Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
Pract Radiat Oncol. 2019 May;9(3):e322-e330. doi: 10.1016/j.prro.2019.01.001. Epub 2019 Jan 17.
Intensity modulated radiation therapy (IMRT) is widely used in the treatment of head and neck cancers (HNC). There is not enough evidence to suggest that some radiation oncologists (ROs) are associated with better outcomes in patients with HNC. We conducted a cross-sectional analysis to evaluate the effect of ROs' characteristics on outcomes in patients with HNC treated with IMRT.
The study used the Surveillance Epidemiology and End Results-Medicare linked database to identify patient characteristics. Physician records were obtained from the American Medical Association. Logistic regression models with propensity scores were analyzed to look for an association between RO characteristics and patient outcomes.
RO characteristics showed that approximately 30% of ROS completed their training in or after the year 2000 (recently trained), and 17% were in top decile of treatment volume (high volume). Less than 3% of ROs work in academic settings. We found that ROs who were recently trained have higher odds (odds ratio [OR]: 1.10; 95% confidence interval [CI], 1.011-1.191) compared with those who were not. In addition, ROs who were treating high volumes of patients have higher odds (OR: 1.08; 95% CI, 1.010-1.165) compared with those treating low volumes of an event of adverse effect of IMRT or death among patients. ROs who work in academic settings have a protective effect (OR: 0.72; 95% CI, 0.569-0.925).
ROs who were recently trained and had a high treatment volume are associated with poorer outcomes among patients with HNC who receive IMRT treatment.
调强放射治疗（IMRT）广泛应用于头颈部癌症（HNC）的治疗。目前尚无足够的证据表明，某些放射肿瘤学家（RO）与 HNC 患者的治疗结果有关。我们进行了一项横断面分析，以评估 RO 特征对接受 IMRT 治疗的 HNC 患者结局的影响。
该研究使用监测、流行病学和最终结果-医疗保险数据库来确定患者特征。从美国医学协会获得医生记录。使用倾向评分的逻辑回归模型进行分析，以寻找 RO 特征与患者结局之间的关联。
RO 特征显示，大约 30%的 ROS 于 2000 年或之后完成培训（最近培训），17%的 ROS 处于治疗量的前十分位数（高量）。不到 3%的 RO 在学术环境中工作。我们发现，最近接受培训的 RO 比未接受培训的 RO 有更高的几率（优势比[OR]：1.10；95%置信区间[CI]，1.011-1.191）。此外，治疗大量患者的 RO 比治疗少量患者的 RO 有更高的几率（OR：1.08；95% CI，1.010-1.165）。在学术环境中工作的 RO 具有保护作用（OR：0.72；95% CI，0.569-0.925）。
接受 IMRT 治疗的 HNC 患者中，最近接受培训和高治疗量的 RO 与较差的治疗结果相关。
