患者和提供者因素预测复杂的上部胃肠道癌症的非手术管理
Hanna H Kakish1, Alexander W Loftus2, Fasih Ali Ahmed2
1Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH. Electronic address: https://twitter.com/HannaKakish.
Surgery
|June 30, 2023
概括
手术是治疗上部胃肠道癌症的唯一潜在的治疗方法. 诸如年龄,种族和社会经济地位等因素显著影响手术决策和生存结果,这表明在护理方面存在潜在的偏见.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 手术为非转移性上部胃肠道癌症提供了唯一的潜在治疗方法.
- 非手术治疗是常见的,需要对相关患者和提供者特征进行分析.
研究的目的:
- 确定与患者拒绝或禁忌接受上部胃肠道癌症手术相关的因素.
- 分析这些因素对整体存活率的影响.
主要方法:
- 在国家癌症数据库 (2004-2018) 中查询了患上胃肠道上部癌症的患者.
- 多变量后勤回归和卡普兰-梅尔曲线被用来确定非手术管理的预测因素和评估生存率.
- 分析了患者的人口统计,社会经济地位,保险,并发病症和设施特征.
主要成果:
- 在249,813名患者中,86.3%接受了手术,2.4%拒绝了手术,11.3%有禁忌.
- 手术拒绝/禁忌与年龄较大,黑人种族,并发症,低社会经济地位,缺乏保险,社区癌症计划,低体积设施和第三阶段疾病有关.
- 与接受手术 (48.2个月) 患者相比,拒绝 (16.3个月) 或有禁忌 (9.4个月) 的患者的中位生存时间明显较低.
结论:
- 拒绝和对手术的禁忌显著降低了上部胃肠道癌症患者的整体存活率.
- 非手术治疗的预测因素与影响生存的因素重叠,包括种族,社会经济地位和医院特征.
- 这些发现突出了关于癌症手术的医生和患者讨论中的潜在变化和偏见.
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