地理因素对不可治愈的胰腺腺癌患者治疗和生存的影响：一项基于人群的分析。

Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis.

机构信息

1Faculty of Medicine, University of Toronto, Toronto, Ontario.

2Cancer Program - Evaluative Clinical Sciences, and.

出版信息

J Natl Compr Canc Netw. 2020 Dec 2;18(12):1642-1650. doi: 10.6004/jnccn.2020.7605. Print 2020 Dec.

DOI:10.6004/jnccn.2020.7605

PMID:33285520

Abstract

BACKGROUND

Little is known about how the geographic distribution of cancer services may influence disparities in outcomes for noncurable pancreatic adenocarcinoma. We therefore examined the geographic distribution of outcomes for this disease in relation to distance to cancer centers.

METHODS

We conducted a retrospective population-based analysis of adults in Ontario, Canada, diagnosed with noncurable pancreatic adenocarcinoma from 2004 through 2017 using linked administrative healthcare datasets. The exposure was distance from place of residence to the nearest cancer center providing medical oncology assessment and systemic therapy. Outcomes were medical oncology consultation, receipt of cancer-directed therapy, and overall survival. We examined the relationship between distance and outcomes using adjusted multivariable regression models.

RESULTS

Of 15,970 patients surviving a median of 3.3 months, 65.6% consulted medical oncology and 38.5% received systemic therapy. Regions with comparable outcomes were clustered throughout Ontario. Mapping revealed regional discordances between outcomes. Increasing distance (reference, ≤10 km) was independently associated with lower likelihood of medical oncology consultation (relative risks [95% CI] for 11-50, 51-100, and ≥101 km were 0.90 [0.83-0.98], 0.78 [0.62-0.99], and 0.77 [0.55-1.08], respectively) and worse survival (hazard ratios [95% CI] for 11-50, 51-100, and ≥101 km were 1.08 [1.04-1.12], 1.17 [1.10-1.25], and 1.10 [1.02-1.18], respectively), but not with likelihood of receiving therapy. Receipt of therapy seems less sensitive to distance, suggesting that distance limits entry into the cancer care system via oncology consultation. Regional outcome discordances suggest inefficiencies within and protective factors outside of the cancer care system.

CONCLUSIONS

These findings provide a basis for clinicians to optimize their practices for patients with noncurable pancreatic adenocarcinoma, for future studies investigating geographic barriers to care, and for regional interventions to improve access.

摘要

背景

对于癌症服务的地理分布如何影响不可治愈的胰腺腺癌患者结局的差异，我们知之甚少。因此，我们研究了与癌症中心距离相关的这种疾病的结局的地理分布。

方法

我们使用链接的行政医疗保健数据集，对加拿大安大略省 2004 年至 2017 年间被诊断为不可治愈的胰腺腺癌的成年人进行了回顾性基于人群的分析。暴露因素是从居住地到最近提供医学肿瘤评估和全身治疗的癌症中心的距离。结局是医学肿瘤学咨询、接受癌症定向治疗和总生存。我们使用调整后的多变量回归模型检查了距离与结局之间的关系。

结果

在中位生存时间为 3.3 个月的 15970 名患者中，65.6%接受了医学肿瘤学咨询，38.5%接受了系统治疗。安大略省各地都有类似的结果集群。绘图显示了结果之间存在区域差异。距离增加（参考，≤10km）与接受医学肿瘤学咨询的可能性降低独立相关（距离为 11-50km、51-100km 和≥101km 的相对风险[95%CI]分别为 0.90[0.83-0.98]、0.78[0.62-0.99]和 0.77[0.55-1.08]），生存状况更差（距离为 11-50km、51-100km 和≥101km 的风险比[95%CI]分别为 1.08[1.04-1.12]、1.17[1.10-1.25]和 1.10[1.02-1.18]），但与接受治疗的可能性无关。接受治疗似乎对距离不太敏感，这表明距离通过肿瘤学咨询限制了进入癌症护理系统的机会。区域结果差异表明癌症护理系统内部存在效率低下和外部存在保护因素。