澳大利亚新南威尔士州（NSW）相关数据显示，偏远地区和社会经济处于不利地位的女性在乳腺癌治疗和生存方面存在差异。
Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia.
机构信息
Cancer Epidemiology and Population Health Research Group, Allied Health & Human Performance, University of South Australia, Adelaide, Australia.
Cancer Institute NSW, Level 4, 1 Reserve Road, St Leonards, NSW, 2065, Australia.
出版信息
Breast Cancer Res Treat. 2021 Jul;188(2):547-560. doi: 10.1007/s10549-021-06170-2. Epub 2021 Mar 21.
INTRODUCTION
Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks.
METHODS
A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan-Meier product-limit estimates and multivariate competing risk regression.
RESULTS
Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival.
CONCLUSION
This study provides benchmarks for monitoring future variations in treatment and survival.
介绍
减少癌症治疗和生存的差异是新南威尔士州癌症计划的主要目标。本研究旨在调查新南威尔士州乳腺癌治疗和生存的差异，分析其与居住的偏远程度和社会经济地位的关系，以确定基准。减少癌症治疗和生存的差异是新南威尔士州癌症计划的主要目标。本研究旨在调查新南威尔士州乳腺癌治疗和生存的差异，分析其与居住的偏远程度和社会经济地位的关系，以确定基准。
方法
本研究采用回顾性队列研究，利用新南威尔士州癌症登记处 2002 年 5 月至 2015 年 12 月期间诊断的浸润性乳腺癌患者的相关数据，以及对应的住院、医疗和药物保险数据。采用逻辑回归分析探讨治疗方式、地区社会经济状况和居住偏远程度之间的关系。采用 Kaplan-Meier 乘积限估计和多变量竞争风险回归分析乳腺癌生存的预测因素。
结果
结果表明，新南威尔士州的 5 年疾病特异性生存率高达 90%。按居住偏远程度划分，粗生存率相当，而在社会经济水平较低的地区略低。竞争风险回归显示，除了最不处于不利地位的五分位数组外，不同地区社会经济状况的生存结果相当，该组的生存率更高。年龄在 70 岁及以上和更晚期的乳腺癌患者的死亡风险更高。调整分析显示，社会经济水平较低的地区分期更晚，乳房重建和放疗的比例较低，激素治疗的比例也较低。相反，在这些接受保乳手术的妇女中，化疗的使用率更高。在调整分析中，居住的偏远程度与放疗和即刻乳房重建的使用率较低有关。在这些短期数据中，居住的偏远程度与生存率的降低无关。
结论
本研究为监测未来治疗和生存的变化提供了基准。
Zotero 插件