ArticleJournal of oncology practice2015
Individual, Area, and Provider Characteristics Associated With Care Received for Stages I to III Breast Cancer in a Multistate Region of Appalachia.
Article in Journal of oncology practice, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Association of Race With Receipt of Proton Beam Therapy for Patients With Newly Diagnosed Cancer in the US, 2004-2018.JAMA network open · 2022Article
- Spatial analysis of colorectal cancer outcomes and socioeconomic factors in Virginia.BMC public health · 2021Article
- Article
- Clinical Molecular Marker Testing Data Capture to Promote Precision Medicine Research Within the Cancer Research Network.JCO clinical cancer informatics · 2019Article
- Disparities in the Initial Local Treatment of Older Women with Early-Stage Breast Cancer: A Population-Based Study.Journal of women's health (2002) · 2017Observational
- The quality of invasive breast cancer care for low reimbursement rate patients: A retrospective study.PloS one · 2017Article
- Geographic disparities in adherence to adjuvant endocrine therapy in Appalachian women with breast cancer.Research in social & administrative pharmacy : RSAPArticle
- Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015.Cancer control : journal of the Moffitt Cancer CenterArticle
- The association of chronic diseases and mammography among Medicare beneficiaries living in Appalachia.Women's health (London, England)Article
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
Abstract
purposeWe describe individual, area, and provider characteristics associated with care patterns for early-stage breast cancer in Appalachian counties of Kentucky, North Carolina, Ohio, and Pennsylvania.
methodsCases of stages I to III breast cancer from 2006 to 2008 were linked to Medicare claims occurring within 1 year of diagnosis. Rates of guideline-concordant endocrine therapy (n = 1,429), chemotherapy (n = 1,480), and radiation therapy (RT) after breast-conserving surgery were studied; RT was studied in women age ≥ 70 years with stage I estrogen receptor (ER) -positive/progesterone receptor (PR) -positive cancer, for whom RT was optional (n = 1,108), and in all others, for whom RT was guideline concordant (n = 1,422). Univariable and multivariable analyses were performed. Independent variables included age, race, county-level economic status, state, surgeon graduation year and volume, comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, trastuzumab use, and surgery type.
resultsPopulation mean age was 74 years; 97% were white. For endocrine therapy, chemotherapy, and RT, guideline concordance was 76%, 48%, and 83%, respectively. Where it was optional, 77% received RT. Guideline-concordant endocrine therapy was lower in North Carolina versus Pennsylvania (odds ratio [OR], 0.60; 95% CI, 0.41 to 0.88) and higher if surgeon graduated between 1984 and 1988 versus ≥ 1989 (OR, 1.58; 95% CI, 1.06 to 2.34). Guideline-concordant chemotherapy varied significantly by state, county-level economic status, and surgeon volume. In guideline-concordant RT, lower surgeon volume (v highest) predicted RT use (OR, 1.63; 95% CI, 1.61 to 2.36). In optional RT, North Carolina residence (v Pennsylvania; OR, 0.29; 95% CI, 0.17 to 0.48) and counties with higher economic status (OR, 0.61; 95% CI, 0.40 to 0.94) predicated RT omission.
conclusionNotable variation in care by geographic and surgical provider characteristics provides targets for further research in underserved areas.
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