Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYA:16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). We examined whether joint care impacted patient-reported outcomes when compared to care at one site. Methods: A cross-sectional survey was conducted in England, Scotland, and Wales. This included validated measures of quality of life (QoL), anxiety and depression, health status, social support, and illness perception. Comparisons were made based on young people’s exposure to specialist care within 6 months of diagnosis, defined as care in a TYA PTC: all-TYA-care (all care in a TYA unit), no-TYA-care (no care in a TYA unit, care delivered in a children’s/adult unit only), and joint-care (care in a TYA-PTC and in a children’s/adult unit). Results: Overall, 260/1009 (25.8%) participants responded (England n = 241; Scotland/Wales n = 19). Due to different healthcare policies, statistical analysis was applied to England only. Mean QoL scores were <69.7, the threshold indicating impaired QoL (mean 58.65, standard deviation 20.13). After adjustment for confounding factors, no clinically significant differences in mean QoL between categories existed. The adjusted mean difference for all-TYA-care (n = 66) versus no-TYA-care (n = 89) was −2.28 units (95% confidence interval (CI: −8.85 to 4.29) and for joint-care versus no-TYA-care (n = 85), −4.35 units (CI: −10.34 to 1.63). Similarly, no notable differences in social support, anxiety, depression, or illness perception between categories existed. Patients receiving all-TYA-care had a lower average health status compared with no-TYA-care (difference in means −0.09 (CI:−0.18 to −0.01). Conclusions: No evidence that patient-reported outcomes differ by categories of care existed. This may suggest the evolution of TYA cancer services has led to similar outcomes regardless of care category. However, given the small sample size it is not possible to draw firm conclusions.
背景：英国医疗政策认识到青少年和年轻成人（TYA：诊断时年龄16-24岁）需要专科医疗。在英格兰，设有主要治疗中心（PTCs），提供完全在PTC内进行的强化治疗，或与指定医院（DHs）共同实施的“联合治疗”。本研究旨在比较联合治疗与单一机构治疗对患者报告结局的影响。方法：在英格兰、苏格兰和威尔士开展横断面调查，采用经过验证的生活质量（QoL）、焦虑抑郁、健康状况、社会支持及疾病感知量表进行评估。根据青少年确诊后6个月内接受的专科治疗类型分组比较：全TYA治疗（全部在TYA单元治疗）、无TYA治疗（仅在儿童/成人单元治疗）及联合治疗（同时在TYA-PTC和儿童/成人单元治疗）。结果：共260/1009（25.8%）参与者完成调查（英格兰241例；苏格兰/威尔士19例）。因医疗政策差异，仅对英格兰数据进行统计分析。平均QoL得分均低于提示生活质量受损的阈值69.7分（均值58.65，标准差20.13）。校正混杂因素后，各组间平均QoL未出现具有临床意义的差异：全TYA治疗组（n=66）与无TYA治疗组（n=89）校正后均数差为-2.28单位（95%置信区间：-8.85至4.29）；联合治疗组与无TYA治疗组（n=85）为-4.35单位（-10.34至1.63）。各组在社会支持、焦虑、抑郁及疾病感知方面亦无显著差异。全TYA治疗组患者平均健康状况低于无TYA治疗组（均数差-0.09，95%CI：-0.18至-0.01）。结论：未发现患者报告结局因治疗类型不同而产生差异的证据，这可能提示TYA肿瘤服务的演进使不同治疗模式产生了相近的结局。然而受限于样本量较小，尚无法得出确定性结论。
肿瘤(癌症)患者之家