ts not waitlisted for transplant and with the highest predicted 5-year survival, there was a deficit of screening compared with waitlisted patients. Background The Choosing Wisely campaign suggests an individualized approach to cancer screening among patients receiving dialysis. We aimed to evaluate breast and prostate cancer screening among patients receiving maintenance hemodialysis by kidney transplant waitlist status and 5-year survival probability. Methods We conducted a retrospective cohort study using a nationally representative population of hemodialysis patients. Patients receiving hemodialysis each calendar year from 2003 to 2018, ≥1 year of Medicare as the Primary Payer, and age 50–69 years were included. The cohort was split into prognosis and cancer screening sets. Models of 5-year survival were built in the prognosis set using logistic regression. Five-year survival probabilities were generated in the cancer screening set, excluding patients with prior breast or prostate cancer, and screening over the next year was assessed. Results One hundred sixty thousand five hundred thirty-seven patients contributed 356,165 person-years to the cancer screening set (59% of the person-years were contributed by males, median age was 60 years). Compared with a benchmark rate of 50% (e.g., mammography every other year), 42% of waitlisted female-years were screened by mammography. Overall, 17% of nonwaitlisted female-years were screened (20% among those with >50% probability of 5-year survival and 8% among those with <10% probability of 5-year survival). Compared with a benchmark rate of 20% (e.g., serum prostate-specific antigen screening up to 5 years apart), 24% of waitlisted male-years were screened with serum prostate-specific antigen. Overall, 15% of nonwaitlisted male-years were screened (13% among those with >50% probability of 5-year survival and 11% among those with <10% probability of five-survival). Patterns were similar after age-standardization. Conclusions Patients with higher predicted survival have higher rates of cancer screening, suggesting providers consider life expectancy. However, nonwaitlisted patients with high probability of 5-year survival were less likely to be screened compared with waitlisted patients. Interventions may be needed to close this screening gap....

中文翻译：

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按透析肾功能衰竭患者预期寿命进行乳腺癌和前列腺癌筛查


TS 未列入移植等待名单且预测 5 年生存率最高，与等待名单患者相比，存在筛查不足。背景 Choosing Wisely 活动建议对接受透析的患者进行个体化癌症筛查。我们旨在通过肾移植候补名单状态和 5 年生存概率评估接受维持血液透析患者的乳腺癌和前列腺癌筛查。方法 我们使用具有全国代表性的血液透析患者人群进行了一项回顾性队列研究。包括 2003 年至 2018 年每个日历年接受血液透析的患者，≥ 1 年的 Medicare 作为主要付款人，年龄 50-69 岁。该队列分为预后和癌症筛查组。使用 logistic 回归在预后集中构建 5 年生存模型。在癌症筛查集中生成五年生存概率，不包括既往患有乳腺癌或前列腺癌的患者，并评估了明年的筛查。结果 160,537 名患者为癌症筛查组贡献了 356,165 人年 （59% 的人年为男性，中位年龄为 60 岁）。与 50% 的基准比率（例如，每隔一年进行一次乳腺 X 线摄影）相比，42% 的候补名单女性年龄组接受了乳腺 X 线摄影筛查。总体而言，筛查了 17% 的未候补名单女性年龄（20% 的 5 年生存概率为 >50% 的人群和 8% 的 5 年生存概率为 <10% 的人群）。与 20% 的基准率（例如，间隔长达 5 年的血清前列腺特异性抗原筛查）相比，24% 的等待名单男性年龄组接受了血清前列腺特异性抗原筛查。 总体而言，筛查了 15% 的未候补名单男性年龄（13% 的 5 年生存概率为 >50% 的男性，11% 的 5 年生存概率为 <10% 的男性）。年龄标准化后模式相似。结论 预测生存率较高的患者癌症筛查率较高，建议提供者考虑预期寿命。然而，与等待名单患者相比，具有高 5 年生存概率的非等待名单患者接受筛查的可能性较小。可能需要采取干预措施来缩小这一筛查差距。