在早期乳腺癌的老年人中降级治疗的区域差异
Christina A Minami1,2,3, Tanujit Dey3,4, Yu-Jen Chen4
1Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA network open
|October 24, 2024
概括
地理区域,而不是患者因素,显著影响了老年妇女的乳腺癌治疗使用量减少. 决策支持应针对基于证据的治疗缓和率较低的地区,以减少过度治疗.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 老年医学 老年医学
背景情况:
- 试验数据支持70岁以上妇女的T1N0激素受体阳性 (HR+) 乳腺癌缺失手术和放射治疗 (RT).
- 过度治疗在老年人中仍然存在,特别是那些脆弱的人.
研究的目的:
- 量化早期HR+乳腺癌的局部区域治疗中的地理空间变化.
- 确定区域与患者因素对这种变化的相对贡献.
主要方法:
- 使用SEER-Medicare数据对70岁以上HR+/ERBB2-乳腺癌患者 (2013-2017年) 的女性进行了回顾性横截面研究.
- 层次的多变量建模,以评估因随机,区域 (卫生服务领域[HSA]),患者因素和无法解释的领域而导致的脱级护理 (缺失手术,RT或两者) 的差异.
- 患者的因素包括年龄,虚弱,查尔森并发症指数 (CCI) 和社会经济地位.
主要成果:
- 在9173名患者中,有50.9%接受了减级治疗.
- 区域/HSA解释了脱级治疗使用的差异的35.3%,而患者因素的差异为2.8%.
- 虚弱 (OR,1.70) 和年龄增加与更高的缓和疗法使用有关,而农村地区和非西班牙裔白人种族/种族与更低的使用有关.
结论:
- 在老年女性中,地理区域 (HSA) 是减缓乳腺癌治疗使用的较大驱动因素,而不是个体患者因素.
- 无法解释的变化表明未测量的因素,如多学科的护理和患者的偏好.
- 在降级率较低的地区,有针对性的决策支持对于解决过度处理至关重要.
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