政策与头颈癌患者接受姑息治疗的关系

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-05-09 DOI:10.1002/hed.28185

Soraya Fereydooni, Sarina Fereydooni, Lauren Williams, Avanti Verma, Benjamin Judson

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引用次数: 0

摘要

背景：头颈部鳞状细胞癌在晚期表现出严重的症状负担，但只有一小部分患者接受姑息治疗（PC）。医疗补助扩张和各州特定的个人电脑政策可能会影响这一人群对个人电脑的吸收。目的：本研究评估医疗补助扩大和州一级PC法律对美国III期和IV期HNC患者PC使用的影响。方法：使用2015-2020年国家癌症数据库（NCDB）数据，我们确定了III期或IV期癌症且预后低于6个月的死亡HNC患者。使用调整后的逻辑回归，我们分析了医疗补助扩大在个人电脑利用率中的作用。此外，耶鲁姑息治疗GPS被用来评估州PC法的分布。结果：在10305名符合条件的患者中，69.7%来自医疗补助扩张州。医疗补助扩大（aOR: 1.22, 95% CI: 1.01-1.49）、较高的Charles合并症指数（CCI≥3 vs. CCI = 1, aOR: 1.84, 95% CI: 1.16-2.81）以及老年患者使用PC的增加相关。在PC法律实施方面存在地域差异，西部制定/通过的法律最多，而东北部的PC利用率最高。结论：医疗补助扩大和特定的州PC法对晚期HNC患者PC获取有积极影响。这些发现强调了政策干预在提高易感癌症人群PC可及性和利用方面的潜力。

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Association of Policy With Palliative Care Uptake in Patients With Head and Neck Cancer.

Background: Head and neck squamous cell carcinoma presents substantial symptom burdens in advanced stages, yet only a small fraction of patients receive palliative care (PC). Medicaid expansion and state-specific PC policies may influence PC uptake in this population.

Objective: This study evaluates the impact of Medicaid expansion and state-level PC laws on PC utilization among patients with stage III and IV HNC across the United States.

Methods: Using 2015-2020 National Cancer Database (NCDB) data, we identified deceased HNC patients with stage III or IV cancer and prognoses under 6 months. Using adjusted logistic regression, we analyzed the role of Medicaid expansion in PC utilization. Additionally, the Yale Palliative Care GPS was used to assess the distribution of state PC laws.

Results: Of 10 305 eligible patients, 69.7% were from Medicaid expansion states. Medicaid expansion (aOR: 1.22, 95% CI: 1.01-1.49), higher Charles Comorbidity Index (CCI ≥ 3 vs. CCI = 1, aOR: 1.84, 95% CI: 1.16-2.81), and later years were associated with increased PC use. Geographic differences in PC law implementation were observed, with the West having the most enacted/passed laws while the Northeast had the highest PC utilization rate.

Conclusions: Medicaid expansion and specific state PC laws positively impact PC access for advanced HNC patients. These findings underscore the potential of policy interventions in enhancing PC accessibility and utilization among vulnerable cancer populations.

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.