Examining Determinants of Radiotherapy Access: Do Cost and Radiotherapy Inconvenience Affect Uptake of Breast-conserving Treatment for Early Breast Cancer?

Lam, Johnson K.S.; Cook, Taylor; Foster, Steven; Poon, Rita; Milross, Christopher G.; Sundaresan, Puma

doi:10.1016/j.clon.2015.04.034

Cited by 27 publications

(25 citation statements)

References 34 publications

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“…The following scenarios would indicate an inequity in access to care; first, when women from areas of less accessibility were not offered the opportunity to make an informed decision regarding BCS versus mastectomy where it was clinically appropriate, or second, when women had a mastectomy solely due to difficulties in accessing radiotherapy services even if they preferred BCS. A recent Australian study highlighted how access to treatment impacts on treatment choice, with a greater proportion of women diagnosed with breast cancer having BCS following the opening of a local publicly funded radiotherapy centre in their local area [ 53 ]. While there has been an expansion of radiotherapy infrastructure in regional centres since 2011 [ 32 ], the last year of our study cohort, our categories of accessibility have taken that into account, so this expansion cannot explain the reducing impact of distance on the choice of surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

Baade

Dasgupta

Youl

et al. 2016

IJERPH

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The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%). After adjustment for socio-demographic and clinical factors, compared to women living in very high accessibility areas, women in high (Odds Ratio (OR) 0.58 (95% confidence intervals (CI) 0.49, 0.69)), low (OR 0.47 (0.41, 0.54)) and very low (OR 0.44 (0.34, 0.56)) accessibility areas had lower odds of having BCS, while the odds for women from middle (OR 0.81 (0.69, 0.94)) and most disadvantaged (OR 0.87 (0.71, 0.98)) areas was significantly lower than women living in affluent areas. The association between accessibility and the type of surgery reduced over time (interaction p = 0.028) but not for area disadvantage (interaction p = 0.209). In making informed decisions about surgical treatment, it is crucial that any geographical-related barriers to implementing their preferred treatment are minimised.

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Section: Discussionmentioning

confidence: 99%

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

Baade

Dasgupta

Youl

et al. 2016

IJERPH

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“…Numerous studies have assessed the impact of travel time and distance on a patient receiving healthcare or choosing treatment options. 3 4 In some international studies, patients who had to travel many miles for radiotherapy after breast cancer treatment chose a mastectomy rather than breast conservation 5–7 and multiple fractions of whole breast radiotherapy, but this was not seen in some UK studies. 3 8 Similarly, the uptake of chemotherapy or postmastectomy radiotherapy may be lower in rural communities where travel to a radiotherapy centre is difficult.…”

Section: Introductionmentioning

confidence: 99%

Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT

Coombs

Coombs²,

Vaidya

et al. 2016

BMJ Open

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ObjectiveTo quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment.Setting(1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.Participants485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.Outcome measuresThe shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.MethodsDistances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test.ResultsTARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).ConclusionsThe use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.Trial registration numberISRCTN34086741; Post-results.

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“…It has been comprehensively shown that where treatment is consistent (within clinical teams or within clinical trials) socio-economic differences are not apparent [29, 30]. Differences in treatment actually received might originate from differences in ease of travel to appointments, flexibility of work, other commitments or levels of social support [31–33]. Differences in nutrition, smoking, alcohol consumption or other health-related behaviors are also possible explanations, although evidence for the impact of these upon cancer survival differentials is mixed [14].…”

Section: Discussionmentioning

confidence: 99%

What might explain deprivation-specific differences in the excess hazard of breast cancer death amongst screen-detected women? Analysis of patients diagnosed in the West Midlands region of England from 1989 to 2011

2016

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BackgroundBreast cancer survival is higher in less deprived women, even amongst women whose tumor was screen-detected, but reasons behind this have not been comprehensively investigated.MethodsThe excess hazard of breast cancer death in 20,265 women diagnosed with breast cancer, followed up to 2012, was estimated for screen-detected and non-screen-detected women, comparing more deprived to less deprived women using flexible parametric models. Models were adjusted for individual and tumor factors, treatment received and comorbidity. For screen-detected women, estimates were also corrected for lead-time and overdiagnosis.ResultsThe excess hazard ratio (EHR) of breast cancer death in the most deprived group, adjusted only for age and year of diagnosis, was twice that of the least deprived among screen-detected women (EHR=2.12, 95%CI 1.48-2.76) and 64% higher among non-screen-detected women (EHR=1.64, 95%CI 1.41-1.87). Adjustment for stage at diagnosis lowered these estimates by 25%. Further adjustment had little extra impact. In the final models, the excess hazard for the most deprived women was 54% higher (EHR=1.54, 95%CI 1.10-1.98) among screen-detected women and 39% higher (EHR=1.39, 95%CI 1.20-1.59) among non-screen-detected women.ConclusionA persistent socio-economic gradient in breast cancer-related death exists in this cohort, even for screen-detected women. The impact of differential lifestyles, management and treatment warrant further investigation.

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Examining Determinants of Radiotherapy Access: Do Cost and Radiotherapy Inconvenience Affect Uptake of Breast-conserving Treatment for Early Breast Cancer?

Cited by 27 publications

References 34 publications

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT

What might explain deprivation-specific differences in the excess hazard of breast cancer death amongst screen-detected women? Analysis of patients diagnosed in the West Midlands region of England from 1989 to 2011

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