Dataset Information

Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia.

ABSTRACT:

Objective

To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments.

Data sources

Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia.

Study design

Using multivariable logistic regression, we examined predictors of adjuvant chemo-, radiation, and hormonal therapy regimens defined as guideline-concordant according to the 2000 National Institutes of Health Consensus Development Conference Statement.

Principal findings

Overall, 35.2 percent of women received guideline-concordant care for all three adjuvant therapies. Higher socioeconomic status was associated with receiving guideline-concordant care for all three adjuvant therapies jointly, and for chemotherapy. Compared with private insurance, having Medicaid was associated with guideline-concordant chemotherapy. Unmarried women were more likely to be nonconcordant for chemotherapy and radiation therapy. Increased age predicted nonconcordance for adjuvant therapies jointly, for chemotherapy, and for hormonal therapy.

Conclusions

A number of factors were independently associated with receiving guideline-concordant adjuvant therapy. Identifying and addressing factors that lead to nonconcordance may reduce disparities in treatment and survival.

SUBMITTER: Guy GP

PROVIDER: S-EPMC4545348 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Publications

Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia.

Guy Gery P GP Lipscomb Joseph J Gillespie Theresa W TW Goodman Michael M Richardson Lisa C LC Ward Kevin C KC

Health services research 20141210 4

<h4>Objective</h4>To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments.<h4>Data sources</h4>Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia.<h4>Study design</h4>Using multivariable logistic regres ...[more]

PMID: 25491350

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Project description:BackgroundWomen with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment.MethodsWe created a cohort of women ages 66 to 85?y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated ? tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy.ResultsOur cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69?y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility.ConclusionsDiabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment.ImpactOther factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.

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Dataset Information

Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia.

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