基于计划的肺癌治疗:一项前瞻性观察性肿瘤登记关联研究。

Wei Liao PhD , Meredith Ray PhD , Carrie Fehnel BBA , Jordan Goss MA , Catherine J. Shepherd MFA , Anita Patel MHA , Talat Qureshi BS , Federico Caro BA , Jessica Roma AS , Anna Derrick AA , Anberitha T. Matthews PhD , Nicholas R. Faris M. Div , Matthew Smeltzer PhD , Raymond U. Osarogiagbon M.B.B.S., FACP
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引用次数: 0

摘要

导言低剂量计算机断层扫描筛查(LDCT)和肺结节计划(LNP)促进了早期肺癌的发现,提高了生存率;多学科护理计划(MDC)促进了与指南相一致的护理。这种基于项目的治疗对 "真实世界 "肺癌生存率的影响尚未量化。我们评估了社区医疗系统中通过结构化计划提供的肺癌治疗效果。方法我们进行了一项队列研究,将机构前瞻性观察性 LDCT、LNP 和 MDC 数据库与浸信会癌症中心设施的肿瘤登记处联系起来。我们将 2011 年至 2021 年期间确诊的所有肺癌患者分为基于项目的治疗队列和非基于项目的治疗队列。结果 在12148名患者中,通过LDCT、LNP、MDC或无计划诊断的患者分别为237、1165、1140和9606人;非计划治疗的比例从96.3%依次下降到66.5%。3%降至66.5%,通过LDCT确诊的比例从0.5%增至7.1%,通过LNP确诊的比例从3.5%增至20.8%;而仅通过MDC确诊的比例则从2014年最高的12.8%降至2021年的5.6%。基于计划的治疗与较早的分期(p <0.001)、较高的手术切除率(p <0.001)、较多的辅助治疗(p <0.001)、较好的总生存率和分期生存率(p <0.001)以及较低的全因死亡率和肺癌特异性死亡率(p <0.001)相关。接受非计划治疗的患者接受肺癌治疗的可能性要低得多;如果排除未接受治疗的患者,结果仍然一致。作为一项紧迫的公共政策,应探讨增加获得基于计划的护理的机会。
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Program-Based Lung Cancer Care: A Prospective Observational Tumor Registry Linkage Study

Introduction

Low-dose computed tomography screening (LDCT) and lung nodule programs (LNP) promote early lung cancer detection, improve survival; Multidisciplinary Care Programs (MDC) promote guideline-concordant care. The impact of such program-based care on “real-world” lung cancer survival is unquantified. We evaluated outcomes of lung cancer care delivered through structured programs in a community health care system.

Methods

We conducted a cohort study linking institutional prospective observational LDCT, LNP and MDC databases with Tumor Registry of Baptist Cancer Center facilities. We categorized all patients diagnosed with lung cancer between 2011 and 2021 into program-based care versus non-program-based care cohorts. We compared patient characteristics, stage distribution, treatment modalities, survival and mortality in each pathway of care.

Results

Of 12,148 patients, 237, 1,165, 1,140 and 9,606 were diagnosed through the LDCT, LNP, MDC or no program, respectively; non-program-based care sequentially diminished from 96.3% to 66.5%, diagnosis through LDCT increased from 0.5% to 7.1%, LNP from 3.5% to 20.8%; and MDC alone decreased from a high of 12.8% in 2014 to 5.6% in 2021. Program-based care was associated with earlier stage (p < 0.001), higher surgical resection rates (p < 0.001), greater use of adjuvant therapy (p < 0.001), better aggregate and stage-stratified survival (p < 0.001), and lower all-cause and lung cancer-specific mortality (p < 0.001). Recipients of non-program-based care were considerably less likely to receive lung cancer treatment; results remained consistent when patients receiving no treatment were excluded.

Conclusions

Program-based care was associated with substantially better survival. Increasing access to program-based care should be explored as a matter of urgent public policy.

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CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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