患有晚期卵巢癌的女性在健康相关生活质量方面的差异：个体层面和背景社会决定因素的作用。
Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants.
机构信息
National Cancer Institute, Bethesda, MD, USA.
George Washington University School of Nursing, Washington, DC, USA.
出版信息
Support Care Cancer. 2019 Feb;27(2):531-538. doi: 10.1007/s00520-018-4340-9. Epub 2018 Jul 12.
PURPOSE
Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer.
METHODS
The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL.
RESULTS
Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, - 1.00 (standard error[SE] = 0.49) points, uninsured, - 1.93 (SE = 0.63) points; functional well-being: public, - 1.29 (SE = 0.59), uninsured, - 1.98 (SE = 0.76); ovarian cancer-specific: public, - 1.60 (SE = 0.59), uninsured, - 1.66 (SE = 0.75); TOI: public, - 3.81 (SE = 1.46), uninsured, - 5.51 (SE = 1.86); all p < .05).
CONCLUSIONS
Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.
目的
社会决定因素可能会影响卵巢癌女性的健康相关生活质量（HRQOL），从而导致临床结局的差异。我们研究了 HRQOL 与健康社会决定因素之间的关系，包括接受癌症治疗的出行距离和医疗保险类型，这些因素与参加原发性辅助治疗晚期卵巢癌的随机试验的女性有关。
方法
功能性评估癌症治疗卵巢（FACT-O）问卷在化疗前（基线）、试验期间以及化疗开始后 84 周时，对患有晚期上皮性卵巢癌、原发性腹膜癌或输卵管癌的女性进行了 HRQOL（身体状况、功能状况、卵巢特异性和试验结局指数[TOI]）的测定。我们构建了双变量和多变量线性混合效应模型，以研究健康社会决定因素（个体和环境因素）与 84 周时 HRQOL 评分的关联，将参与者（n=993）按治疗中心和人口普查区域聚类，并控制基线 HRQOL。
结果
大多数个体（种族、年龄、癌症分期、不良事件）和环境（到治疗中心的出行距离、社区社会经济地位）因素与 HRQOL 无统计学显著相关性。与拥有私人医疗保险的参与者相比，其他参与者的 HRQOL 平均值较低（身体状况：公共保险，-1.00（标准误差[SE] = 0.49）点，无保险，-1.93（SE = 0.63）点；功能状况：公共，-1.29（SE = 0.59），无保险，-1.98（SE = 0.76）；卵巢癌特异性：公共，-1.60（SE = 0.59），无保险，-1.66（SE = 0.75）；TOI：公共，-3.81（SE = 1.46），无保险，-5.51（SE = 1.86）；所有 p<0.05）。
结论
私人医疗保险与晚期卵巢癌治疗完成后的 HRQOL 提高有关。医疗保险对 HRQOL 的影响应进一步调查，特别是在接受标准治疗的卵巢癌女性中。
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