宫颈癌治疗的起始和生存：居住与癌症护理的接近程度的作用。

Cervical cancer treatment initiation and survival: The role of residential proximity to cancer care.

机构信息

Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, SC, United States of America; Rural and Minority Health Research Center, University of South Carolina Arnold School of Public Health, Columbia, SC, United States of America.

Rural and Minority Health Research Center, University of South Carolina Arnold School of Public Health, Columbia, SC, United States of America.

出版信息

Gynecol Oncol. 2021 Jan;160(1):219-226. doi: 10.1016/j.ygyno.2020.10.006. Epub 2020 Oct 17.

DOI:10.1016/j.ygyno.2020.10.006

PMID:33081985

Abstract

OBJECTIVE

To examine the role of driving time to cancer care facilities on days to cancer treatment initiation and cause-specific survival for cervical cancer patients.

METHODS

A retrospective cohort analysis of patients diagnosed with invasive cervical cancer during 2001-2016, using South Carolina Central Cancer Registry data linked to vital records. Kaplan-Meier survival curves and Cox proportional hazards models were used to examine the association of driving times to both a patient's nearest and actual cancer treatment initiation facility with cause-specific survival and time to treatment initiation.

RESULTS

Of 2518 eligible patients, median cause-specific survival was 49 months (interquartile, 17-116) and time to cancer treatment initiation was 21 days (interquartile, 0-40). Compared to patients living within 15 min of the nearest cancer provider, those living more than 30 min away were less likely to receive initial treatment at teaching hospitals, Joint Commission accredited facilities, and/or Commission on Cancer accredited facilities. After controlling for patient, clinical, and provider characteristics, no significant associations existed between driving times to the nearest cancer provider and survival/time to treatment. When examining driving times to treatment initiation (rather than simply nearest) provider, patients who traveled farther than 30 min to their actual providers had delayed initiation of cancer treatment (hazard ratio, 0.81; 95% confidence interval, 0.73-0.90), including surgery (0.82; 95% CI, 0.72-0.92) and radiotherapy (0.82, 95% CI, 0.72-0.94). Traveling farther than 30 min to the first treating provider was not associated with worse cause-specific survival.

CONCLUSIONS

For cervical cancer patients, driving time to chosen treatment providers, but not to the nearest cancer care provider, was associated with prolonged time to treatment initiation. Neither was associated with survival.

摘要

目的

探讨前往癌症治疗机构的时间对宫颈癌患者治疗起始时间和癌症特异性生存的影响。

方法

采用南卡罗来纳州中央癌症登记处数据与生命记录相关联的回顾性队列分析，对 2001 年至 2016 年间诊断为浸润性宫颈癌的患者进行分析。使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型，检验患者前往最近和实际癌症治疗启动机构的时间与癌症特异性生存和治疗起始时间之间的关系。

结果

在 2518 名符合条件的患者中，中位癌症特异性生存时间为 49 个月（四分位距，17-116），癌症治疗起始时间为 21 天（四分位距，0-40）。与居住在距离最近癌症提供者 15 分钟以内的患者相比，居住距离超过 30 分钟的患者不太可能在教学医院、联合委员会认证机构和/或癌症委员会认证机构接受初始治疗。在控制患者、临床和提供者特征后，前往最近癌症提供者的时间与生存/治疗起始时间之间没有显著关联。当检查到治疗启动时（而不仅仅是最近）的提供者的驾驶时间时，那些前往实际提供者的距离超过 30 分钟的患者癌症治疗的起始时间延迟（风险比，0.81；95%置信区间，0.73-0.90），包括手术（0.82；95%置信区间，0.72-0.92）和放疗（0.82，95%置信区间，0.72-0.94）。前往第一个治疗提供者的距离超过 30 分钟与癌症特异性生存无明显相关性。