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J AM COLL RADIOL:当日乳腺活检计划对严重精神疾病患者活检时间差异的影响

2022-07-08 shaosai MedSci原创

与普通人群相比,严重精神疾病患者平均要经历10至30年的潜在生命损失,其中癌症是第二大死因。

据估计,美国有1310万成年人受到严重精神疾病(SMI)的影响,国家精神卫生研究所将其定义为导致严重功能损害的精神疾病,包括精神分裂症、双相情感障碍和严重的重度抑郁症。与普通人群相比,SMI患者平均要经历10至30年的潜在生命损失,其中癌症是第二大死因。患有SMI的女性与没有SMI的女性相比,尽管发病率相似,但乳腺癌的死亡率却有所增加。导致乳腺癌差异的潜在因素包括:乳腺钼靶筛查使用率较低、接受治疗较晚、诊断延误、癌症治疗中断以及护理质量较低。精神病症状,包括认知混乱、偏执狂和低动机,都会对护理造成障碍。

据我们所知有关SMI女性乳腺癌护理的研究和干预措施主要集中在乳腺钼靶筛查和癌症治疗的差异上,对于获得建议的乳腺活检所需时间的潜在差异知之甚少。

SMI患者构成了全世界人口中的一个脆弱部分,SMI女性乳腺癌筛查制定干预措施将对这类患者十分有益。近日,发表在J AM COLL RADIOL杂志的一项研究探讨了SMI患者的活检时间是否存在差异,以及干预后2.5年内乳腺活检计划对这一弱势人群的影响。

本研究作者所在的学术性乳腺影像中心2017年8月开始在推荐活检当天常规提供针式活检检查。主要结果是在2.5年的干预前与干预后期间,作为SDB进行的活检比例和从活检建议到完成的天数,比较了所有SMI患者与非SMI患者以及年龄小于65岁的SMI(SMI-PP)。多变量比例赔率和逻辑回归模型被用来评估SMI状态、年龄、种族/民族、语言和保险与每个时期内活检天数和SDB的关系。 

干预前有2026例活检,干预后有2361例活检。干预前,8.43%的SMI患者(83人中的7人)进行了SDB,而非SMI患者(1,943人中的303人)为15.59%(P = .076),2.7%的SMI-PP亚组(37人中的1人)进行了SDB,而非SMI-PP亚组(296人中的47人)为15.88%(P = .031)。对年龄、种族/民族和语言进行调整后,与干预前的非SMI-PP亚组相比,SMI-PP亚组接受SDB的几率(调整后的几率比,0.13;95%置信区间,0.02-0.92;P = .04)和进行活检的时间更长(调整后的几率比,2.35;95%置信区间,1.26-4.37;P = .01),差异持续存在。没有证据表明SMI-PP亚组在干预后存在这些差异。所有患者的SDB比例从15.3%(2,026人中的310人)增加到36.09%(2,361人中的852人)(P < .001)。 

 
图 在所有病人中比较干预前和干预后组的回归模型

本研究表明,当天的乳腺活检计划缓解了SMI患者在活检时间上的差异,有助于改善这一弱势群体的乳腺癌护理及治疗预后。

 

原文出处:

Gary X Wang,Alison R Hwong,Sarah F Mercaldo,et al.Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy for Patients With Serious Mental Illness.DOI:10.1016/j.jacr.2021.09.009.

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    2022-12-05 waiwai3030
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    2022-07-09 smlt2008
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1783400, encodeId=bec51e83400b1, content=<a href='/topic/show?id=f16a499652' target=_blank style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Mon Dec 05 22:57:10 CST 2022, time=2022-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799235, encodeId=ee581e99235bf, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Fri Oct 14 14:57:10 CST 2022, time=2022-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278273, encodeId=48be12e82739b, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1469035, encodeId=f0c81469035b2, content=<a href='/topic/show?id=c42121206a5' target=_blank style='color:#2F92EE;'>#严重精神疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21206, encryptionId=c42121206a5, topicName=严重精神疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a426994829, createdName=sjq029, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493626, encodeId=fd741493626d5, content=<a href='/topic/show?id=aa2923e177d' target=_blank style='color:#2F92EE;'>#乳腺活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23717, encryptionId=aa2923e177d, topicName=乳腺活检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acba9077826, createdName=circumcision, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231456, encodeId=b75212314564a, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sat Jul 09 10:04:15 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231398, encodeId=201112313984c, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Fri Jul 08 21:49:16 CST 2022, time=2022-07-08, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1783400, encodeId=bec51e83400b1, content=<a href='/topic/show?id=f16a499652' target=_blank style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Mon Dec 05 22:57:10 CST 2022, time=2022-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799235, encodeId=ee581e99235bf, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Fri Oct 14 14:57:10 CST 2022, time=2022-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278273, encodeId=48be12e82739b, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1469035, encodeId=f0c81469035b2, content=<a href='/topic/show?id=c42121206a5' target=_blank style='color:#2F92EE;'>#严重精神疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21206, encryptionId=c42121206a5, topicName=严重精神疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a426994829, createdName=sjq029, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493626, encodeId=fd741493626d5, content=<a href='/topic/show?id=aa2923e177d' target=_blank style='color:#2F92EE;'>#乳腺活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23717, encryptionId=aa2923e177d, topicName=乳腺活检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acba9077826, createdName=circumcision, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231456, encodeId=b75212314564a, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sat Jul 09 10:04:15 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231398, encodeId=201112313984c, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Fri Jul 08 21:49:16 CST 2022, time=2022-07-08, status=1, ipAttribution=)]
    2022-07-09 xulv123

    认真学习~~

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1783400, encodeId=bec51e83400b1, content=<a href='/topic/show?id=f16a499652' target=_blank style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Mon Dec 05 22:57:10 CST 2022, time=2022-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799235, encodeId=ee581e99235bf, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Fri Oct 14 14:57:10 CST 2022, time=2022-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278273, encodeId=48be12e82739b, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1469035, encodeId=f0c81469035b2, content=<a href='/topic/show?id=c42121206a5' target=_blank style='color:#2F92EE;'>#严重精神疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21206, encryptionId=c42121206a5, topicName=严重精神疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a426994829, createdName=sjq029, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493626, encodeId=fd741493626d5, content=<a href='/topic/show?id=aa2923e177d' target=_blank style='color:#2F92EE;'>#乳腺活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23717, encryptionId=aa2923e177d, topicName=乳腺活检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acba9077826, createdName=circumcision, createdTime=Sat Jul 09 14:57:10 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231456, encodeId=b75212314564a, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sat Jul 09 10:04:15 CST 2022, time=2022-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1231398, encodeId=201112313984c, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Fri Jul 08 21:49:16 CST 2022, time=2022-07-08, status=1, ipAttribution=)]
    2022-07-08 医鸣惊人

    认真学习了

    0

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