低水平的胰腺腺癌不可治愈患者的专科癌症咨询和癌症导向治疗：基于人群的分析。
Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis.
机构信息
Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
出版信息
CMAJ. 2019 May 27;191(21):E574-E580. doi: 10.1503/cmaj.190211.
BACKGROUND
Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancer-directed therapy for patients with non-curative pancreatic adenocarcinoma.
METHODS
We conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005-2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancer-directed therapy (chemotherapy or a combination of chemo- and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepato-pancreatico-biliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancer-directed therapy.
RESULTS
Of 10 881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-biliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancer-directed therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancer-directed therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancer-directed therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancer-directed therapy was significantly higher compared with surgery.
INTERPRETATION
A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancer-directed therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancer-directed therapy that indicate potential gaps in assessment.
背景
尽管系统治疗的进步改善了胰腺腺癌患者的预后，但尚不清楚患者是否能获得这些治疗方法。我们旨在研究非治愈性胰腺腺癌患者获得专门癌症咨询的模式和相关因素，以及随后接受癌症靶向治疗的情况。
方法
我们通过链接行政医疗保健数据集，对安大略省 2005 年至 2016 年间诊断的非治愈性胰腺腺癌患者进行了一项基于人群的分析。我们的主要结局是专门的癌症咨询和接受癌症靶向治疗（化疗或化疗联合放疗[放化疗]）。我们检查了与肝胆胰外科、医学和放射肿瘤学相关的专门癌症咨询。我们使用多变量逻辑回归来确定与医学肿瘤学咨询和癌症靶向治疗相关的因素。
结果
在 10881 名患者中，64.9%的患者接受了医学肿瘤学专家的咨询，35.1%的患者接受了肝胆胰外科专家的咨询，24.7%的患者接受了放射肿瘤学专家的咨询。社会人口统计学特征与接受医学肿瘤学咨询的可能性无关。在这些患者中，4144 人接受了癌症靶向治疗，占所有患者的 38.1%，占接受医学肿瘤学咨询的患者的 58.6%。在未接受癌症靶向治疗的 6737 名患者中，有 2988 名（44.4%）接受了医学肿瘤学咨询。年龄较大和收入最低的五分位数与癌症靶向治疗的可能性较低独立相关。如果第一次专门的癌症咨询是与医学或放射肿瘤学，那么接受癌症靶向治疗的可能性显著高于手术。
解释
安大略省相当一部分患有不可治愈的胰腺腺癌的患者没有接受专门的癌症咨询，大多数患者也没有接受癌症靶向治疗。我们发现专门的癌症咨询和接受系统性癌症靶向治疗方面存在差异，这表明评估方面存在潜在差距。
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