Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer

Abstract

Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the paper was to examine how age may modify the effect of geographic access on chemotherapy use in elderly patients with MBC. This was a retrospective cohort study based on the surveillance, epidemiology, and end results-Medicare-linked database of 1992-2002. Chemotherapy use was defined as at least one chemotherapy-related claim within 6-month post-diagnosis. Geographic access to cancer care was measured by four variables: patient travel time to the nearest oncologist practice, local area per capita number of oncologists, local area per capita number of hospices, and local area chemotherapy rate. Using multivariate logistic regression model, both aggregate models with interaction terms and subgroup analyses were conducted. Among 4,533 elderly with MBC, 30.16 % used chemotherapy. Chemotherapy use decreased with age. Both the aggregate model with interaction terms and the subgroup analysis showed that local area chemotherapy rate was positively associated with chemotherapy use (P = .0004 in the whole group; in the subgroup analyses, P < .0001, P = .0006, P = .0006, P = .18, P = .026, respectively). In addition, subgroup analysis showed that, among patients aged 85+ years old, local area oncologist supply was negatively associated with chemotherapy use (P = .028). The impact of geographic access to cancer care is the greatest among the oldest group, for whom the clinical evidence is the least certain.

Factors Associated with Early Mortality Among Patients with De Novo Metastatic Breast Cancer: A Population-Based Study

“…In an era in which increasing costs of cancer care are likely to increase differences in access to care, this finding highlights the need for continuous and sustainable efforts focused on equitable treatment. In addition, our findings with regard to geographical variation in outcomes have been observed in many studies, both in the early and advanced setting , and may be related to differences in access to care, quality of care, insurance coverage, provider or institutional treatment preferences, and variability in patient populations, all of which should be further examined.…”

Origin-destination flows in chemotherapy for breast cancer in Brazil: implications for pharmaceutical services

“…The results corroborate other studies showing that breast cancer patients are more likely to access the supply of services when the place of residence and place of treatment coincide. These studies also associate better access with higher human development index (HDI) 6,20,21 . Flow types were also characteristic of each geographic region.…”

“…For breast cancer patients, this means considering the number of sessions and the total treatment time, which can reach 60 months 30 . In this context, the distance travelled to obtain care may even determine whether the patient completes or abandons treatment 21,42 . Despite current government measures such as financial assistance for patients undergoing treatment away from home 43 and the use of elective health transportation 10 , there is nevertheless observable inequality in access to services.…”

Cancer-Specific Outcomes in the Elderly with Triple-Negative Breast Cancer: A Systematic Review

“…Elderly patients with TNBC were also less likely to receive chemotherapy. A major factor for the omission of chemotherapy included the concern of tolerability in a population with decreased functional reserve [ 15 , 16 , 17 ]. Indeed, <40% of patients ≥75 years of age are referred to medical oncology for consideration of chemotherapy, compared to 76% for patients <75 ( p < 0.001) [ 9 ].…”