Thamm Carla, Button Elise, Johal Jolyn, Knowles Reegan, Gulyani Aarti, Paterson Catherine, Halpern Michael T, Charalambous Andreas, Chan Alexandre, Aranda Sanchia, Taylor Carolyn, Chan Raymond J
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
Cancer and Palliative Care Outcomes Center, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
Cancer. 2025 Jan 1;131(1):e35646. doi: 10.1002/cncr.35646. Epub 2024 Nov 20.
This systematic review describes difference in patient-relevant outcomes between comprehensive cancers (CCCs) versus non-CCCs. Studies were identified in PubMed, Cochrane CENTRAL, Epistemonikos, and gray literature from January 2002 to May 2024. Data were extracted and appraised by two authors. Results were narratively synthesized, and meta-analyzed where appropriate. Of 2272 records screened, 36 observational studies were included, predominantly from the United States, and focused on adults with solid cancers. Compared to non-CCCs, studies consistently or predominantly reported superior outcomes at CCCs relating to mortality and survival, quality of peri- and postoperative care, rates of cancer recurrence or progression, and impact on symptoms and health-related quality of life. Meta-analysis showed a significantly lower overall mortality risk of 23% in CCCs compared to non-CCCs (hazard ratio, 0.77; 95% confidence interval, 0.74-0.81, p < .001), with medium heterogeneity (I = 64.61%; Q-test = 36.29, p < .01) observed between the studies. Studies reporting on health equity and costs outcomes consistently or predominantly favored non-CCCs over CCCs. Mixed results were reported for outcomes relating to time to care, palliative and end-of-life care, and health care utilization. The literature reports CCCs are associated with superior outcomes in many areas, especially around mortality and survival. Greater focus is needed to explore outcomes that are important to people with cancer including health-related quality of life, symptoms, and treatment experience, and economic evaluation. Rather than aiming for superior outcomes, CCCs should be striving to enable equitable, high value, patient-centered outcomes for all people affected by cancer.
本系统评价描述了综合性癌症中心（CCC）与非综合性癌症中心在患者相关结局方面的差异。通过检索2002年1月至2024年5月期间的PubMed、Cochrane CENTRAL、Epistemonikos以及灰色文献来确定研究。由两位作者提取并评估数据。对结果进行叙述性综合，并在适当情况下进行荟萃分析。在筛选的2272条记录中，纳入了36项观察性研究，这些研究主要来自美国，且聚焦于实体癌成人患者。与非综合性癌症中心相比，研究一致或主要报告称综合性癌症中心在死亡率和生存率、围手术期和术后护理质量、癌症复发或进展率以及对症状和健康相关生活质量的影响等方面有更优结局。荟萃分析显示，综合性癌症中心的总体死亡风险比非综合性癌症中心显著低23%（风险比，0.77；95%置信区间，0.74 - 0.81，p <.001），各研究之间观察到中等异质性（I = 64.61%；Q检验 = 36.29，p <.01）。报告健康公平性和成本结局的研究一致或主要表明非综合性癌症中心优于综合性癌症中心。关于获得护理时间、姑息治疗和临终关怀以及医疗保健利用等结局的报告结果不一。文献报道综合性癌症中心在许多领域与更优结局相关，尤其是在死亡率和生存率方面。需要更加关注探索对癌症患者重要的结局，包括健康相关生活质量、症状和治疗体验以及经济评估。综合性癌症中心不应追求卓越结局，而应努力为所有受癌症影响的人实现公平、高价值、以患者为中心的结局。
