Real-world associations among patient-physician sex concordance, treatment practices, and cancer outcomes.
Notice bibliographique
Résumé
e18511 Background: Prior research has linked patient-physician sex discordance with inferior surgical and cardiac outcomes. The impact of such sex inequities may be magnified in medical oncology, where patients often face a life-limiting illness and physicians assume the role of primary healthcare provider. This study examined cancer treatment practices and survival outcomes in sex-concordant vs. discordant patient-physician dyads. Methods: This was a population-based, retrospective cohort study of adults diagnosed with stage II-IV colon or lung cancer in 2013-2020 in Alberta, Canada and referred to a medical oncologist. Study data included physician- and patient-level demographics and cancer disease characteristics. Patient-physician dyads were classified as sex-concordant (female-female, male-male) or discordant (female-male, male-female). Time-to-event data were analysed using Kaplan-Meier methods and associations were assessed with Cox and logistic regression. Results: A total of 11,131 patients and 188 medical oncologists were included. Among patients, 49% were female and 50% were in sex-concordant patient-physician dyads. The median age was 68 years, 7615 (68%) had lung cancer, and 6016 (54%) had stage IV disease. In sex-concordant and discordant dyads, respectively, median overall survival (OS) was 17.1 and 18.7 months ( p = 0.047) while median cancer-specific survival (CSS) was 20.2 and 22.4 months ( p = 0.21). In multivariable analysis, sex-concordance was not significantly associated with OS or CSS in the overall cohort and in female patients. However, among male patients, sex-discordance was significantly associated with lower OS (hazard ratio [HR], 1.11; 95% CI, 1.04-1.19) and CSS (HR, 1.12; 95% CI 1.04 -1.21), largely driven by differences in survival outcomes in stage IV disease. Older age, higher comorbidity burden, lung cancer, and advanced stage correlated with worse outcomes in all multivariable models. Sex concordance was not significantly associated with adjuvant systemic anti-cancer therapy (SACT) use in stage II-III disease or with SACT use in stage IV disease. Treatment practices are summarized in the table. Conclusions: Sex concordance between patients and medical oncologists did not generally correlate with differential SACT use and survival. However, male patients treated by female physicians had worse outcomes compared to those treated by male physicians. Cancer outcomes may be prone to the effects of sex bias in specific patient-physician relationships. [Table: see text]
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».