及时性护理对肺癌生存的影响——基于人群的方法。
The Effect of Timeliness of Care on Lung Cancer Survival - A Population-Based Approach.
机构信息
NOVA National School of Public Health, NOVA University of Lisbon, Portugal.
Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal.
出版信息
Ann Glob Health. 2023 Jun 5;89(1):39. doi: 10.5334/aogh.3845. eCollection 2023.
BACKGROUND
Timeliness of care is an important dimension of healthcare quality but it's unclear whether it improves clinical outcomes in lung cancer (LC) patients.
OBJECTIVES
This study aims to analyze treatment patterns, time-to-treatment (TTT) and the impact of treatment timeliness (TT) in overall survival (OS) of patients diagnosed with LC in 2009-2014 in a population-based registry from Southern Portugal.
MATERIALS AND METHODS
We estimated median TTT for overall population, treatment type and stage. The impact of treatment and TT on five-year OS was analyzed using the Kaplan-Meier method and Cox regression modelling to determine the hazard ratio (HR) of death associated with treatment and TT.
RESULTS
From the 11,308 cases diagnosed, 61.7% received treatment. Treatment rate decreased with increasing stage from 88% in stage I to 66.1% in stage IV. Overall median TTT was 49 days (IQR: 28-88) and 43.3% received TT. Surgery had a longer TTT than radiotherapy and systemic treatment. Patients in earlier stages had lower TT rates and longer TTT compared to more advanced, 24.7% and 80 days in stage I versus 51.3% and 42 days in stage IV (p < 0.0001). OS was 14.9% for total population and 19.6% and 7.1% for patients with and without treatment registered, respectively. TT had no observed impact on OS for stages I/II but a negative effect for stages III/IV. Relative to treated, the adjusted mortality risk was higher in untreated patients (HR = 2.240; 95%CI: 2.293-2.553). Contrary to treatment, TT had a negative impact on survival, with 11.3% in timely vs. 21.5% in untimely treated. Compared to untimely treated, the risk of death in TT patients was 46.6% higher (HR = 1.465; 95%CI: 1.381-1.555).
CONCLUSIONS
LC survival is highly dependent on early diagnosis and adequate treatment. Time-to-treatment was longer than recommended for all treatment types but particularly for surgery. Overall TT results were paradoxical, as better survival was observed in patients untimely treated. The factors associated with TT were not possible to analyze and its impact on patient outcomes remains unclear. However, it is important to assess quality-of-care to improved LC management.
背景
医疗及时性是医疗质量的一个重要维度，但尚不清楚它是否能改善肺癌（LC）患者的临床结局。
目的
本研究旨在分析葡萄牙南部人群基于登记的研究中，2009 年至 2014 年间诊断为 LC 的患者的治疗模式、治疗时间（TT）以及治疗及时性（TT）对总生存（OS）的影响。
材料和方法
我们估计了总体人群、治疗类型和分期的中位 TT。使用 Kaplan-Meier 方法和 Cox 回归模型分析治疗和 TT 对 5 年 OS 的影响，以确定与治疗和 TT 相关的死亡风险比（HR）。
结果
在诊断出的 11308 例患者中，61.7%接受了治疗。治疗率随分期的增加而降低，从 I 期的 88%降至 IV 期的 66.1%。总体中位 TT 为 49 天（IQR：28-88），43.3%的患者接受了 TT。手术的 TT 长于放疗和全身治疗。早期患者的 TT 率和 TT 较低，与更晚期患者相比，I 期患者的 TT 率和 TT 分别为 24.7%和 80 天，IV 期患者的 TT 率和 TT 分别为 51.3%和 42 天（p < 0.0001）。总人群的 OS 为 14.9%，有治疗和无治疗登记的患者的 OS 分别为 19.6%和 7.1%。TT 对 I/II 期无观察到的 OS 影响，但对 III/IV 期有负面影响。与治疗相比，未治疗患者的调整死亡率风险更高（HR=2.240；95%CI：2.293-2.553）。与治疗相反，TT 对生存有负面影响，及时 TT 的患者为 11.3%，不及时 TT 的患者为 21.5%。与不及时 TT 的患者相比，TT 患者的死亡风险高 46.6%（HR=1.465；95%CI：1.381-1.555）。
结论
LC 的生存高度依赖于早期诊断和充分治疗。所有治疗类型的 TT 都长于推荐时间，但手术尤其如此。总体 TT 结果具有矛盾性，因为不及时 TT 的患者的生存更好。无法分析与 TT 相关的因素，其对患者结局的影响仍不清楚。然而，评估医疗质量以改善 LC 管理非常重要。
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