Supportive Care Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Depart. of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Dept. of Urology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, South Korea.
Disabil Health J. 2021 Oct;14(4):101125. doi: 10.1016/j.dhjo.2021.101125. Epub 2021 Jun 1.
Disparities in cancer care have not been well documented for individuals with disability.
To investigate potential disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status.
A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. Totals of 7924 prostate cancer cases among patients with disabilities (diagnosed between 2005 and 2013) and 34,188 PC patients without disability were included.
While overall PC stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18.1% vs. 16.2%, respectively). People with disabilities were less likely to undergo surgery (33.1% vs. 38.6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74-0.84), and more likely to receive androgen deprivation therapy (ADT) (57.9% vs. 55%, respectively; aOR 1.10, 95% CI 1.04-1.16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0.29 for surgery; 1.52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1.20; 95% CI, 1.15-1.25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1.11, 95% CI 1.04-1.18) than people without disability.
PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse.
残疾个体的癌症护理差异尚未得到充分记录。
根据残疾状况，调查前列腺癌（PC）患者诊断、治疗和生存方面的潜在差异。
使用残疾登记数据与韩国国家健康保险和国家癌症登记数据相链接的回顾性队列研究。共纳入 7924 例残疾患者（2005 年至 2013 年间确诊）和 34188 例非残疾 PC 患者。
尽管总体上 PC 诊断时的分期分布相似，但严重残疾患者中未知分期更为常见（分别为 18.1%和 16.2%）。与非残疾患者相比，残疾患者接受手术的可能性较小（分别为 33.1%和 38.6%；调整后的优势比[aOR]0.79，95%置信区间[CI]0.74-0.84），而接受雄激素剥夺疗法（ADT）的可能性更大（分别为 57.9%和 55%；aOR 1.10，95% CI 1.04-1.16）。对于严重脑/精神障碍患者，这种差异更为明显（手术的 aOR 为 0.29；ADT 的 aOR 为 1.52）。残疾患者的总死亡率较高（调整后的危害比[aHR]1.20；95%CI，1.15-1.25），但在调整患者因素和治疗后，PC 特异性死亡率仅略高（aHR 1.11，95%CI 1.04-1.18）。
与非残疾患者相比，接受 PC 诊断的残疾患者接受的分期检查较少，更有可能接受 ADT 治疗而非手术治疗。残疾 PC 患者的总死亡率高于非残疾 PC 患者，但 PC 特异性死亡率仅略高。
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