Accessibility as a major determinant of radiotherapy underutilization: A population based study

Pagano, Eva; Cuonzo, Daniela Di; Bona, Cristina; Baldi, Ileana; Gabriele, P.; Ricardi, Umberto; P, Rotta; Bertetto, Oscar; Appiano, Silvana; Merletti, Franco; Segnan, Nereo; Ciccone, Giovannino

doi:10.1016/j.healthpol.2006.05.006

Cited by 43 publications

(26 citation statements)

References 22 publications

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“…The results from the Dutch survey were consistent with the assessment made by the Swedish Council on Technology Assessment in Health Care (SBU) which in 2001 established a radiotherapy utilization rate of 47% in Sweden, 15% higher than in 1992 [11] [15]. Identical approaches with somewhat similar results on radiotherapy utilization rate have been followed in Austria (42%) [16], Italy (41%) [17], and Spain (38%) [13]. External beam radiation sessions; α: Prospective survey in radiotherapy departments; β: Retrospective survey in radiotherapy departments; δ: Governmental report on the use of special medical techniques, including radiotherapy; φ: Decision trees based on evidence-based guidelines and population-based data; γ: Decision trees based on evidence-based guidelines (CCORE model) and estimated population-based data (Globocan 2002); σ: Expert's opinion.…”

Section: Discussionsupporting

confidence: 80%

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

Camacho¹,

Neves²,

Piñeros³

et al. 2014

JCT

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Background: Treatment is an important component of a comprehensive cancer control approach and its outcomes strongly depend on infrastructure, equipment, human and financial resources available. Therefore it is imperative to generate evidence-based tools to assist health policy makers from low resourced countries in planning efficient and equitable treatment services for a defined population based on what it is feasible to these settings. Methods: The intended cancer specific treatment planned and written in the patients' medical record (treatment prescription) of untreated adult cancer cases (≥18 years of age), excluding non-melanoma skin cancer, was recorded in a chronological way from 1 January 2012 onwards in a group of eight comprehensive cancer centres located in middle income countries and offering the main modalities of cancer * Affiliations are as of 1 March 2014. # Corresponding author. R. Camacho et al.990 treatment (surgery, medical oncology and radiotherapy). Results: A total of 17,713 medical records were reviewed, of which 7106 (54.2%) met the eligibility criteria. Prescription of main cancer treatment modalities were distributed as follows: 57.6% for chemotherapy (n = 4093), 56.8% for surgery (n = 4038), and 46.8% for radiotherapy (n = 3327). There was a predominance of plans consisting of combined treatment modalities over monotherapy (55.2% versus 44.8%). At the time of diagnosis 54.3% of the cancer cases had disease that had spread beyond the primary site, 41.2% were considered as having local disease and in 4.5% of the cases the information on disease extension was unknown. Conclusions: The results obtained should be seen as an approximation of cancer treatment service demand based on what it is currently practiced and therefore feasible in developing countries, particularly in middle income countries.

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Section: Discussionsupporting

confidence: 80%

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

Camacho¹,

Neves²,

Piñeros³

et al. 2014

JCT

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“…Also, women receiving BCS in extra-regional hospitals showed significantly reduced access to RT, likely due to difficulties in warranting continuous care in healthcare migrations. This is likely to be due to lower levels of completeness in data from other regions, the database for outpatient RT has been previously analyzed in depth and provided reliable results with a high level of completeness [26].…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

Rosato

Sacerdote

Pagano

et al. 2008

Breast Cancer Res Treat

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Administrative data may provide valuable information for monitoring the quality of care at population level and offer an efficient way of gathering data on individual patterns of care, and also to shed light on inequalities in access to appropriate medical care. The aim of the study was to investigate the role of patient and hospital characteristics in the initial treatment of early breast cancer using administrative data. Incident breast cancer patients were identified from hospital discharge records and linked to the radiotherapy outpatient database during 2000-2004 in the Piedmont region of Northwestern Italy. Women treated with breast-conserving surgery followed by radiotherapy (BCS ? RT) were compared to those treated with BCS without radiotherapy (BCS w/o RT) or mastectomy using multinomial logistic regression models. Out of 16,022 incident cases, 46.2% received BCS ? RT, 20.3% received BCS w/o RT, and 33.5% received a mastectomy. Compared to BCS ? RT, the factors associated with BCS w/o RT were: increased age (OR = 1.54; 95% CI = 1.29-1.85, for ages 70-79 vs. \50), being unmarried (1.24; 1.13-1.36), presence of co-morbidities (1.32; 1.10-1.58), being treated at hospitals with low surgical volume (1.31; 1.07-1.60 for hospitals with less than 50 vs. C150 interventions/year), and living far from radiotherapy facilities (1.75; 1.39-2.20 for those at a distance of [45 min). These same factors were also associated with mastectomy. During the 5-year period observed, there was a trend of reduced probability of receiving a mastectomy (0.70; 0.56-0.88 for 2004 vs. 2000). The presence or absence of nodal involvement was positively associated with mastectomy (2.28; 1.83-2.85) and negatively associated with BCS w/o RT (0.65; 0.56-0.76). After adjustment for potential confounders, education level did not show any association with the type of treatment. Social and geographical factors, in addition to hospital specialization, should be considered to reduce inappropriateness of care for breast cancer.

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“…In the light of concerns related to variations in health inequalities, an increasing number of studies have analysed distance to screening, radiation therapy utilization and other forms of cancer treatment in relation to survival rates (Bentham et al 1995;Hyndman et al 2000;Sheehan et al 2000;Bryant et al 2002;Dejardin et al 2005;French et al 2006;Pagano et al 2007). Variations in access to oncology centres have been studied as a potential explanatory factor for inequalities in patient survival from lung cancer in the South East of England (Jack et al 2003).…”

Section: Health Service Under Considerationmentioning

confidence: 99%

The role of GIS for health utilization studies: literature review

Higgs

2009

Health Serv Outcomes Res Method

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There have been a plethora of studies investigating access issues in relation to health services but until recently a relative lack of research on geographical factors that may be influencing utilisation patterns. This paper includes a timely review on what is known from existing studies, a description of the main methodological concerns highlighted by such studies and draws on the review to present some ideas for more research in this area. The use of Geographical Information Systems (GIS) in investigating the relative importance of geographical factors on utilisation patterns is advocated through a review of published studies and a call made for more research to examine potential relationships with for example health outcomes. Recent advances with regard to the availability of detailed geographically disaggregate data and new location-based techniques such as developments in Global Positioning Systems (GPS) hold out great promise in such regards. Finally the policy relevance of such studies is re-iterated in terms of helping to tackle perceived inequities in the system, addressing health inequalities as well as gauging the effectiveness of current and planned service configurations.

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Accessibility as a major determinant of radiotherapy underutilization: A population based study

Cited by 43 publications

References 22 publications

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

The role of GIS for health utilization studies: literature review

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