Ore Robert M, Chen Quan, DeSimone Christopher P, Miller Rachel W, Baldwin Lauren A, van Nagell John R, Huang Bin, Tucker Thomas C, Johnson M Symmes, Fredericks Tricia I, Ueland Frederick R
From the Department of Obstetrics and Gynecology, and Biostatistics and Bioinformatics Shared Resource Facility, Division of Gynecologic Oncology, Markey Cancer Center, the Departments of Biostatistics and Epidemiology, College of Public Health, University of Kentucky, Lexington.
South Med J. 2018 Jun;111(6):333-341. doi: 10.14423/SMJ.0000000000000821.
Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia.
Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and survival.
Most women were aged 65 years or older (62.5%) and had high-grade (65.9%) and advanced-stage (61.0%) ovarian cancer. Two-thirds of cases (65.9%) received NCCN-recommended treatment for ovarian cancer. The hazard ratio of death for women who did not receive NCCN-compliant care was 62% higher compared with the women who did receive NCCN-compliant treatment. Results from the logistic regression showed that NCCN-compliant treatment was more likely for women aged 65 to 74 years compared with women aged 20 to 49 years, late-stage compared with early-stage cancers, receipt of care at tertiary care hospitals, and privately insured compared with Medicaid or Medicare.
When the treatment of ovarian cancer did not follow NCCN recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were younger (20-49 years), had early-stage disease, did not have private insurance, or had care provided at a nontertiary care hospital.
遵循美国国立综合癌症网络（NCCN）卵巢癌治疗指南可改善患者预后。本研究旨在评估肯塔基州和阿巴拉契亚中部地区卵巢癌治疗方面的差异。
从与行政索赔相关联的肯塔基癌症登记数据中提取2007年至2011年被诊断为卵巢癌的患者数据。NCCN依从性根据分期、分级、手术程序和化疗来定义。仔细审查选择标准以确保数据质量和准确性。进行描述性分析、逻辑回归分析和Cox回归分析，以检查与指南依从性和生存率相关的因素。
大多数女性年龄在65岁及以上（62.5%），患有高级别（65.9%）和晚期（61.0%）卵巢癌。三分之二的病例（65.9%）接受了NCCN推荐的卵巢癌治疗。未接受符合NCCN标准治疗的女性的死亡风险比接受符合NCCN标准治疗的女性高62%。逻辑回归结果显示，与20至49岁的女性相比，65至74岁的女性更有可能接受符合NCCN标准的治疗；与早期癌症相比，晚期癌症患者更有可能接受符合NCCN标准的治疗；在三级医院接受治疗的患者更有可能接受符合NCCN标准的治疗；与参加医疗补助或医疗保险的女性相比，有私人保险的女性更有可能接受符合NCCN标准的治疗。
当卵巢癌治疗未遵循NCCN建议时，患者死亡风险显著更高。如果女性年龄较小（20至49岁）、患有早期疾病、没有私人保险或在非三级医院接受治疗，则她们接受符合NCCN标准治疗的可能性较小。
