Access to Care in Vermont: Factors Linked With Time to Chemotherapy for Women With Breast Cancer—A Retrospective Cohort Study

Abstract

Most female patients with stage I to III breast cancer in Vermont are receiving adjuvant chemotherapy within the National Comprehensive Cancer Network-recommended timeframe; however, improvements remain needed for certain subgroups. Novel approaches for women with long drive times need to be developed and evaluated in the community. Variation in TTC by hospital, even after adjusting for patient, tumor, and treatment factors, also suggests opportunities for process improvement.

Delayed initiation of adjuvant chemotherapy in older women with breast cancer

“…Despite the benefits of adjuvant chemotherapy, there is concern that delays in initiating adjuvant chemotherapy can negatively affect survival. Prior studies show that delaying adjuvant chemotherapy beyond 60 2,3 or 90 4 days leads to worse outcomes. In a large analysis using the California Cancer Registry (CCR), our group described that delays in chemotherapy administration affect survival outcomes with a particular detriment among patients with stage III disease or HER2‐positive or triple negative BC (TNBC) 4 .…”

Health insurance and use of recommended routine care in adults with cystic fibrosis

“…In our descriptive and multivariable analyses, public insurance predicted equal or greater use of recommended surveillance care and chronic medication use among adults with CF compared to private insurance. This finding is surprising, as use of Medicaid insurance is typically associated with lower access to care in most chronic diseases . Therefore, the high prevalence of public insurance use among adults with CF should not preclude improving CF care access in this population …”

“…This finding is surprising, as use of Medicaid insurance is typically associated with lower access to care in most chronic diseases. 29,30 Therefore, the high prevalence of public insurance use among adults with CF should not preclude improving CF care access in this population. 4,31,32 Despite similar use of routine care between public and private insurance, this study provides evidence that losing insurance coverage is associated with lower adherence to routine care guidelines.…”

Disease-specific incident glomerulonephritis displays geographic clustering in under-serviced rural areas of British Columbia, Canada

“…21,22 Those with large driving distances may have more restricted therapeutic options and are likely to wait longer to receive appropriate treatment. 23,24 The culmination of these factors may contribute to worse cancer-related survival rates in rural subpopulations. 25 Although our results are specific to BC, the existence of region-and disease-specific subpopulations at high risk for glomerular disease but with reduced access to care is likely the case in other geographic areas, and it has significant implications for the appropriate planning and delivery of glomerular disease-related health services.…”