Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK.
Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
BMJ Open. 2020 Nov 26;10(11):e038471. doi: 10.1136/bmjopen-2020-038471.
In England, healthcare policy advocates specialised age-appropriate services for teenagers and young adults (TYA), those aged 13 to 24 years at diagnosis. Specialist Principal Treatment Centres (PTC) provide enhanced TYA age-specific care, although many still receive care in adult or children's cancer services. We present the first prospective structured analysis of quality of life (QOL) associated with the amount of care received in a TYA-PTC DESIGN: Longitudinal cohort study.
Hospitals delivering inpatient cancer care in England.
1114 young people aged 13 to 24 years newly diagnosed with cancer.
Exposure to the TYA-PTC defined as patients receiving NO-TYA-PTC care with those receiving ALL-TYA-PTC and SOME-TYA-PTC care.
Quality of life measured at five time points: 6, 12, 18, 24 and 36 months after diagnosis.
Group mean total QOL improved over time for all patients, but for those receiving NO-TYA-PTC was an average of 5.63 points higher (95% CI 2.77 to 8.49) than in young people receiving SOME-TYA-PTC care, and 4·17 points higher (95% CI 1.07 to 7.28) compared with ALL-TYA-PTC care. Differences were greatest 6 months after diagnosis, reduced over time and did not meet the 8-point level that is proposed to be clinically significant. Young people receiving NO-TYA-PTC care were more likely to have been offered a choice of place of care, be older, from more deprived areas, in work and have less severe disease. However, analyses adjusting for confounding factors did not explain the differences between TYA groups.
Receipt of some or all care in a TYA-PTC was associated with lower QOL shortly after cancer diagnosis. The NO-TYA-PTC group had higher QOL 3 years after diagnosis, however those receiving all or some care in a TYA-PTC experienced more rapid QOL improvements. Receipt of some care in a TYA-PTC requires further study.
在英国，医疗保健政策提倡为青少年和年轻人（13 至 24 岁确诊）提供专门的适龄服务。专科主要治疗中心（PTC）提供增强的青少年年龄特异性护理，尽管许多人仍在成人或儿童癌症服务中接受护理。我们首次对在 TYA-PTC 中接受护理量相关的生活质量（QOL）进行了前瞻性结构化分析。
纵向队列研究。
在英格兰提供住院癌症护理的医院。
1114 名新诊断为癌症的 13 至 24 岁的年轻人。
暴露于 TYA-PTC 定义为接受 NO-TYA-PTC 护理的患者与接受 ALL-TYA-PTC 和 SOME-TYA-PTC 护理的患者。
生活质量在五个时间点进行测量：诊断后 6、12、18、24 和 36 个月。
所有患者的组平均总 QOL 随时间推移而改善，但对于接受 NO-TYA-PTC 护理的患者，其 QOL 平均比接受 SOME-TYA-PTC 护理的患者高 5.63 分（95%CI 2.77 至 8.49），比接受 ALL-TYA-PTC 护理的患者高 4.17 分（95%CI 1.07 至 7.28）。差异在诊断后 6 个月最大，随时间推移而减少，且未达到建议的 8 分临床显著水平。接受 NO-TYA-PTC 护理的年轻人更有可能被提供护理地点的选择，年龄更大，来自更贫困的地区，在职，且疾病较轻。然而，调整混杂因素的分析并未解释 TYA 组之间的差异。
在 TYA-PTC 中接受部分或全部护理与癌症诊断后不久的 QOL 较低相关。在诊断后 3 年，NO-TYA-PTC 组的 QOL 较高，然而，在 TYA-PTC 中接受全部或部分护理的患者经历了更快的 QOL 改善。在 TYA-PTC 中接受部分护理需要进一步研究。
