Park Yu Shin, Jang Sung-In, Shin Jaeyong, Nam Chung Mo, Park Eun-Cheol, Jang Suk-Yong
Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
Breast Cancer. 2025 Mar;32(2):337-346. doi: 10.1007/s12282-024-01659-2. Epub 2024 Dec 19.
Although the demand for care immediately after mastectomy is rising, and such medical services are referred to as post-acute care (PAC), there is limited evidence on the factors influencing PAC choices among these patients in Korea.
A total of 106,670 patients diagnosed with breast cancer and undergoing mastectomy were extracted from the Central Cancer Registry data from 2012 to 2019 using Public Cancer Library data of KCURE. PAC was defined as utilization of long-term care hospital (LTCH), hospital-based nursing care (HBNC), or HBC (hospital-based care) within 2 months post-surgery. Multinomial logistic regression was used to identify factors associated with different types of PAC utilization.
The utilization patterns of different types of PAC within 2 months after mastectomy were associated with age, income, cancer severity, and particularly the region of residence (Metropolitan; HBNC, OR 0.16, 95% CI 0.10-0.26; LTCH, OR 2.35, 95% CI 2.21-2.50; HBC, OR 2.17, 95% CI 1.97-2.39), as well as the location (capital areas; HBNC, OR 12.46, 95% CI 4.97-31.25; LTCH, OR 1.21, 95% CI 1.15-1.28; HBC, OR 1.90, 95% CI 1.74-2.07) and type of the hospital (tertiary hospital; HBNC, OR 13.70, 95% CI 7.86-23.86; LTCH, OR 1.45, 95% CI 1.37-1.53; HBC, OR 3.38, 95% CI 3.00-3.80) where the surgery was performed.
In this study, we found the factors associated with PAC utilization on mastectomy patients. Our study found that middle-aged breast cancer patients, residents of metropolitan or rural areas, and those who underwent surgery at hospitals in capital area were particularly associated with higher utilization of inpatient-related PAC services. Breast cancer patients with higher income, older adults, metropolitan residents, patients who underwent breast cancer surgery at metropolitan hospitals, and those treated at tertiary hospitals were strongly associated with higher utilization of HBNC services. Identifying factors that determine the use of PAC has meaningful implications for patients and healthcare systems.
尽管乳房切除术后对护理的需求正在上升，此类医疗服务被称为急性后期护理（PAC），但在韩国，关于影响这些患者PAC选择的因素的证据有限。
利用韩国癌症研究与教育基金会（KCURE）的公共癌症库数据，从2012年至2019年的中央癌症登记数据中提取了总共106670例诊断为乳腺癌并接受乳房切除术的患者。PAC被定义为术后2个月内使用长期护理医院（LTCH）、医院护理（HBNC）或医院护理（HBC）。采用多项逻辑回归来确定与不同类型PAC使用相关的因素。
乳房切除术后2个月内不同类型PAC的使用模式与年龄、收入、癌症严重程度相关，尤其与居住地区（大都市；HBNC，比值比[OR]0.16，95%置信区间[CI]0.10 - 0.26；LTCH，OR 2.35，95% CI 2.21 - 2.50；HBC，OR 2.17，95% CI 1.97 - 2.39）、手术地点（首都地区；HBNC，OR 12.46，95% CI 4.97 - 31.25；LTCH，OR 1.21，95% CI 1.15 - 1.28；HBC，OR 1.90，95% CI 1.74 - 2.07）以及手术所在医院的类型（三级医院；HBNC，OR 13.70，95% CI 7.86 - 23.86；LTCH，OR 1.45，95% CI 1.37 - 1.53；HBC，OR 3.38，95% CI 3.00 - 3.80）有关。
在本研究中，我们发现了与乳房切除患者PAC使用相关的因素。我们的研究发现，中年乳腺癌患者、大都市或农村地区居民以及在首都地区医院接受手术的患者尤其与住院相关PAC服务的较高使用率相关。收入较高的乳腺癌患者、老年人、大都市居民、在大都市医院接受乳腺癌手术的患者以及在三级医院接受治疗的患者与HBNC服务的较高使用率密切相关。确定决定PAC使用的因素对患者和医疗保健系统具有重要意义。
