Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California
| Autor: | Argyrios Ziogas, Jenny Chang, Krista S. Pfaendler, Kristine R. Penner, Robert E. Bristow |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Population Uterine Cervical Neoplasms Black People Medicare Article California Paediatrics and Reproductive Medicine 03 medical and health sciences 0302 clinical medicine Clinical Research Internal medicine Ethnicity Medicine Humans Healthcare Disparities education Obstetrics & Reproductive Medicine Proportional Hazards Models Aged Cancer Cervical cancer education.field_of_study 030219 obstetrics & reproductive medicine business.industry Medicaid Hazard ratio Obstetrics and Gynecology Odds ratio Guideline Middle Aged medicine.disease Survival Analysis United States Cancer registry Brain Disorders Social Class 030220 oncology & carcinogenesis Practice Guidelines as Topic Female Guideline Adherence business Cohort study |
| Zdroj: | Obstetrics and gynecology, vol 131, iss 5 |
| Popis: | OBJECTIVE: To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB–IIA cervical cancer and to analyze the relationship between adherent care and survival. METHODS: This is a retrospective population-based cohort study of patients with stage IB–IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer–specific 5-year survival. RESULTS: A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline–adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57–0.84), low–middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64–0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69–0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84–0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34–1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08–2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15–1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68–2.56) were all associated with increased risk of dying from cervical cancer. CONCLUSION: Among patients with early-stage cervical cancer, National Comprehensive Cancer Network guideline-nonadherent care was independently associated with increased cervical cancer–specific mortality along with black race and Medicaid payer status. Nonadherence was more prevalent in patients with older age, lower socioeconomic status, and receipt of care in low-volume centers. Attention should be paid to increase guideline adherence. |
| Databáze: | OpenAIRE |
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