Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK.
Clin Oncol (R Coll Radiol). 2024 Oct;36(10):e398-e407. doi: 10.1016/j.clon.2024.06.050. Epub 2024 Jun 26.
This national study investigated hospital quality and patient factors associated with treatment location for systemic anticancer treatment (SACT) in patients with metastatic cancers.
Using linked administrative datasets from the English NHS, we identified all patients diagnosed with metastatic breast and bowel cancer between 1 January 2016 and 31 December 2018, who subsequently received SACT within 4 months from diagnosis. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regression models were used to estimate the impact of travel time, hospital quality and patient characteristics on where patients underwent SACT.
541 of 2,364 women (22.9%) diagnosed with metastatic breast cancer, and 2,809 of 10,050 (28.0%) patients diagnosed with metastatic bowel cancer bypassed their nearest hospital providing SACT. There was a strong preference for receiving treatment at hospitals near where patients lived (p < 0.001). However, patients who were younger (p = 0.043 for breast cancer; p < 0.001 for bowel cancer) or from rural areas (p = 0.001 for breast cancer; p < 0.001 for bowel cancer) were more likely to travel to more distant hospitals. Patients diagnosed with rectal cancer were more likely to travel further for SACT than patients with colon cancer (p = 0.002). Patients were more likely to travel to comprehensive cancer centres (p = 0.019 for bowel cancer) and designated Experimental Cancer Medicine Centres (ECMCs) although the latter association was not significant. Patients were less likely to receive SACT in hospitals with the highest readmission rates (p = 0.046 for bowel cancer).
Patients with metastatic cancer receiving primary SACT are prepared to travel to alternative more distant hospitals for treatment with a preference for larger comprehensive centres providing multimodal care or hospitals which offer early phase cancer clinical trials.
本项全国性研究调查了与转移性癌症患者接受全身性抗癌治疗（SACT）的治疗地点相关的医院质量和患者因素。
我们使用来自英国国民保健制度（NHS）的链接行政数据集，确定了所有在 2016 年 1 月 1 日至 2018 年 12 月 31 日期间被诊断为转移性乳腺癌和结直肠癌的患者，随后在诊断后 4 个月内接受 SACT。使用地理信息系统（ArcGIS）调查患者绕过最近医院的程度。使用条件逻辑回归模型来估计旅行时间、医院质量和患者特征对患者接受 SACT 的位置的影响。
541 名被诊断为转移性乳腺癌的女性（22.9%）和 2809 名被诊断为转移性结直肠癌的患者（28.0%）绕过了最近提供 SACT 的医院。患者强烈倾向于在居住地附近的医院接受治疗（p<0.001）。然而，年龄较小的患者（p=0.043 乳腺癌；p<0.001 结直肠癌）或来自农村地区的患者（p=0.001 乳腺癌；p<0.001 结直肠癌）更有可能前往更远的医院。与结肠癌患者相比，被诊断为直肠癌的患者更有可能进行更远距离的 SACT（p=0.002）。尽管与指定的实验性癌症治疗中心（ECMCs）的关联没有统计学意义，但患者更有可能前往综合性癌症中心（p=0.019 结直肠癌）和指定的实验性癌症治疗中心（ECMCs）。患者在住院率最高的医院接受 SACT 的可能性较低（p=0.046 结直肠癌）。
接受初次 SACT 的转移性癌症患者愿意前往替代的更远距离的医院进行治疗，他们更倾向于选择提供多模式治疗的大型综合性中心或提供早期癌症临床试验的医院。
