一项全国范围的研究：胃食管结癌患者护理分散和医院肿瘤类型与生存的关系。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery Pub Date : 2025-01-16 DOI:10.1016/j.gassur.2025.101962

Rejoice F. Ngongoni , Hester C. Timmerhuis , Amy Y. Li , Heather Day , Jon Harrison , Brendan C. Visser

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引用次数: 0

摘要

背景：分散护理（FC）是由不同的提供者和/或设施提供的医疗保健。FC与预后较差有关，但它改善了获得专门癌症治疗的机会。我们的目的是确定碎片性胃食管结癌（GEJ）护理与生存的关系。方法：在这项回顾性队列研究中，在2007年1月1日至2017年12月31日期间被诊断为原发性GEJ癌的成年人，在加州癌症登记处（患者数据）中被确定，并与加州医疗保健访问和信息数据库（每个患者就诊的设施级数据）合并。FC通过数量来衡量，定义为患者在诊断后1年内访问的设施数量，以及FC方向性，定义为患者如何在不同的医疗保健设施（有/没有癌症中心指定）之间转换。采用多变量时变Cox回归模型确定FC与生存率的关系，以风险比（HR）表示。结果：共发现6025例患者。2919例（48.4%）FC患者中，1979例（67.8%）在两家医院就诊。FC数量的时变Cox回归显示FC数量与较高的死亡率相关（2个设施：HR:1.21,(1.12-1.31)）。结论：碎片化的GEJ癌症治疗与生存率降低相关。然而，将护理升级到指定的癌症设施可以减轻碎片化与生存率降低的有害关联。

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Association of care fragmentation and hospital cancer designation with survival in gastroesophageal junction cancer: a statewide study

Background

Fragmentation of care (FC) refers to healthcare provided by different providers and facilities. FC has been associated with inferior outcomes. However, it improves access to specialized cancer care. This study aimed to identify the association between fragmented gastroesophageal junction (GEJ) cancer care and survival.

Methods

In this retrospective cohort study, adults diagnosed with primary GEJ cancer between January 1, 2007, and December 31, 2017, were identified in the California Cancer Registry (patient data) and merged with the California Department of Healthcare Access and Information database (facility-level data for each patient encounter). FC was measured by quantity, defined as the number of facilities a patient visited within 1 year after diagnosis, and FC directionality, defined by how patients transitioned across different healthcare facilities (with/without cancer center designation). Multivariate time-varying Cox regression models were used to determine the association between FC and survival, which was expressed as hazard ratios (HRs).

Results

Overall, 6025 patients were identified. Of the 2919 patients (48.4%) who experienced FC, 1979 (67.8%) were observed at 2 facilities. Time-varying Cox regression for FC quantity showed that FC quantity was associated with higher mortality (2 facilities: HR, 1.21; 95% CI, 1.12–1.31; P <.001, 3 facilities: HR, 1.47; 95% CI, 1.31–1.65; P <.001; ≥4 facilities: HR, 2.34; 95% CI, 1.93–2.82; P <.001). Upgrading care received from a non-designated center to a designated center was associated with a higher survival than patients who received unfragmented non-designated care (HR: 1.40 [95% CI, 1.16–1.70; P=.001] vs 1.48 [95% CI, 1.29–1.70; P <.001] respectively).

Conclusion

Fragmented GEJ cancer care was associated with decreased survival rates. However, upgrading care from a nondesignated cancer facility to a designated cancer facility could mitigate the deleterious association between FC and decreased survival rates.

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.