Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK.
University of Exeter Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK.
Cancer Epidemiol. 2019 Aug;61:70-78. doi: 10.1016/j.canep.2019.04.011. Epub 2019 May 30.
Whether diagnostic route (e.g. emergency presentation) is associated with cancer care experience independently of tumour stage is unknown.
We analysed data on 18 590 patients with breast, prostate, colon, lung, and rectal cancers who responded to the 2014 English Cancer Patient Experience Survey, linked to cancer registration data on diagnostic route and tumour stage at diagnosis. We estimated odds ratios (OR) of reporting a negative experience of overall cancer care by tumour stage and diagnostic route (crude and adjusted for patient characteristic and cancer site variables) and examined their interactions with cancer site.
After adjustment, the likelihood of reporting a negative experience was highest for emergency presenters and lowest for screening-detected patients with breast, colon, and rectal cancers (OR versus two-week-wait 1.51, 95% confidence interval [CI] 1.24-1.83; 0.88, 95% CI 0.75-1.03, respectively). Patients with the most advanced stage were more likely to report a negative experience (OR stage IV versus I 1.37, 95% CI 1.15-1.62) with little confounding between stage and route, and no evidence for cancer-stage or cancer-route interactions.
Though the extent of disease is strongly associated with ratings of overall cancer care, diagnostic route (particularly emergency presentation or screening detection) exerts important independent effects.
诊断途径（例如急诊就诊）是否与癌症治疗体验独立于肿瘤分期有关尚不清楚。
我们分析了 18590 名患有乳腺癌、前列腺癌、结肠癌、肺癌和直肠癌的患者的数据，这些患者对 2014 年英国癌症患者体验调查做出了回应，并与诊断途径和诊断时肿瘤分期的癌症登记数据相关联。我们根据肿瘤分期和诊断途径（未经调整和调整患者特征和癌症部位变量）估计了报告整体癌症治疗负面体验的比值比（OR），并检查了它们与癌症部位的相互作用。
调整后，急诊就诊患者报告负面治疗体验的可能性最高，而通过筛查发现的乳腺癌、结肠癌和直肠癌患者报告负面治疗体验的可能性最低（与两周内就诊相比，OR 分别为 1.51、95%CI1.24-1.83；0.88、95%CI0.75-1.03）。分期最严重的患者更有可能报告负面治疗体验（与 I 期相比，IV 期 OR 为 1.37、95%CI1.15-1.62），分期和途径之间几乎没有混杂，并且没有癌症分期或癌症途径相互作用的证据。
尽管疾病的严重程度与整体癌症治疗的评价密切相关，但诊断途径（特别是急诊就诊或筛查发现）具有重要的独立影响。
