Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
Cancer Epidemiology Program, Center for Immunization and Infection Research in Cancer (CIIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
Int J Environ Res Public Health. 2021 Jun 4;18(11):6040. doi: 10.3390/ijerph18116040.
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004-2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III-IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53-2.12), and cervical (aOR: 1.45,95% CI: 1.26-1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48-0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60-0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58-0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.
姑息治疗可以提高生活质量并延长生存时间，但在美国（U.S.），妇科癌症患者对此的利用率较低。我们的目标是评估医疗保健获取（HCA）措施与美国妇科癌症患者总体以及按种族/族裔使用姑息治疗之间的关联。我们使用了 2004 年至 2016 年美国国家癌症数据库的数据，纳入了转移性（初诊时为 III-IV 期）卵巢癌、宫颈癌和子宫癌患者（n = 176,899）。姑息治疗被定义为非治愈性治疗，可包括手术、放疗、化疗和疼痛管理，或任何组合。HCA 措施包括保险类型、地区社会经济水平、距医疗机构距离和癌症治疗机构类型。我们使用多变量逻辑回归评估了 HCA 措施与姑息治疗使用的关联，总体和按种族/族裔进行分析。我们的人群主要是非西班牙裔白人（72%），患有卵巢癌（72%），24%的患者生存时间<6 个月。5%的转移性妇科癌症患者使用了姑息治疗。与拥有私人保险的患者相比，没有保险的卵巢癌（aOR：1.80，95%CI：1.53-2.12）和宫颈癌（aOR：1.45，95%CI：1.26-1.67）患者更有可能使用姑息治疗。卵巢癌（aOR：0.58，95%CI：0.48-0.70）或宫颈癌（aOR：0.74，95%CI：0.60-0.88）患者距其医疗机构>45 英里，使用姑息治疗的可能性低于距医疗机构<2 英里的患者。与在社区癌症项目中接受治疗的患者相比，在学术/研究项目中接受治疗的卵巢癌患者使用姑息治疗的可能性较低（aOR：0.70，95%CI：0.58-0.84）。HCA 措施与姑息治疗使用之间的关联在美国不同种族/族裔群体中基本一致。保险类型、癌症治疗机构类型和距医疗机构的距离可能会影响美国转移性妇科癌症患者姑息治疗的使用。
