在肝细胞癌的治疗结果和治疗选择的差异性和获取
Sara Beltrán Ponce1, Yevgeniya Gokun2, Francisca Douglass3
1Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Journal of the National Cancer Institute
|October 13, 2023
概括
健康影响的社会决定因素 肝细胞癌 (HCC) 存活率和治疗准入. 收入和阶段是关键预测因素,突出了需要紧急关注的护理差异.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 健康差距 研究 研究 研究 研究
背景情况:
- 肝细胞癌 (HCC) 不成比例地影响少数群体和社会经济地位较低的人群.
- 健康的社会决定因素 (SDH) 导致HCC护理获取和结果的差异.
- 了解SDH和HCC治疗之间的联系对于解决不平等至关重要.
研究的目的:
- 研究肝细胞癌 (HCC) 患者的健康社会决定因素 (SDH) 和生存率之间的关系.
- 分析SDH如何影响获得HCC的局部区域治疗选择的机会.
- 确定HCC中生存和治疗模式利用的关键预测因素.
主要方法:
- 利用国家癌症数据库 (2004-2017) 对140,340名HCC患者的队列.
- 评估生存率和获得非移植手术,肝移植 (LT) 和肝脏导向放射治疗 (LDRT) 的机会.
- 员工考克斯比例危险回归和主导分析,考虑临床阶段,年龄,种族,收入,农村和保险.
主要成果:
- 晚期,年龄较大,黑人种族,农村,公共保险,非学术中心和较低收入与HCC存活率较差有关.
- 阶段,年龄和收入是生存的最强有力的预测因素.
- 根据治疗方式,治疗机会有所不同:按阶段/设施/保险进行手术;按年龄/诊断年龄/并发症得分计算LT;根据诊断年龄/设施/并发症得分计算LDRT.
结论:
- 阶段,年龄和收入是HCC生存的主要预测因素.
- 保险和收入显著影响到手术治疗的获取,强调医疗保健的财务负担.
- 解决差距需要改善保险准入,减轻财务毒性,并使社区中心的护理平等.
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