去看医生的时间和膀胱癌的预后。

JU open plus Pub Date : 2025-04-01 Epub Date: 2025-04-17 DOI:10.1097/ju9.0000000000000273
Sruthi L Muluk, Coleman Drake, Zhaojun Sun, Manisha Bhattacharya, Bruce L Jacobs, Lindsay M Sabik
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引用次数: 0

摘要

目的:对于肌肉浸润性膀胱癌(MIBC)患者,膀胱切除术时间和接受新辅助化疗与生存率的提高有关。旅行负担可能是及时进行指导一致治疗的重要障碍。材料和方法:我们对宾夕法尼亚州首次诊断为MIBC的患者进行了一项横断面研究,这些患者在2010-2016年宾夕法尼亚州癌症登记处与宾夕法尼亚州医疗成本控制委员会(PHC4)到2018年的住院患者数据相关的非联邦短期综合医院接受了根治性膀胱切除术。医生的位置来自医疗保险和医疗补助服务中心。结果:开车到最近的肿瘤科医生的平均(标准差)时间为17.1(11.4)分钟,到最近的泌尿科医生的平均(标准差)时间为13.9(9.2)分钟。到泌尿科医生的开车时间增加30分钟,与90天内接受膀胱切除术的可能性降低12.5个百分点相关(95% CI: -24.3至-0.6),对社会经济条件较差的地区影响更大(降低18.7个百分点[95% CI: -33.1至-4.3])。每增加30分钟,接受新辅助化疗的可能性降低11.9个百分点(95% CI: -23.4至-0.4)。开车时间与90天死亡率或再入院无显著相关性。结论:驱车前往肿瘤科和泌尿科的时间与及时接受指南推荐的MIBC患者护理有关。了解地理可及性对需要多专科治疗的癌症患者临床结果的影响可以为提供者和决策者提供信息,以努力改善癌症治疗的可及性和结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Drive Time to Physicians and Outcomes for Bladder Cancer.

Purpose: For patients with muscle-invasive bladder cancer (MIBC), time to cystectomy and receipt of neoadjuvant chemotherapy are associated with improved survival. Travel burden may be an important barrier to timely guideline-concordant treatment.

Materials and methods: We conducted a cross-sectional study of patients in Pennsylvania with a first lifetime cancer diagnosis of MIBC who underwent radical cystectomy at non-federal short-term general hospitals identified in 2010-2016 Pennsylvania Cancer Registry linked to Pennsylvania Healthcare Cost Containment Council (PHC4) inpatient data through 2018. Physician location came from the Centers for Medicare and Medicaid Services.

Results: Mean (standard deviation) drive time to nearest oncologist was 17.1 (11.4) minutes and to nearest urologist was 13.9 (9.2) minutes. A 30-minute increase in drive time to the urologist was associated with a 12.5 percentage point lower likelihood of undergoing cystectomy within 90 days (95% CI: -24.3 to -0.6), with greater effects for more socioeconomically disadvantaged areas (18.7 percentage point lower [95% CI: -33.1 to -4.3]). A 30-minute increase to the oncologist was associated with an 11.9 percentage point lower likelihood of receiving neoadjuvant chemotherapy (95% CI: -23.4 to -0.4). Drive time was not significantly associated with 90-day mortality or readmission.

Conclusions: Drive time to oncologists and urologists is associated with timely receipt of guideline-recommended care for patients with MIBC. Understanding the impact of geographic access on clinical outcomes for patients with cancer who require multispecialty care can inform providers and policymakers in efforts to improve cancer care access and outcomes.

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