Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, HPNP 3111, PO Box 100195, Gainesville, FL, 32610, USA.
Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Support Care Cancer. 2021 Feb;29(2):813-821. doi: 10.1007/s00520-020-05549-z. Epub 2020 Jun 4.
The USA has observed a significant increase in the use of palliative care for patients diagnosed with advanced cancer. However, it is unknown how geographic variation affects patients' use of palliative care services. We examined temporal and demographic trends in receipt of and timing of palliative care by state and region.
A retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Study sample included community-dwelling patients aged ≥ 65 years with metastatic lung cancer who were diagnosed between 2001 and 2015. Cochran-Armitage trend test was used to evaluate temporal trends in receipt of and timing of palliative care by states and census region.
The proportion of metastatic lung cancer patients who received palliative care ranged from 16.4% in Washington and 16.3% in Connecticut to 6.4% in Louisiana. From 2001 to 2015, use of palliative care increased from 3.2 to 29.8% in the West region, from 3.3 to 31.9% in the Northeast region, from 3.8 to 36.2% in the Midwest region, and from 0.9 to 23.3% in the South region (all P < 0.001). The median time from the date of cancer diagnosis to the date of first palliative care visit varied geographically, from 44 days in Utah to 66 days in California. Hospital-based palliative care was most common in these states.
The substantial geographic variation in the use of palliative care suggesting a need for additional research on geographic disparities in palliative care and strategies that might improve state-level palliative care delivery.
美国观察到，接受晚期癌症诊断的患者对姑息治疗的使用显著增加。然而，尚不清楚地理差异如何影响患者对姑息治疗服务的使用。我们检查了各州和地区姑息治疗接受情况和时间的时间和人口统计学趋势。
这是一项对监测、流行病学和最终结果（SEER）-医疗保险数据库的回顾性队列研究。研究样本包括年龄≥65 岁、患有转移性肺癌且在 2001 年至 2015 年间确诊的居住在社区的患者。采用 Cochran-Armitage 趋势检验评估各州和普查区姑息治疗接受情况和时间的时间趋势。
接受姑息治疗的转移性肺癌患者比例从华盛顿州的 16.4%和康涅狄格州的 16.3%到路易斯安那州的 6.4%不等。从 2001 年到 2015 年，西部地区姑息治疗的使用率从 3.2%增加到 29.8%，东北地区从 3.3%增加到 31.9%，中西部地区从 3.8%增加到 36.2%，南部地区从 0.9%增加到 23.3%（均 P<0.001）。从癌症诊断日期到首次姑息治疗就诊日期的中位时间在地理上有所不同，从犹他州的 44 天到加利福尼亚州的 66 天。这些州最常见的是基于医院的姑息治疗。
姑息治疗使用的巨大地理差异表明需要对姑息治疗的地理差异以及可能改善州级姑息治疗提供的策略进行更多研究。
