在型DX测试和基于分数的治疗中基于社会经济和保险的不平等
Courtney P Williams1,2, Jessica Shuey3, Joud El Dick3
1Division of General Internal Medicine & Population Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Cancer medicine
|December 21, 2025
概括
社会经济因素和保险状况影响乳腺癌治疗决策. 瘤型DX (ODX) 测试利用和ODX评分导向治疗中的不平等导致符合条件的患者接受过度治疗和治疗不足.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 基因组医学是基因组医学.
背景情况:
- 个性化乳腺癌治疗越来越依赖于基因组测试,如型DX (ODX).
- 关于社会经济地位和保险如何影响ODX测试和随后的治疗决定的数据有限.
- 了解这些差异对于公平的癌症护理至关重要.
研究的目的:
- 调查社会经济地位和保险对使用ODX测试的影响.
- 检查这些因素如何影响ODX评分引导的辅助化疗治疗决策.
- 确定乳腺癌早期管理中的潜在不平等.
主要方法:
- 使用美国电子健康记录 (EHR) 数据库 (2011-2023) 的回顾性队列研究.
- 包括有早期,HR+/HER2-乳腺癌的妇女,有资格接受ODX检测.
- 社区贫困评估的社会经济状况;在诊断时捕获的保险状况. 利用Poisson模型来估计治疗可能性.
主要成果:
- 几乎一半的符合条件的患者 (47%) 接受了ODX测试;那些有商业保险和富裕背景的人更有可能接受测试.
- 富裕社区的患者比贫困社区的患者更频繁地接受辅助化疗,即使复发风险低 (潜在的过度治疗).
- 与私人保险患者相比,公共保险患者接受化疗的可能性是私人保险患者的两倍 (潜在的过度治疗);医疗保险受益者接受的化疗比私人保险患者少 (潜在的治疗不足).
结论:
- 基于社会经济和保险的差异导致了ODX测试的早期乳腺癌患者的过度治疗和治疗不足.
- 这些发现突出了重要的护理质量机会.
- 解决这些不平等问题对于确保公平和适当的个性化癌症治疗至关重要.
相关概念视频
02:56Treatment Resistant Cancers
3.7K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.7K
02:50Combination Therapies and Personalized Medicine
5.8K
Combining two or more treatment methods increases the life span of cancer patients while reducing damage to vital organs or tissue from the overuse of a single treatment. Combination therapy also targets different cancer-inducing pathways, thus reducing the chances of developing resistance to treatment.
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
5.8K
01:21Cancer Survival Analysis
629
Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
629
02:57Targeted Cancer Therapies
8.6K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
8.6K
02:49Cancer Therapies
9.8K
Cancer therapies are various modes of treatment, such as surgery, radiation therapy, and chemotherapy that are administered to cancer patients.
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
9.8K
01:27Nursing Ethical Principles II
2.0K
Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
2.0K