Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America; Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America.
Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America; Iowa Cancer Registry, State Health Registry of Iowa, University of Iowa, Iowa City, IA, United States of America.
Gynecol Oncol. 2022 Jan;164(1):3-11. doi: 10.1016/j.ygyno.2021.11.001. Epub 2021 Nov 12.
We aim to evaluate the impact gynecologic oncologists have on ovarian cancer adjuvant chemotherapy care from their role as surgeons recommending adjuvant chemotherapy care and their role as adjuvant chemotherapy providers while considering rural-urban differences.
Multivariable adjusted logistic regressions and Cox proportional hazards models were developed using a population-based, retrospective cohort of stage II-IV and unknown stage ovarian cancer patients diagnosed in Iowa, Kansas, and Missouri in 2010-2012 whose medical records were abstracted in 2017-2018.
Gynecologic oncologist surgeons (versus other type of surgeon) were associated with increased odds of adjuvant chemotherapy initiation (adjusted odds ratio (OR) 2.18; 95% confidence interval (CI) 1.10-4.33) and having a gynecologic oncologist adjuvant chemotherapy provider (OR 10.0; 95% CI 4.58-21.8). Independent of type of surgeon, rural patients were less likely to have a gynecologic oncologist chemotherapy provider (OR 0.52; 95% CI 0.30-0.91). Gynecologic oncologist adjuvant chemotherapy providers (versus other providers) were associated with decreased surgery-to-chemotherapy time (rural: 6 days; urban: 8 days) and increased distance to chemotherapy (rural: 22 miles; urban: 11 miles). Rural women (versus urban) traveled 38 miles farther when their chemotherapy provider was a gynecologic oncologist and 27 miles farther when it was not.
Gynecologic oncologist surgeons may impact adjuvant chemotherapy initiation. Gynecologic oncologists serving as adjuvant chemotherapy providers were associated with some care benefits, such as reduced time from surgery-to-chemotherapy, and some care barriers, such as travel distance. The barriers and benefits of having a gynecologic oncologist involved in adjuvant chemotherapy care, including rural-urban differences, warrant further research in other populations.
本研究旨在评估妇科肿瘤学家在卵巢癌辅助化疗中的作用，包括作为推荐辅助化疗的外科医生和作为辅助化疗提供者的作用，并考虑城乡差异。
使用 2010-2012 年在爱荷华州、堪萨斯州和密苏里州诊断的 II-IV 期和未知期卵巢癌患者的基于人群的回顾性队列，对其病历进行了 2017-2018 年的提取，采用多变量调整逻辑回归和 Cox 比例风险模型进行分析。
妇科肿瘤学家外科医生（与其他类型的外科医生相比）与辅助化疗开始的几率增加相关（调整后的优势比（OR）2.18；95%置信区间（CI）1.10-4.33），并且有妇科肿瘤学家辅助化疗提供者（OR 10.0；95%CI 4.58-21.8）。独立于外科医生的类型，农村患者更不可能有妇科肿瘤学家化疗提供者（OR 0.52；95%CI 0.30-0.91）。妇科肿瘤学家辅助化疗提供者（与其他提供者相比）与手术至化疗时间减少（农村：6 天；城市：8 天）和化疗距离增加（农村：22 英里；城市：11 英里）相关。当化疗提供者是妇科肿瘤学家时，农村女性（与城市女性相比）多行驶 38 英里，当不是时多行驶 27 英里。
妇科肿瘤学家外科医生可能会影响辅助化疗的启动。作为辅助化疗提供者的妇科肿瘤学家与一些护理益处相关，例如手术至化疗的时间减少，以及一些护理障碍，例如旅行距离。妇科肿瘤学家参与辅助化疗护理的障碍和益处，包括城乡差异，需要在其他人群中进一步研究。
