UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States of America; Department of Population Health, Duke Health System, Durham, North Carolina, United States of America.
Department of Population Health, Duke Health System, Durham, North Carolina, United States of America.
Gynecol Oncol. 2021 Feb;160(2):469-476. doi: 10.1016/j.ygyno.2020.11.031. Epub 2020 Dec 2.
Palliative care (PC) is recommended for gynecological cancer patients to improve survival and quality-of-life. Our objective was to evaluate racial/ethnic disparities in PC utilization among patients with metastatic gynecologic cancer.
We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18-90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer who were deceased at last contact or follow-up (n = 124,729). PC was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in PC use.
The study population was primarily NH-White (74%), ovarian cancer patients (74%), insured by Medicare (47%) or privately insured (36%), and had a Charlson-Deyo score of zero (77%). Over one-third of patients were treated at a comprehensive community cancer program. Overall, 7% of metastatic gynecologic deceased cancer patients based on last follow-up utilized palliative care: more specifically, 5% of ovarian, 11% of cervical, and 12% of uterine metastatic cancer patients. Palliative care utilization increased over time starting at 4% in 2004 to as high as 13% in 2015, although palliative care use decreased to 7% in 2016. Among metastatic ovarian cancer patients, NH-Black (aOR:0.87, 95% CI:0.78-0.97) and Hispanic patients (aOR:0.77, 95% CI:0.66-0.91) were less likely to utilize PC when compared to NH-White patients. Similarly, Hispanic cervical cancer patients were less likely (aOR:0.75, 95% CI:0.63-0.88) to utilize PC when compared to NH-White patients.
PC is highly underutilized among metastatic gynecological cancer patients. Racial disparities exist in palliative care utilization among patients with metastatic gynecological cancer.
姑息治疗（PC）被推荐用于妇科癌症患者，以提高生存率和生活质量。我们的目的是评估转移性妇科癌症患者中 PC 使用的种族/民族差异。
我们使用了 2016 年国家癌症数据库（NCDB）的数据，纳入了年龄在 18-90 岁之间、患有转移性（III-IV 期）妇科癌症（包括卵巢癌、宫颈癌和子宫内膜癌）且在最后一次接触或随访时死亡或失访的患者（n=124729）。NCDB 将 PC 定义为非治愈性治疗，可包括手术、放疗、化疗、疼痛管理或任何组合。我们使用多变量逻辑回归来评估 PC 使用中的种族差异。
研究人群主要为 NH-白人（74%）、卵巢癌患者（74%）、由医疗保险（47%）或私人保险（36%）承保，Charlson-Deyo 评分为零（77%）。超过三分之一的患者在综合性社区癌症项目中接受治疗。总体而言，根据最后一次随访，7%的转移性妇科癌症死亡患者接受了姑息治疗：具体来说，5%的卵巢癌患者、11%的宫颈癌患者和 12%的子宫内膜癌患者接受了姑息治疗。姑息治疗的使用随着时间的推移而增加，从 2004 年的 4%增加到 2015 年的 13%，尽管 2016 年姑息治疗的使用降至 7%。在转移性卵巢癌患者中，与 NH-白人患者相比，NH-黑人（OR：0.87，95%CI：0.78-0.97）和西班牙裔患者（OR：0.77，95%CI：0.66-0.91）不太可能使用 PC。同样，与 NH-白人患者相比，西班牙裔宫颈癌患者不太可能使用 PC（OR：0.75，95%CI：0.63-0.88）。
转移性妇科癌症患者中 PC 的使用率非常低。转移性妇科癌症患者的姑息治疗使用率存在种族差异。
