目的:临床实践指南建议在乳腺癌治疗后提供康复服务,然而,我们对利用可能因患者水平特征而异知之甚少,我们旨在使用SEER-Medicare数据进行研究.
方法:来自监测的数据,流行病学,和最终结果(SEER)-Medicare关联数据库用于识别2011年至2016年间诊断的年龄≥66岁的非转移性乳腺癌幸存者.诊断后0-11个月提供的康复服务是通过门诊或医师就诊索赔确定的。使用改进的Poisson模型估计相对风险(RR)和相应的95%置信区间(CI),计算了描述性统计数据以及患者特征与康复服务之间的关联。
结果:在55,539名乳腺癌幸存者中,33%(n=18,244)接受过任何类型的康复服务。幸存者的平均年龄为75岁(SD6.7),88%白色86%居住在城市,和21%的医疗保险/医疗补助双重登记。在调整后的模型中,年龄>75岁的患者vs.≤75有6%(RR0.94,95%CI0.92-0.96)的患者接受康复服务的可能性较小。在教育程度较高的地区的幸存者与受教育程度较低,白色vs.非白色,或者生活在农村城市面积为26%(1.26,CI1.22-1.30),6%(1.06,CI1.02-1.11),6%(1.06,CI1.02-1.10)更有可能接受康复服务,分别。
结论:不同教育和治疗状态的幸存者在康复利用方面存在最大差异。
结论:需要对障碍进行进一步研究,access,以及提供康复服务,专门针对老年乳腺癌幸存者,非白色,或Medicare/Medicaid双重资格。
OBJECTIVE: Rehabilitation services are recommended by clinical practice guidelines following breast cancer treatment, yet little is known about how utilization may vary by patient-level characteristics which we aimed to study using SEER-Medicare data.
METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used to identify non-metastatic breast cancer survivors aged ≥ 66 years diagnosed between 2011 and 2016. Rehabilitation services delivered 0-11 months post-diagnosis were identified via outpatient or physician visit claims. Descriptive statistics and associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs).
RESULTS: Of 55,539 breast cancer survivors, 33% (n = 18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, and 21% Medicare/Medicaid dually enrolled. In adjusted models, patients aged > 75 vs. ≤ 75 were 6% (RR 0.94, 95% CI 0.92-0.96) less likely to have received rehabilitative services. Survivors in an area with greater educational attainment vs. less educational attainment, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively.
CONCLUSIONS: The largest differences in rehabilitation utilization were observed for survivors of differing educational and treatment statuses.
CONCLUSIONS: Further research is needed on barriers, access, and delivery of rehabilitation services, specifically for breast cancer survivors who are older-aged, non-White, or Medicare/Medicaid dual eligible.