scholarly journals Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Yan Lin ◽  
Michael C. Wimberly ◽  
Patricia Da Rosa ◽  
Joseph Hoover ◽  
William F. Athas
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Treatment ◽  
South Dakota ◽  
Cancer Patients ◽  
Early Stage ◽  
Breast Cancer Treatment ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
To Receive

Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i) the odds of mastectomy versus breast conserving surgery (BCS); ii) the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence. The spatial scan statistic method was used to identify geographic areas with significantly higher likelihood of experiencing mastectomy. The study found that geographic accessibility to radiation therapy facilities was negatively associated with the likelihood of receiving mastectomy after adjustment for other covariates, but not associated with radiation therapy use among patients receiving BCS. Compared with patients travelling less than 30 minutes to a radiation therapy facility, patients travelling more than 90 minutes were about 1.5 times more likely to receive mastectomy (odds ratio, 1.51; 95% confidence interval, 1.08-2.11) and patients travelling more than 120 minutes were 1.7 times more likely to receive mastectomy (odds ratio, 1.70; 95% confidence interval, 1.19-2.42). The study also identified a statistically significant cluster of patients receiving mastectomy who were located in south-eastern South Dakota, after adjustment for other factors. Because geographic proximity to treatment facilities plays an important role on the treatment for early-stage breast cancer patients, this study has important implications for developing targeted intervention to reduce disparities in breast cancer treatment in South Dakota.

scholarly journals Radiation Therapy Resources and Guideline-Concordant Radiotherapy for Early-Stage Breast Cancer Patients in an Underserved Region

2013 ◽  
Vol 48 (4) ◽  
pp. 1433-1449 ◽  
Author(s):  
Nengliang Yao ◽  
Stephen A. Matthews ◽  
Marianne M. Hillemeier ◽  
Roger T. Anderson
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients

Primary care provider-reported participation in breast cancer treatment decision making.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 78-78
Author(s):  
Lauren P. Wallner ◽  
Yun Li ◽  
Chandler McLeod ◽  
Archana Radhakrishnan ◽  
Sarah T. Hawley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Early Stage ◽  
Treatment Decision ◽  
Breast Cancer Treatment ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Treatment Decision Making

78 Background: Surgical treatment decisions for early-stage breast cancer patients are complex and often involve discussions with multiple oncology providers. However, with the increasing adoption of team-based cancer care models, it remains unknown to what extent primary care providers (PCPs) are participating in breast cancer treatment decisions and whether they feel they have enough knowledge to participate in these decisions effectively. Methods: A stratified random sample of PCPs identified by newly diagnosed early-stage breast cancer patients who participated in iCanCare Study (Georgia and Los Angeles SEER registries) were surveyed about their experiences caring for cancer patients (N = 519, 58% current response rate). PCPs were asked how frequently they discussed which surgery a patient should have, how comfortable they were with these discussions, whether they had the necessary knowledge to participate in treatment decision making and their confidence in their ability to help with treatment decision making (5-item likert-type scales). The individual items were then categorized as somewhat/often/always vs. never/rarely for analyses. Results: In this preliminary sample, 62% of PCPs were not comfortable having a discussion about surgery options with a patient newly diagnosed with breast cancer, 41% did not feel that they had the necessary knowledge to participate in treatment decision-making, and 34% were not confident in the ability to help with treatment decision-making. One third (32%) of PCPs reported discussing surgical treatment options with their newly diagnosed breast cancer patients, but 22% of these PCPs also reported that they were not comfortable having these discussions and 16% reported they did not have necessary knowledge to participate in decision-making. Conclusions: A minority of PCPs participate in breast cancer treatment decision-making and there are notable gaps in their self-reported knowledge about decision-making and confidence in their ability to help with these decisions. Efforts to increase PCP knowledge about the specifics of cancer treatments may be warranted, but further research is needed to assess the impact of PCP participation on treatment decision-making outcomes.

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