Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Gynecol Cancer. 2022 Jul 4;32(7):899-905. doi: 10.1136/ijgc-2021-003219.
To describe trends in healthcare system use over time between onset of classic ovarian cancer symptoms and ovarian cancer diagnosis in the United States.
A population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted on patients aged ≥66 years with stage II-IV epithelial ovarian cancer between 1992 and 2015 with at least one of the following diagnosis codes: abdominal pain, bloating, difficulty eating, and/or urinary symptoms. The outcomes were frequency of visit type, frequency of diagnostic modality, and Medicare reimbursement between first symptomatic claim and cancer diagnosis. Jonckheere-Terpstra and Cochran-Armitage tests were used to evaluate trends over time.
Among 13 872 women, 13 541 (97.6%) had outpatient, 6466 (46.6%) had inpatient, and 4906 (35.4%) had emergency room visits. The frequency of outpatient (p<0.001) and emergency room visits (p<0.001) increased while the frequency of inpatient visits (p<0.001) decreased between 1992 and 2015. The median number of outpatient visits (p<0.001) and physician specialties seen (p<0.001) increased over time. The median hospital length of stay decreased from 10 days in 1992 to 5 days in 2015 (p<0.001). Between 1992 and 2015, the frequency of ultrasound decreased (p<0.001) while the frequency of computed tomography, magnetic resonance imaging, positron emission tomography imaging, and cancer antigen 125 tumor immunoassay increased (p<0.001). Median monthly total (p<0.001), inpatient (p<0.001), and outpatient (p=0.006) reimbursements decreased while emergency room reimbursements increased (p<0.001) over time.
Healthcare reimbursement between symptomatic presentation and ovarian cancer diagnosis has decreased over time and may reflect the trends in fewer and shorter hospitalizations and increased use of emergency and outpatient management during the evaluation of symptoms of women with ovarian cancer.
描述美国经典卵巢癌症状出现到卵巢癌诊断之间，医疗系统使用随时间的变化趋势。
对 1992 年至 2015 年间年龄≥66 岁、患有 II-IV 期上皮性卵巢癌且至少有以下一种诊断代码的患者进行了一项基于人群的监测、流行病学和最终结果-医疗保险数据库研究：腹痛、腹胀、进食困难和/或泌尿系统症状。结果是首次出现症状性索赔与癌症诊断之间的就诊类型频率、诊断方式频率和医疗保险报销。使用 Jonckheere-Terpstra 和 Cochran-Armitage 检验来评估随时间的变化趋势。
在 13872 名女性中，13541 名（97.6%）有门诊就诊，6466 名（46.6%）有住院就诊，4906 名（35.4%）有急诊就诊。门诊就诊（p<0.001）和急诊就诊（p<0.001）的频率增加，而住院就诊（p<0.001）的频率降低，从 1992 年至 2015 年。门诊就诊次数（p<0.001）和就诊的医生专科（p<0.001）中位数随时间增加。医院住院时间中位数从 1992 年的 10 天缩短至 2015 年的 5 天（p<0.001）。1992 年至 2015 年期间，超声的频率降低（p<0.001），而计算机断层扫描、磁共振成像、正电子发射断层扫描成像和癌抗原 125 肿瘤免疫测定的频率增加（p<0.001）。每月总（p<0.001）、住院（p<0.001）和门诊（p=0.006）报销中位数随时间减少，而急诊报销增加（p<0.001）。
自症状出现到卵巢癌诊断的医疗保健报销随时间减少，这可能反映了女性卵巢癌症状评估期间住院时间减少和缩短、急诊和门诊管理增加的趋势。
