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

Abstract

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.

Inequalities in access to cancer treatment: an analysis of cross-regional patient mobility in Greece

“…Moreover, longitudinal data trends, like the above presented, could provide a valuable assessment and feedback tool in the case where an intervention to counteract patient migration took place, e. g., a new oncology-specific structure has been added in the district or an existing one was upgraded. Taking into account the international perspective, the findings of the present study are in line with reports from the literature that document that geography presents a serious barrier to adequate treatment for cancer both in countries with an established National Health Service [27][28][29], like the case presented in this paper, as well as for countries with "less centralized" types of health services provision [30,31]. The analysis of patient mobility could apply for both types of service provision and produce important findings as to the responsiveness of the system, or the financial burden placed upon patients or healthcare budgets, as a result of unmet needs for inelastic demands, like cancer treatment, or treatment for other life-threatening diseases.…”

Education, survival, and avoidable deaths in Lithuanian cancer patients, 2001–2009

“…Some studies have shown that determinants related to health care, such as unequal access to treatment, are important factors in the differences in the survival rates of cancer patients by socio-economic status [14]. For example, disadvantages in receiving timely treatment or breast, colorectal or lung cancer surgery among less educated or poor (with lower income) individuals or people living in socio-economically deprived areas have been reported in Italy, England, and Denmark [21][22][23][24]. Evidence from Denmark suggests that substantial socio-economic differences also exist in cancer rehabilitation and this may contribute to the observed disparities in cancer survival [25].…”

Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis

“…The underlying mechanism for the volume-outcome relationship in breast cancer remains unclear and may be influenced by a number of factors including surgeon volume [3][4][5][6][7], hospital volume [6,[8][9][10][11][12][13][14][15][16][17][18], level of specialization of both the provider and hospital [5,[19][20][21], teaching status of the hospital [13,22,23], and processes of care [11,[14][15][16]24]. Several studies have attempted to attribute the hospital volume-outcome relationship in breast cancer to differences in processes of care.…”

“…For example, in one study using data from the Nationwide Inpatient Sample database, higher volume hospitals were associated with increased use of breast-conserving surgery [14]. These & Amanda L. Kong akong@mcw.edu studies have examined individual processes of care in isolation with respect to their effect on hospital volume and outcomes [11,[14][15][16]. The purpose of this study was to examine differences in patterns of care among breast cancer patients treated in high-and lower-volume hospitals as a possible explanation for the well-documented differences in survival among patients treated at these hospitals.…”