Disparities in Breast Cancer: Private Patients Have Better Outcomes Than Public Patients

Coetzee, W C; Apffelstaedt, Justus; Zeeman, T.; Plessis, Manisha du

doi:10.1007/s00268-017-4187-0

Cited by 11 publications

(14 citation statements)

References 30 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 Per capita spending in the public health care system is < 15% of that in the coexisting private system; BC survival differs significantly between the two. 14,15 National policy specifies that low- or no-cost cancer surgery, chemotherapy, radiotherapy, and endocrine therapy be available at tertiary-level public hospitals, but timely access to these treatments is inconsistent.…”

Section: Methodsmentioning

confidence: 99%

Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

O’Neil

Chen

Ayeni

et al. 2019

JGO

View full text Add to dashboard Cite

PURPOSEThe quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance.MATERIALS AND METHODSAmong 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors.RESULTSOf 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality.CONCLUSIONMore timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.

show abstract

Section: Methodsmentioning

confidence: 99%

Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

O’Neil

Chen

Ayeni

et al. 2019

JGO

View full text Add to dashboard Cite

show abstract

“…However, studies have found that women from low SES, racial minorities and LEP are less likely to receive this standard of treatment . Similar trends have been reported in the receipt of chemotherapy and hormonal therapy as well . These findings are particularly concerning given systemic therapy in breast cancer is associated with reduced risk of metastasis and improved overall survival .…”

Section: Discussionmentioning

confidence: 75%

“…Such a discrepancy was not observed in our cohort, and the public and private hospitals were equivalent in surgical treatment delivery. Another study in a similar setting observed significantly higher reconstruction rates following mastectomy in the private vs public hospital . At large, African American women are noted to have lower rates of reconstruction in comparison to Caucasian women.…”

Section: Discussionmentioning

confidence: 92%

“…Another study in a similar setting observed significantly higher reconstruction rates following mastectomy in the private vs public hospital. 23 At large, African American women are noted to have lower rates of reconstruction in comparison to Caucasian women. Insurance coverage, socioeconomic status, and physician referral may be contributing factors.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 Similar trends have been reported in the receipt of chemotherapy and hormonal therapy as well. 18,23 These findings are particularly concerning given systemic therapy in breast cancer is associated with reduced risk of metastasis and improved overall survival. 29 Hence, it is reassuring to see similar rates of RT and systemic therapy between both our patient populations.…”

Section: Ta B L E 4 Factors Affecting Surgical Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment of young women with breast cancer: Public vs private hospitals

et al. 2019

View full text Add to dashboard Cite

Disparities in breast cancer treatment have been documented in young and underserved women. This study aimed to determine whether surgical disparities exist among young breast cancer patients by comparing cancer treatment at a public safety‐net hospital (BH) and private cancer center (PCC) within a single institution. This was a retrospective study of young women (<45) diagnosed with invasive breast cancer (stage I‐III) from 2011‐2016. Patient information was abstracted from the breast cancer database at BH and PCC. Demographic variables, surgery type, method of presentation, and stage were analyzed using Pearson's chi‐square tests and binary logistic regression. A total of 275 patients between ages 25‐45 with invasive breast cancer (Stage I‐III) were included in the study. There were 69 patients from BH and 206 patients from PCC. At PCC, the majority of patients were Caucasian (68%), followed by Asian (11%), Hispanic (10%), and African American (8.7%). At BH, patients were mostly Hispanic (47.8%), followed by Asian (27.5%), and African American (10.1%). At PCC, 82% had a college/graduate degree versus 18.6% of patients at BH (P < 0.001). All patients at PCC reported English as their primary language versus 30% of patients at BH (P < 0.001). Patients at PCC were more likely to present with lower stage cancer (P = 0.04), and less likely to present with a palpable mass (P = 0.04). Hospital type was not a predictor of receipt of mastectomy (P = 0.5), nor was race, primary language, or education level. Of patients who received a mastectomy, 87% at BH and 76% at PCC had immediate reconstruction. Surgical management of young women with breast cancer in a public hospital versus private hospital setting was equivalent, even after controlling for race, primary language, stage, and education level.

show abstract

Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018

et al. 2021

View full text Add to dashboard Cite

Background Breast cancer is the second most common cancer among women in Zimbabwe. Patients face socioeconomic barriers to accessing oncology care, including radiotherapy. We sought to understand patterns of care and adherence for women with breast cancer in sub‐Saharan Africa (SSA) with radiotherapy access. Methods A retrospective cohort was created for women with breast cancer evaluated at the Parirenyatwa Hospital Radiotherapy and Oncology Center (RTC) from 2014 to 2018. Clinical data were collected to define patterns of care. Non‐adherence was modeled as a binary outcome with different criteria for patients with localized versus metastatic disease. Results In total, 351 women presented with breast cancer with median age 51 at diagnosis (IQR: 43–61). Receptor status was missing for 71% (248). 199 (57%) had non‐metastatic disease, and 152 (43%) had metastases. Of women with localized disease, 34% received post‐mastectomy radiation. Of women with metastatic disease, 9.7% received radiotherapy. Metastatic disease and missing HIV status were associated with increased odds of study‐defined non‐adherence (aOR: 1.85, 95% CI: 1.05, 3.28; aOR: 2.13, 95% CI: 1.11, 4.05), while availability of ER/PR status was associated with lower odds of non‐adherence (aOR: 0.18, 95% CI: 0.09, 0.36). Conclusions Radiotherapy is likely underutilized for women with breast cancer, even in a setting with public sector availability. Exploring patient‐level factors that influence adherence to care may provide clinicians with better tools to support adherence and improve survival. Greater investment is needed in multidisciplinary, multimodality care for breast cancer in SSA.

show abstract

Disparities in Breast Cancer: Private Patients Have Better Outcomes Than Public Patients

Abstract: The greatest impact on outcome was stage at presentation, but more aggressive therapy for each stage resulted in a trend to better outcome for private patients.

Cited by 11 publications

References 30 publications

Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

Surgical treatment of young women with breast cancer: Public vs private hospitals

Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018

Contact Info

Product

Resources

About