癌症患者结局的数十年间地域差异：监测、流行病学和最终结果。
Geographic Disparity of Outcome in Patients With Cancer Over Decades: The Surveillance, Epidemiology, and End Results.
机构信息
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
出版信息
Clin Lymphoma Myeloma Leuk. 2023 Nov;23(11):e369-e378. doi: 10.1016/j.clml.2023.08.001. Epub 2023 Aug 6.
BACKGROUND
Improvements in prevention, early detection, and effective cancer therapy have decreased cancer-related mortality; however, significant health disparities exist. Therefore, we investigated the impact of these disparities on survival.
METHODS
In the Surveillance, Epidemiology, and End Results, we identified 784,341 patients with cancer between 1990 and 2016 in Georgia, 68,493 between 1990 and 1999; 371,353 between 2000 and 2009; and 322,932 between 2010 and 2016. We assessed the overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer, given the dramatic improvement in outcomes in patients with CML since 2000 compared to the generally considerably worse outcomes in lung cancer. In addition, we assessed the distance from each county to the Georgia Cancer Center (GCC) or the National Cancer Institute-designated Cancer Center (NCI-CC).
RESULTS
The 5-year OS of patients with any cancer was 55%, and the 5-year OS of each county ranged from 33% to 82% (interquartile range, 51%-65%) (P < .001). In patients with lung cancer and CML, the 5-year OS rates were 15% and 52%, respectively. The geographic differences between counties were relatively small and constant over time for patients with lung cancer. However, geographic differences were more prominent in patients with CML and widened after the introduction of modern therapies. Multivariate Cox regression showed that age, median county income, race, and distance to GCC or NCI-CC were predictive factors.
CONCLUSIONS
Significant disparities in cancer care exist among geographic locations. Geographic differences in survival appear more prominent when highly effective therapies are available.
背景
预防、早期发现和有效的癌症治疗方面的进步降低了癌症相关死亡率；然而，仍然存在显著的健康差异。因此，我们研究了这些差异对生存的影响。
方法
我们在监测、流行病学和结果数据库中确定了 1990 年至 2016 年期间佐治亚州的 784341 例癌症患者，1990 年至 1999 年为 68493 例，2000 年至 2009 年为 371353 例，2010 年至 2016 年为 322932 例。我们评估了所有癌症、慢性髓性白血病（CML）和肺癌患者的总生存（OS），因为与肺癌相比，自 2000 年以来 CML 患者的治疗效果显著改善。此外，我们还评估了每个县到佐治亚癌症中心（GCC）或国家癌症研究所指定癌症中心（NCI-CC）的距离。
结果
所有癌症患者的 5 年 OS 为 55%，每个县的 5 年 OS 范围为 33%至 82%（四分位距为 51%至 65%）（P<0.001）。肺癌和 CML 患者的 5 年 OS 率分别为 15%和 52%。对于肺癌患者，县与县之间的地理差异相对较小且随时间保持不变。然而，对于 CML 患者，地理差异更为显著，并且在引入现代疗法后扩大。多变量 Cox 回归显示，年龄、县中位数收入、种族以及与 GCC 或 NCI-CC 的距离是预测因素。
结论
癌症治疗方面存在显著的地域差异。在提供高效治疗方法时，生存方面的地理差异更为明显。
Zotero 插件