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Health Serv Res. 2015 Aug;50(4):1088-108. doi: 10.1111/1475-6773.12269. Epub 2014 Dec 10.

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

Author information

1
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, GA.
2
Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA.
3
Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
4
Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA.

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.

KEYWORDS:

Quality assessment; breast cancer; cancer care; quality of care; rural health

PMID:
25491350
PMCID:
PMC4545348
DOI:
10.1111/1475-6773.12269
[Indexed for MEDLINE]
Free PMC Article

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