Department of Registration, Cancer Registry of Norway, Oslo, Norway.
Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
BMC Cancer. 2020 May 30;20(1):488. doi: 10.1186/s12885-020-06979-y.
Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion.
All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015-2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity.
From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70-2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00-1.54) and lung (OR = 1.52, 95%CI: 1.16-1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients.
The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.
癌症患者路径 (CPP) 于 2015 年实施，旨在减少等待时间、降低等待时间的地区差异，并提高患者癌症治疗的可预测性。本研究的目的是确定是否达到了将所有癌症患者的 70%纳入 CPP 的国家目标，并确定与 CPP 纳入相关的因素。
2015 年至 2016 年期间，在挪威癌症登记处登记的结直肠癌、肺癌、乳腺癌或前列腺癌患者，与挪威患者登记处的 CPP 信息以及挪威统计局的社会人口统计学变量相关联。多变量逻辑回归检查了未被纳入 CPP 的几率是否与诊断年份、年龄、性别、肿瘤分期、婚姻状况、教育程度、收入、居住地区和合并症有关。
2015 年至 2016 年间，有 30747 名患者被诊断患有结直肠癌、肺癌、乳腺癌或前列腺癌，其中 24429 名（79.5%）被纳入 CPP。结直肠癌（79.1% 至 86.2%）、肺癌（79.0% 至 87.3%）、乳腺癌（91.5% 至 97.2%）和前列腺癌（62.2% 至 76.2%）患者被纳入 CPP 的概率显著增加（p<0.001）。年龄增加与肺癌（p<0.001）和前列腺癌（p<0.001）患者未被纳入 CPP 的几率增加有关。年龄<50 岁的结直肠癌患者未被纳入 CPP 的几率增加了两倍（OR=2.23，95%CI：1.70-2.91）。收入较低的结直肠癌（OR=1.24，95%CI：1.00-1.54）和肺癌（OR=1.52，95%CI：1.16-1.99）患者未被纳入 CPP 的几率显著增加。居住地区与 CPP 纳入显著相关（p<0.001），调整病例组合后，概率从前列腺癌患者所在的西部地区的 62.4%到乳腺癌患者所在的北部地区的 97.6%不等。
CPP 实施后 1 年内，达到了 70%的国家目标。尽管所有患者都应该平等获得 CPP，但前列腺癌诊断、年龄较大、高合并症或低收入与未被纳入 CPP 的几率增加显著相关。
