cancer Med. 2018 Feb;7(2):370-379. doi: 10.1002/cam4.1304. Epub 2018 Jan 22.
Radiotherapy (RT) is the standard treatment for breast cancer patients after conserving surgery or mastectomy when patients are at high risk of relapse. Major obstacles to appropriate RT delivery are journey times. Since studies on access to RT were carried out mostly in large countries, this study investigated factors in an Italian region and the influence of RT delivery on survival. A total of 4735 female candidates for RT were included in the study. A geographic information system calculated journey times from patients' homes and surgery hospitals to RT centers. Logistic regression analyzed the influence of journey times, socioeconomic status, and other factors on RT delivery. Survival probabilities and excess mortality were assessed in 4364 propensity score-matched patients. Journey times of 40 min or less from residence and from surgery hospital to RT center played a major role in access to RT. A large survival difference emerged between treated and untreated breast cancer patients. The excess mortality for untreated patients compared with propensity score-matched women receiving RT was 3.1 (95% CI: 2.2-4.3). Expansion of RT facilities during the 11-year study period improved RT delivery and outcomes by increasing availability but mainly by shortening journey times.
放射治疗（RT）是保乳手术后或乳房切除术后乳腺癌高危复发患者的标准治疗方法。适当的 RT 治疗的主要障碍是旅行时间。由于关于获得 RT 的研究主要在大国进行，因此本研究调查了意大利一个地区的因素以及 RT 治疗对生存的影响。共有 4735 名接受 RT 的女性候选者纳入了该研究。地理信息系统从患者的家和手术医院计算到 RT 中心的旅行时间。Logistic 回归分析了旅行时间、社会经济地位和其他因素对 RT 治疗的影响。在 4364 名倾向评分匹配的患者中评估了生存概率和超额死亡率。从居住地和手术医院到 RT 中心的 40 分钟或更短的旅行时间在获得 RT 方面起着重要作用。治疗和未治疗的乳腺癌患者之间的生存差异很大。与接受 RT 的倾向评分匹配女性相比，未治疗患者的超额死亡率为 3.1（95%CI：2.2-4.3）。在 11 年的研究期间，RT 设施的扩展通过增加可用性但主要通过缩短旅行时间来提高 RT 治疗效果和结局。
