Influence of Race, Insurance, Socioeconomic Status, and Hospital Type on Receipt of Guideline-Concordant Adjuvant Systemic Therapy for Locoregional Breast Cancers

Wu, Xiao‐Cheng; Lund, Mary Jo; Kimmick, Gretchen; Richardson, Lisa C.; Sabatino, Susan A.; Chen, Vivien W.; Fleming, Steven T.; Morris, Cyllene R.; Huang, Bin; Trentham‐Dietz, Amy; Lipscomb, Joseph

doi:10.1200/jco.2011.36.8399

Cited by 160 publications

(120 citation statements)

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“…These results contradict those of studies examining socio economic status and access to health care in other countries. 29,30 Specific ally in cancer care, differences in socio economic status have been found for several different types of cancer [31][32][33][34] and may influence cancer-related outcomes. Canada's public health care system mandates equal access for all patients, regardless of socio economic status.…”

Section: Discussionmentioning

confidence: 99%

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A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Gillis

Dixon

Smith

et al. 2014

cjs

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Background: Administrative wait times reflect the time from the decision to treat until surgery; however, this does not reflect the total time a patient actually waits for treatment. Several factors may prolong the wait for colon cancer surgery. We sought to analyze the time from the date of surgical consultation to the date of surgery and any events within this time frame that may extend wait times. Methods:We retrospectively reviewed the cases of all adult patients in Ontario aged 18-80 years with diagnosed colon cancer who did not receive neoadjuvant therapy and underwent resection electively between Jan. 1, 2002, and Dec. 31, 2009. Wait times were measured from the date of surgical consultation to the date of surgery. We chose a wait time of 28 days, reflecting local administrative targets, as a comparative benchmark. We performed univariate and multivariate analyses to identify variables contributing to a waits longer than 28 days. Variables were analyzed in continuous linear and logistic regression models. Results:We included 10 223 patients in our study. The median wait time from initial surgical consultation to resection was 31 (range 0-182) days. Age older than 65 years had a negative impact on wait time. Preoperative services, including computed tomography, cardiac consultation, echocardiography, multigated acquisition scan, magnetic resonance imaging, colonoscopy and cardiac catheterization also significantly increased wait times. Wait times were longer in rural hospitals. Conclusion:Preoperative services significantly increased wait times between initial surgical consultation and surgery.Contexte : Au plan administratif, les temps d'attente sont le reflet de l'intervalle entre la prise de décision de traiter et la chirurgie elle-même. Toutefois, cette mesure ne tient pas toujours compte du temps total d'attente d'un patient pour son traitement. Plusieurs facteurs peuvent prolonger l'attente dans le cas d'une chirurgie pour le cancer du côlon. Nous avons voulu mesurer le temps écoulé entre la date de la consultation en chirurgie et la date de la chirurgie, et tout événement à l'intérieur de cet intervalle susceptible de prolonger les délais.Méthodes : Nous avons passé en revue de façon rétrospective le cas de tous les patients adultes ontariens âgés de 18 à 80 ans porteurs d'un diagnostic de cancer du côlon qui n'ont pas reçu de traitement néo-adjuvant et qui ont subi une résection non urgente entre le 1er janvier 2002 et le 31 décembre 2009. Les temps d'attente ont été mesurés entre la date de la consultation en chirurgie et la date de la chirurgie elle-même. Nous avons choisi un temps d'attente de 28 jours qui reflète les objectifs administratifs locaux comme valeur comparative. Nous avons effectué des analyses univariées et multivariées pour faire ressortir les facteurs qui contribuent à des périodes d'attente de plus de 28 jours. Les variables ont été analysées selon des modèles de régression linéaire et logistique continue.Résultats : Nous avons inclus 10 223 patients dans notre étude. Le temps d...

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Section: Discussionmentioning

confidence: 99%

“…We included adult patients (aged 18-80 yr) with resectable colon cancer who were surgically treated in Ontario between Jan. 1, 2002, and Dec. 31,2008. Patients were identified using the Ontario Cancer Registry (OCR), in which they were registered at the time of surgical specimen or cancer biopsy.…”

Section: Methodsmentioning

confidence: 99%

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Gillis

Dixon

Smith

et al. 2014

cjs

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“…14 More than two thirds of premenopausal women with breast cancer, 15,16 but only 15% to 30% of older women age Ն 65 years, receive adjuvant chemotherapy. 13,15,[17][18][19] A few studies have explored reasons for nonreceipt of adjuvant chemotherapy and identified factors related to the patient, the physician, and patient-physician communication.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

Noninitiation of Adjuvant Chemotherapy in Women With Localized Breast Cancer: The Breast Cancer Quality of Care Study

Neugut

Hillyer

Kushi

et al. 2012

JCO

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A B S T R A C T PurposeFor some women, adjuvant chemotherapy for nonmetastatic breast cancer decreases recurrences and increases survival; however, patient-physician decisions regarding chemotherapy receipt can be influenced by medical and nonmedical factors. Patients and MethodsWe used a prospective cohort design and multivariate modeling to investigate factors related to noninitiation of chemotherapy among women with newly diagnosed breast cancer recruited from three US sites. We interviewed patients at baseline and during treatment on sociodemographic, tumor, and treatment decision-making factors. Patients were categorized according to National Comprehensive Cancer Network guidelines as those for whom chemotherapy was definitely indicated, clinically discretionary, or discretionary based on age greater than 70 years. ResultsOf 1,145 patients recruited, chemotherapy was clinically indicated for 392 patients, clinically discretionary for 459 patients, discretionary because of age for 169 patients, and not indicated for 93 patients; data were insufficient for 32 patients. Chemotherapy rates were 90% for those in whom chemotherapy was clinically indicated, 36% for those in whom it was discretionary because of clinical factors, and 19% for those in whom it was discretionary based on age greater than 70 years. Nonreceipt of chemotherapy was associated with older age, more negative beliefs about treatment efficacy, less positive beliefs about chemotherapy, and more concern about adverse effects. In the two discretionary groups, clinical predictors of worse outcome (greater tumor size, positive nodes, worse grade, and estrogen receptor-and progesterone receptor-negative status) were associated with increased chemotherapy initiation. ConclusionUtilization of adjuvant chemotherapy was most common among patients who, based on clinical criteria, would most likely benefit from it, patients with more positive than negative beliefs regarding treatment efficacy, and patients with few concerns about adverse effects.

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“…Understanding the reasons for differences between 'real-world' treatment decisions and guideline recommendations will enable further guideline clarification. Furthermore, lack of adherence to the guideline-recommended treatments may negatively affect quality of care in patients with BC 2,[7][8][9] . This chart review is the first that evaluates actual physician-reported treatments from adjuvant therapy to completion of three lines of treatment in the advanced BC setting for the purpose of providing evidence of HT and chemotherapy treatment patterns in Europe and assessing the results against guideline recommendations in order to highlight issues requiring further clarification.…”

Section: Introductionmentioning

confidence: 99%

Disease management patterns for postmenopausal women in Europe with hormone-receptor-positive, human epidermal growth factor receptor-2 negative advanced breast cancer

André

Neven²,

Marinsek

et al. 2014

Current Medical Research and Opinion

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Influence of Race, Insurance, Socioeconomic Status, and Hospital Type on Receipt of Guideline-Concordant Adjuvant Systemic Therapy for Locoregional Breast Cancers

Abstract: Sociodemographic and hospital factors are associated with guideline-concordant use of systemic therapy for breast cancer. The identification of modifiable factors that lead to nonguideline treatment may reduce disparities in breast cancer survival.

Cited by 160 publications

References 30 publications

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Noninitiation of Adjuvant Chemotherapy in Women With Localized Breast Cancer: The Breast Cancer Quality of Care Study

Disease management patterns for postmenopausal women in Europe with hormone-receptor-positive, human epidermal growth factor receptor-2 negative advanced breast cancer

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