识别 2014 年医疗补助扩大后肯塔基州乳腺癌治疗延误的影响因素。
Identifying factors influencing delays in breast cancer treatment in Kentucky following the 2014 Medicaid expansion.
机构信息
Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
出版信息
J Surg Oncol. 2020 Jun;121(8):1191-1200. doi: 10.1002/jso.25914. Epub 2020 Mar 29.
BACKGROUND AND OBJECTIVES
A previous analysis of breast cancer care after the 2014 Medicaid expansion in Kentucky demonstrated delays in treatment despite a 12% increase in insurance coverage. This study sought to identify factors associated with treatment delays to better focus efforts for improved breast cancer care.
METHODS
The Kentucky Cancer Registry was queried for adult women diagnosed with invasive breast cancer between 2010 and 2016 who underwent up-front surgery. Demographic, tumor, and treatment characteristics were assessed to identify factors independently associated with treatment delays.
RESULTS
Among 6225 patients, treatment after Medicaid expansion (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.874-2.535, P < .001), urban residence (OR = 1.362, 95% CI = 1.163-1.594, P < .001), treatment at an academic center (OR = 1.988, 95% CI = 1.610-2.455, P < .001), and breast reconstruction (OR = 3.748, 95% CI = 2.780-5.053, P < .001) were associated with delay from diagnosis to surgery. Delay in postoperative chemotherapy was associated with older age (OR = 1.155,95% CI = 1.002-1.332, P = .0469), low education level (OR = 1.324, 95% CI = 1.164-1.506, P < .001), hormone receptor positivity (OR = 1.375, 95% CI = 1.187-1.593, P < .001), and mastectomy (OR = 1.312, 95% CI = 1.138-1.513, P < .001). Delay in postoperative radiation was associated with younger age (OR = 1.376, 95% CI = 1.370-1.382, P < .001), urban residence (OR = 1.741, 95% CI = 1.732-1.751, P < .001), treatment after Medicaid expansion (OR = 2.007, 95% CI = 1.994-2.021, P < .001), early stage disease (OR = 5.661, 95% CI = 5.640-5.682, P < .001), and mastectomy (OR = 1.884, 95% CI = 1.870-1.898, P < .001).
CONCLUSIONS
Patient, tumor, and socioeconomic factors influence the timing of breast cancer treatment. Improving timeliness of treatment will likely require improvements in outreach, education, and healthcare infrastructure.
背景与目的
之前对肯塔基州在 2014 年扩大医疗补助计划后乳腺癌治疗的分析显示，尽管保险覆盖范围增加了 12%，但治疗仍出现了延误。本研究旨在确定与治疗延迟相关的因素，以便更好地集中精力改善乳腺癌的护理。
方法
本研究对肯塔基州癌症登记处 2010 年至 2016 年间接受过前期手术的浸润性乳腺癌成年女性进行了查询。评估了人口统计学、肿瘤和治疗特征，以确定与治疗延迟相关的独立因素。
结果
在 6225 名患者中，医疗补助计划扩大后治疗（比值比[OR] = 2.18，95%置信区间[CI] = 1.874-2.535，P<0.001）、城市居住（OR = 1.362，95%CI = 1.163-1.594，P<0.001）、在学术中心治疗（OR = 1.988，95%CI = 1.610-2.455，P<0.001）和乳房重建（OR = 3.748，95%CI = 2.780-5.053，P<0.001）与从诊断到手术的时间延迟有关。术后化疗延迟与年龄较大（OR = 1.155，95%CI = 1.002-1.332，P = 0.0469）、教育水平较低（OR = 1.324，95%CI = 1.164-1.506，P<0.001）、激素受体阳性（OR = 1.375，95%CI = 1.187-1.593，P<0.001）和乳房切除术（OR = 1.312，95%CI = 1.138-1.513，P<0.001）有关。术后放疗延迟与年龄较小（OR = 1.376，95%CI = 1.370-1.382，P<0.001）、城市居住（OR = 1.741，95%CI = 1.732-1.751，P<0.001）、医疗补助计划扩大后治疗（OR = 2.007，95%CI = 1.994-2.021，P<0.001）、早期疾病（OR = 5.661，95%CI = 5.640-5.682，P<0.001）和乳房切除术（OR = 1.884，95%CI = 1.870-1.898，P<0.001）有关。
结论
患者、肿瘤和社会经济因素影响乳腺癌治疗的时间安排。提高治疗的及时性可能需要改善外联、教育和医疗保健基础设施。
Zotero 插件