对高危宫颈癌前病变患者进行快速切除治疗的相关因素

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-02-01 DOI:10.1016/j.gore.2024.101545

Rebecca B. Perkins , Lindsay Fuzzell , Naomi C. Brownstein , Holly B. Fontenot , Alexandra Michel , Sidika Kajtezovic , Paige Lake , Susan T. Vadaparampil

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引用次数: 0

摘要

背景：2019年ASCCP基于风险的管理共识指南更倾向于加速治疗，定义为对于筛查结果显示宫颈癌前病变高风险的患者，在不首先进行阴道镜活检的情况下进行手术切除治疗。在这个混合方法的研究中，我们探讨了临床医生对加速治疗的态度。方法：2021年，全国671名进行阴道镜检查的临床医生完成了调查；一个子集（n = 41）进行阴道镜检查和/或指导患者治疗的临床医生完成了定性访谈。结果：671名阴道镜医师中，25.7% %目前正在采用加速治疗，50.8%目前未采用但愿意采用这种改变，23.6%不愿意采用加速治疗。二项回归分析表明，内科和家庭医学临床医生（与妇产科医生相比）以及在学术奖章中心执业的临床医生（与私人执业相比）目前实施加速治疗的几率更高；内科和家庭医学临床医生也报告说，愿意接受这一改变的几率更高。定性访谈强调的益处包括改善老年患者的癌症预防，减少随访损失，减少患者的时间和费用，并允许共同决策。所表达的担忧与未来妊娠并发症、缺乏可用的切除治疗服务（例如LEEP）、患者偏好、避免治疗过度和治疗不足以及使用活检结果来计划切除手术有关。结论：目前约有25% %的阴道镜医师采用加速治疗，另有50% %的患者愿意对高危患者采用这种做法。改善适当患者获得快速治疗的机会可以改善宫颈癌的预防。

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Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer

Background

The 2019 ASCCP Risk-Based Management Consensus Guidelines prefer expedited treatment, defined as proceeding to excisional treatment without first performing colposcopic biopsy, for patients with screening results indicating a high risk of cervical precancer. In this mixed methods study, we explored clinician attitudes toward expedited treatment.

Methods

In 2021, a national sample of 671 clinicians who performed colposcopy completed surveys; a subset (n = 41) of clinicians who performed colposcopy and/or directed patient treatment completed qualitative interviews.

Results

Among 671 colposcopists, 25.7 % were currently performing expedited treatment, 50.8% were not currently using expedited treatment but were willing to adopt this change, and 23.6% were not willing to perform expedited treatment. Binomial regression analyses indicated that internal medicine and family medicine clinicians (compared to Obstetrician-Gynecologists), and those practicing in academic medal centers (compared to private practice) had higher odds of currently performing expedited treatment; internal and family medicine clinicians also reported higher odds of being willing to adopt this change. Qualitative interviews highlighted benefits including improved cancer prevention among older patients, reduced loss to follow-up, reduction of time and expense for patients, and allowing shared decision-making. Concerns expressed related to future pregnancy complications, lack of available excisional treatment services (e.g., LEEP), patient preference, avoiding over- and under-treatment, and using biopsy results to plan excisional procedures.

Conclusions

Approximately 25 % of colposcopists are currently performing expedited treatment, and an additional 50 % would be willing to adopt this practice for high-risk patients. Improving access to expedited treatment for appropriate patients could improve cervical cancer prevention.

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.