Influence of patient,physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer |
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| Institution: | 1. Medical Scientist Training Program, University of Wisconsin-Madison, 6068 WIMR, 1111 Highland Avenue, Madison, WI 53705, USA;2. University of Wisconsin-Madison Carbone Cancer Center, 610 Walnut Street, Room 307, WARF Building, Madison, WI 53726, USA;4. Division of Health Services Research, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA;5. Public Health Institute, Cancer Registry of Greater California, Department of Public Health Sciences, UC Davis School of Medicine, One Shields Avenue, Medical Sciences 1C, Davis, CA 95616, USA;6. College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, USA;7. Rollins School of Public Health and Winship Cancer Institute, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA;8. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;9. LSU Health Sciences Center School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA;11. Department of Population Health Sciences, Carbone Cancer Center, University of Wisconsin-Madison, 610 Walnut Street, Room 307, WARF Building, Madison, WI 53726, USA;1. Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States;2. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, United States;1. Group Infection and Cancer, School of Medicine and Corporación Académica para el Estudio de Patologías Tropicales, Universidad de Antioquia (UdeA), Medellín, Colombia;2. Registro Poblacional de Cancer de Cali, Universidad del Valle, Cali, Colombia;3. Grupo Epidemiologia, Instituto Nacional de Cancerologia, Bogotá, Colombia;4. IDIBELL, Institut Català d''Oncologia—Catalan Institute of Oncology, L''Hospitalet de Llobregat, Barcelona, Spain;5. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain;1. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA;2. Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA;3. Colorado Department of Public Health Breast and Cervical Cancer Screening and Prevention Advisory Board, USA;1. Sinai Urban Health Institute, Room K439, 1500 S. Fairfield Ave, Chicago, IL 60608-1797, USA;2. Rosalind Franklin University of Medicine and Science, Chicago Medical School, 3333 Green Bay Rd, North Chicago, IL 60064, USA;1. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;2. Wolff Center of University of Pittsburgh Medical Center, Pittsburgh, PA, USA;3. Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA;4. American College of Surgeons – National Surgical Quality Improvement Program, Chicago, IL, USA;5. Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA;6. Department of Surgery and Olin Business School, Washington University in St Louis, St Louis, MO, USA;7. BJC Healthcare, St Louis, MO, USA |
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| Abstract: | PurposeInflammatory breast cancer (IBC) is an aggressive subtype of breast cancer for which treatments vary, so we sought to identify factors that affect the receipt of guideline-concordant care.MethodsPatients diagnosed with IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registries in seven states. Variation in guideline-concordant care for IBC, based on National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics.ResultsOf the 107 IBC patients in the study without distant metastasis at the time of diagnosis, only 25.8% received treatment concordant with guidelines. Predictors of non-concordance included patient age (≥70 years), non-white race, normal body mass index (BMI 18.5–25 kg/m2), patients with physicians graduating from medical school >15 years prior, and smaller hospital size (<200 beds). IBC patients survived longer if they received guideline-concordant treatment based on either 2003 (p = 0.06) or 2013 (p = 0.06) NCCN guidelines.ConclusionsTargeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Prompt referral for neoadjuvant chemotherapy and post-operative radiation therapy is also crucial. |
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| Keywords: | Inflammatory breast cancer Breast cancer Guideline Healthcare disparities Epidemiology |
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