驾驶时间、距离和社会经济因素对局部晚期直肠癌患者预后的影响。
The impact of driving time, distance, and socioeconomic factors on outcomes of patients with locally advanced rectal cancer.
作者信息
Gotfrit Joanna, Thangarasa Tharshika, Dudani Shaan, Goodwin Rachel, Tang Patricia A, Monzon Jose, Dennis Kristopher, Cheung Winson Y, Marginean Horia, Vickers Michael
机构信息
The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada.
Alberta Health Services, University of Calgary, 2500 University Drive NW Calgary, Alberta, T2N1N4, Canada.
出版信息
Public Health Pract (Oxf). 2020 May 24;1:100012. doi: 10.1016/j.puhip.2020.100012. eCollection 2020 Nov.
OBJECTIVES
Cancer patients experience disparities due to socioeconomic status (SES) factors. We assessed the impact of SES factors on outcomes in patients with locally advanced rectal cancer (LARC) who received neoadjuvant chemoradiation (nCRT) and surgery (Sx) in 3 Canadian provinces.
STUDY DESIGN
This study was a multi-institutional retrospective chart review.
METHODS
Associations among community characteristics (2016 Canadian Census data), distance and time to the cancer center (mapping software), and outcomes were evaluated using the CHORD multi-institutional database.
RESULTS
1,064 patients were included. Median age 62, 68% male, 15% lived in a rural community, 19% with median community household income >$50,000 CAD, median community proportion with post-secondary education 66%, 12% lived >100km away, and 18% lived >1 h away.Factors predictive of worse disease-free survival (DFS) and overall survival (OS) in univariate analysis included driving time >1 h, median community income ≤$50,000 CAD, driving distance >100km, and lower median community proportion with post-secondary education. Driving time >1 h remained significant in multivariate analysis for worse DFS (HR 1.47; 95% CI 1.14-1.90; p = 0.003) and OS (HR 1.60, 95% CI 1.19-2.16; p = 0.002).
CONCLUSION
Outcomes of patients with LARC undergoing nCRT are negatively associated with increased driving time to the cancer centre.
目的
癌症患者因社会经济地位（SES）因素而经历差异。我们评估了SES因素对在加拿大3个省份接受新辅助放化疗（nCRT）和手术（Sx）的局部晚期直肠癌（LARC）患者结局的影响。
研究设计
本研究是一项多机构回顾性病历审查。
方法
使用CHORD多机构数据库评估社区特征（2016年加拿大人口普查数据）、到癌症中心的距离和时间（地图软件）与结局之间的关联。
结果
共纳入1064例患者。中位年龄62岁，68%为男性，15%居住在农村社区，19%的社区家庭收入中位数>50,000加元，社区中接受过高等教育的比例中位数为66%，12%居住在距离>100公里处，18%居住在距离>1小时路程处。单因素分析中，预测无病生存期（DFS）和总生存期（OS）较差的因素包括驾驶时间>1小时、社区收入中位数≤50,000加元、驾驶距离>100公里以及社区中接受过高等教育的比例中位数较低。在多因素分析中，驾驶时间>1小时对于较差的DFS（风险比[HR] 1.47；95%置信区间[CI] 1.14 - 1.90；p = 0.003）和OS（HR 1.60，95% CI 1.19 - 2.16；p = 0.002）仍然具有显著意义。
结论
接受nCRT的LARC患者的结局与到癌症中心的驾驶时间增加呈负相关。
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