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Cancer Epidemiol. 2016 Feb;40:7-14. doi: 10.1016/j.canep.2015.11.003. Epub 2015 Nov 21.

Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer.

Author information

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.
3
Department of Radiation Oncology, Medical College of Wisconsin, 8701W Watertown Plank Rd, Milwaukee, WI 53226, 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.
10
Department of Population Health Sciences, Carbone Cancer Center, University of Wisconsin-Madison, 610 Walnut Street, Room 307, WARF Building, Madison, WI 53726, USA. Electronic address: trentham@wisc.edu.

Abstract

PURPOSE:

Inflammatory 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.

METHODS:

Patients 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.

RESULTS:

Of 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/m(2)), 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.

CONCLUSIONS:

Targeting 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.

KEYWORDS:

Breast cancer; Epidemiology; Guideline; Healthcare disparities; Inflammatory breast cancer

PMID:
26605428
PMCID:
PMC4738104
DOI:
10.1016/j.canep.2015.11.003
[Indexed for MEDLINE]
Free PMC Article

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