1
|
Çakmak GK, Emiroğlu S, Sezer A, Canturk NZ, Yeniay L, Kuru B, Karanlık H, Soyder A, Gökgöz Ş, Sakman G, Ucuncu M, Akcay MN, Girgin S, Gurdal SO, Emiroglu M, Ozbas S, Öz AB, Arici C, Toktas O, Demircan O, Çalık A, Polat AK, Maralcan G, Demirer S, Ozmen V. Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery. JCO Glob Oncol 2021; 6:285-292. [PMID: 32109157 PMCID: PMC7051798 DOI: 10.1200/jgo.19.00275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.
Collapse
Affiliation(s)
- Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Selman Emiroğlu
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Atakan Sezer
- Department of Surgery, The School of Medicine, Trakya University, Edirne, Turkey
| | - Nuh Zafer Canturk
- Department of Surgery, The School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Levent Yeniay
- Department of Surgery, The School of Medicine, Ege University, Izmir, Turkey
| | - Bekir Kuru
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hasan Karanlık
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Aykut Soyder
- Department of Surgery, The School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Şehsuvar Gökgöz
- Department of Surgery, The School of Medicine, Uludag University, Bursa, Turkey
| | - Gürhan Sakman
- Department of Surgery, The School of Medicine, Cukurova University, Adana, Turkey
| | | | - Mufide Nuran Akcay
- Department of Surgery, The School of Medicine, Ataturk University, Erzurum, Turkey
| | - Sadullah Girgin
- Department of Surgery, The School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sibel Ozkan Gurdal
- Department of Surgery, The School of Medicine, Namık Kemal University, Tekirdag, Turkey
| | | | | | - Abdullah Bahadir Öz
- Department of Surgery, The School of Medicine, Erciyes University, Kayseri, Turkey
| | - Cumhur Arici
- Department of Surgery, The School of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Toktas
- Department of Surgery, The School of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | | | - Adnan Çalık
- Department of Surgery, The School of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Ayfer Kamali Polat
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Gokturk Maralcan
- Department of Surgery, The School of Medicine, Sanko University, Gaziantep, Turkey
| | - Seher Demirer
- Department of Surgery, The School of Medicine, Ankara University, Ankara, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| |
Collapse
|
2
|
Youlden DR, Baade PD, Walker R, Pyke CM, Roder DM, Aitken JF. Breast Cancer Incidence and Survival Among Young Females in Queensland, Australia. J Adolesc Young Adult Oncol 2020; 9:402-409. [DOI: 10.1089/jayao.2019.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Danny R. Youlden
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Peter D. Baade
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Rick Walker
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Oncology Service, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher M. Pyke
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Surgery, Mater Hospital, Brisbane, Australia
| | - David M. Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joanne F. Aitken
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
| |
Collapse
|
3
|
Alizadeh R, Aghsaeifard Z, Abbasvandi F, Hazrati E. Evaluation of clinical and non-clinical parameters among partial and total mastectomy patients. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
4
|
Ho-Huynh A, Tran A, Bray G, Abbot S, Elston T, Gunnarsson R, de Costa A. Factors influencing breast cancer outcomes in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13038. [PMID: 30919536 DOI: 10.1111/ecc.13038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION CRD42017072857.
Collapse
Affiliation(s)
- Albert Ho-Huynh
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Tran
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Gerard Bray
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Samuel Abbot
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Ronny Gunnarsson
- Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Alan de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
5
|
Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
6
|
Su S, Bao H, Wang X, Wang Z, Li X, Zhang M, Wang J, Jiang H, Wang W, Qu S, Liu M. The quality of invasive breast cancer care for low reimbursement rate patients: A retrospective study. PLoS One 2017; 12:e0184866. [PMID: 28910357 PMCID: PMC5599036 DOI: 10.1371/journal.pone.0184866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/03/2017] [Indexed: 01/02/2023] Open
Abstract
Though evidence-based treatments have been recommended for breast cancer, underuse of the treatments was still observed. To certain extent, patients' access to care, which can be enhanced by increasing the coverage of health insurance, could account for the current underuse in recommended care. This study aimed to examine the association between different proportions of reimbursement and quality of recommended breast cancer care, as well as length of hospital stay. In this retrospective study, 3669 patients diagnosed with invasive breast cancer between 1 June, 2011 and 30 June, 2013 were recruited. Seven quality indicators from preoperative diagnosis procedures to adjuvant therapy and one composite indicator were selected as dependent variables. Logistic regression and generalized linear models were used to explore the association between quality of care and length of hospital stay with different reimbursement rates. Compared with UEBMI (urban employment basic medical insurance), which represented high level reimbursement rate, patients with lower rates of reimbursement were less likely to receive core biopsy, HER-2 (human epidermal growth factor receptor-2) testing, BCS (breast conserving surgery), SLNB (sentinel lymph nodes biopsy), adjuvant therapy and hormonal treatment. No significant difference in preoperative length of hospital stay was observed among the three insurance schemes, however URBMI (urban resident basic medical insurance) insured patients stayed longer for total length of hospital stay. Significant disparities in utilization of evidence-based breast cancer care among patients with different proportions of reimbursement were observed. Patients with lower rate of reimbursement were less likely to receive recommended care. Our findings could provide important support for further healthcare reform and quality improvement in breast cancer care.
Collapse
Affiliation(s)
- Shaofei Su
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Han Bao
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Xinyu Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Zhiqiang Wang
- School of Medicine, University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Xi Li
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meiqi Zhang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Jiaying Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Hao Jiang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Wenji Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Siyang Qu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meina Liu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
- * E-mail:
| |
Collapse
|
7
|
Dasgupta P, Youl PH, Pyke C, Aitken JF, Baade PD. Geographical disparity in breast reconstruction following mastectomy has reduced over time. ANZ J Surg 2016; 87:E183-E187. [DOI: 10.1111/ans.13710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Philippa H. Youl
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| | | | - Joanne F. Aitken
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Peter D. Baade
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| |
Collapse
|
8
|
Baade PD, Dasgupta P, Youl PH, Pyke C, Aitken JF. Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997-2011: Improvements over Time but Inequalities Remain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E729. [PMID: 27447656 PMCID: PMC4962270 DOI: 10.3390/ijerph13070729] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022]
Abstract
The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%). After adjustment for socio-demographic and clinical factors, compared to women living in very high accessibility areas, women in high (Odds Ratio (OR) 0.58 (95% confidence intervals (CI) 0.49, 0.69)), low (OR 0.47 (0.41, 0.54)) and very low (OR 0.44 (0.34, 0.56)) accessibility areas had lower odds of having BCS, while the odds for women from middle (OR 0.81 (0.69, 0.94)) and most disadvantaged (OR 0.87 (0.71, 0.98)) areas was significantly lower than women living in affluent areas. The association between accessibility and the type of surgery reduced over time (interaction p = 0.028) but not for area disadvantage (interaction p = 0.209). In making informed decisions about surgical treatment, it is crucial that any geographical-related barriers to implementing their preferred treatment are minimised.
Collapse
Affiliation(s)
- Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
| | - Paramita Dasgupta
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
| | - Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
- School of Population Health, University of Queensland, Brisbane 4006, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba 4350, Australia.
| |
Collapse
|
9
|
Geographic variation in the intended choice of adjuvant treatments for women diagnosed with screen-detected breast cancer in Queensland. BMC Public Health 2015; 15:1204. [PMID: 26630881 PMCID: PMC4668608 DOI: 10.1186/s12889-015-2527-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although early diagnosis and improved treatment can reduce breast cancer mortality, there still appears to be a geographic differential in patient outcomes. This study aims to determine and quantify spatial inequalities in intended adjuvant (radio-, chemo- and hormonal) therapy usage among women with screen-detected breast cancer in Queensland, Australia. Methods Linked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry during 1997−2008 for women aged 40−89 years were used. We adopted a Bayesian shared spatial component model to evaluate the relative intended use of each adjuvant therapy across 478 areas as well as common spatial patterns between treatments. Results Women living closer to a cancer treatment facility were more likely to intend to use adjuvant therapy. This was particularly marked for radiotherapy when travel time to the closest radiation facility was 4 + h (OR =0.41, 95 % CrI: [0.23, 0.74]) compared to <1 h. The shared spatial effect increased towards the centres with concentrations of radiotherapy facilities, in north-east (Townsville) and south-east (Brisbane) regions of Queensland. Moreover, the presence of residual shared spatial effects indicates that there are other unmeasured geographical barriers influencing women’s treatment choices. Conclusions This highlights the need to identify the additional barriers that impact on treatment intentions among women diagnosed with screen-detected breast cancer, particularly for those women living further away from cancer treatment centers. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2527-2) contains supplementary material, which is available to authorized users.
Collapse
|
10
|
Race/ethnicity and socio-economic differences in breast cancer surgery outcomes. Cancer Epidemiol 2015; 39:745-51. [PMID: 26231096 DOI: 10.1016/j.canep.2015.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/04/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate racial and socio-economic differences in breast cancer surgery treatment, post-surgical complications, hospital length of stay and mortality among hospitalized breast cancer patients. METHODS We examined the association between race/ethnicity and socio-economic status with treatment and outcomes after surgery among 71,156 women hospitalized with a primary diagnosis of breast cancer using the Nationwide Inpatient Sample database from 2007 to 2011. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals adjusting for age, comorbidities, stage at diagnosis, insurance, and residential region. RESULTS Black women were more likely to receive breast conserving surgery but less likely to receive mastectomies compared with white women. They also experienced significantly longer hospital stays (β=0.31, 95% CI: 0.24, 0.39), post-surgical complications (OR=1.21, 95% CI: 1.04-1.42) and in-hospital mortality (OR=1.26, 95% CI: 1.07-1.50) compared with Whites, after adjusting for other factors including the number of comorbidities and treatment type. CONCLUSION Among patients hospitalized for breast cancer, there were racial differences observed in treatment and outcomes. Further studies are needed to fully characterize whether these differences are due to individual, provider level or hospital level factors, and to highlight areas for targeted approaches to eliminate these disparities.
Collapse
|
11
|
Banks P, Matheson LM, Morrissy K, Olesen I, Pitson G, Chapman A, Ashley DM, Henry MJ. Characteristics of cancer diagnoses and staging in South Western Victoria: A rural perspective. Aust J Rural Health 2014; 22:257-63. [DOI: 10.1111/ajr.12112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Leigh M. Matheson
- Barwon South Western Region Integrated Cancer Services; Geelong Victoria Australia
| | - Kate Morrissy
- Barwon South Western Region Integrated Cancer Services; Geelong Victoria Australia
| | - Inger Olesen
- Andrew Love Cancer Centre; Geelong Victoria Australia
| | - Graham Pitson
- Andrew Love Cancer Centre; Geelong Victoria Australia
| | - Adam Chapman
- Department of Health (Victoria); Melbourne Victoria Australia
| | - David M. Ashley
- Andrew Love Cancer Centre; Geelong Victoria Australia
- Department of Medicine; Barwon Health; Deakin University; Melbourne Victoria Australia
| | - Margaret J. Henry
- Barwon South Western Region Integrated Cancer Services; Geelong Victoria Australia
- Department of Medicine; Barwon Health; Deakin University; Melbourne Victoria Australia
| |
Collapse
|
12
|
Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet 2013; 382:1121-9. [PMID: 24075052 PMCID: PMC4211114 DOI: 10.1016/s0140-6736(13)61215-5] [Citation(s) in RCA: 351] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The use of common surgical procedures varies widely across regions. Differences in illness burden, diagnostic practices, and patient attitudes about medical intervention explain only a small degree of regional variation in surgery rates. Evidence suggests that surgical variation results mainly from differences in physician beliefs about the indications for surgery, and the extent to which patient preferences are incorporated into treatment decisions. These two components of clinical decision making help to explain the so-called surgical signatures of specific procedures, and why some consistently vary more than others. Variation in clinical decision making is, in turn, affected by broad environmental factors, including technology diffusion, supply of specialists, local training frameworks, financial incentives, and regulatory factors, which vary across countries. Better scientific evidence about the comparative effectiveness of surgical and non-surgical interventions could help to mitigate regional variation, but broader dissemination of shared decision aids will be essential to reduce variation in preference-sensitive disorders.
Collapse
Affiliation(s)
- John D Birkmeyer
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Zhou J, Enewold L, Zahm SH, Jatoi I, Shriver C, Anderson WF, Jeffery DD, Andaya A, Potter JF, McGlynn KA, Zhu K. Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system. Am J Surg 2013; 206:393-9. [PMID: 23866763 DOI: 10.1016/j.amjsurg.2013.01.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 12/15/2012] [Accepted: 01/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system. METHODS This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation. RESULTS Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR = 1.27; 95% CI, 1.14 to 1.41). CONCLUSIONS In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.
Collapse
Affiliation(s)
- Jing Zhou
- John P. Murtha Cancer Center, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Goldsbury DE, Armstrong K, Simonella L, Armstrong BK, O'Connell DL. Using administrative health data to describe colorectal and lung cancer care in New South Wales, Australia: a validation study. BMC Health Serv Res 2012; 12:387. [PMID: 23140341 PMCID: PMC3512511 DOI: 10.1186/1472-6963-12-387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/03/2012] [Indexed: 11/10/2022] Open
Abstract
Background Monitoring treatment patterns is crucial to improving cancer patient care. Our aim was to determine the accuracy of linked routinely collected administrative health data for monitoring colorectal and lung cancer care in New South Wales (NSW), Australia. Methods Colorectal and lung cancer cases diagnosed in NSW between 2000 and 2002 were identified from the NSW Central Cancer Registry (CCR) and linked to their hospital discharge records in the NSW Admitted Patient Data Collection (APDC). These records were then linked to data from two relevant population-based patterns of care surveys. The main outcome measures were the sensitivity and specificity of data from the CCR and APDC for disease staging, investigative procedures, curative surgery, chemotherapy, radiotherapy, and selected comorbidities. Results Data for 2917 colorectal and 1580 lung cancer cases were analysed. Unknown disease stage was more common for lung cancer in the administrative data (18%) than in the survey (2%). Colonoscopies were captured reasonably accurately in the administrative data compared with the surveys (82% and 79% respectively; 91% sensitivity, 53% specificity) but all other colorectal or lung cancer diagnostic procedures were under-enumerated. Ninety-one percent of colorectal cancer cases had potentially curative surgery recorded in the administrative data compared to 95% in the survey (96% sensitivity, 92% specificity), with similar accuracy for lung cancer (16% and 17%; 92% sensitivity, 99% specificity). Chemotherapy (~40% sensitivity) and radiotherapy (sensitivity≤30%) were vastly under-enumerated in the administrative data. The only comorbidity that was recorded reasonably accurately in the administrative data was diabetes. Conclusions Linked routinely collected administrative health data provided reasonably accurate information on potentially curative surgical treatment, colonoscopies and comorbidities such as diabetes. Other diagnostic procedures, comorbidities, chemotherapy and radiotherapy were not well enumerated in the administrative data. Other sources of data will be required to comprehensively monitor the primary management of cancer patients.
Collapse
Affiliation(s)
- David E Goldsbury
- Cancer Research Division, Cancer Council NSW, PO Box 572, Kings Cross, NSW 1340, Australia.
| | | | | | | | | |
Collapse
|
15
|
Fallbjörk U, Salander P, Rasmussen BH. From "no big deal" to "losing oneself": different meanings of mastectomy. Cancer Nurs 2012; 35:E41-8. [PMID: 22067698 DOI: 10.1097/ncc.0b013e31823528fb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because of early detection and advanced treatment options, more women with breast cancer survive after mastectomy and thus have to face the choice of living with or without a reconstructed breast for many years to come. OBJECTIVE This article investigates these women's narratives about the impact of mastectomy on their lives, as well as their reflections on breast reconstruction. METHODS Fifteen women were strategically chosen from a previous population-based study on mastectomy. They were contacted for further exploration in thematic narrative-inspired interviews 4.5 years after mastectomy. RESULTS Three types of storylines were identified. In the first storyline, the mastectomy was described as "no big deal"; losing a breast did not disturb the women's view of themselves as women, and breast reconstruction was not even worth consideration. In the second storyline, the women described the mastectomy as shattering their identity. Losing a breast implied losing oneself as a sexual being, a woman, and a person. The third storyline fell in between the other two; the sense of femininity was wounded, but not to the extent that they felt lost as women. CONCLUSION Our findings suggest that the experience of mastectomy due to breast cancer is very much individual and contextual. Losing a breast may be of minor or major importance. IMPLICATIONS FOR PRACTICE Healthcare practitioners should be attentive to how the women themselves experience the personal meaning of losing a breast and guard against vague preconceptions based on the breast-sexuality-femininity discourse and its connection to what the patient needs.
Collapse
|
16
|
Baade PD, Youlden DR, Gardiner RA, Ferguson M, Aitken JF, Yaxley J, Chambers SK. Factors associated with treatment received by men diagnosed with prostate cancer in Queensland, Australia. BJU Int 2012; 110:E712-9. [DOI: 10.1111/j.1464-410x.2012.011533.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
17
|
Dasgupta P, Youlden DR, Baade PD. Multiple primary cancers among colorectal cancer survivors in Queensland, Australia, 1996-2007. Cancer Causes Control 2012; 23:1387-98. [PMID: 22729930 DOI: 10.1007/s10552-012-9990-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/03/2012] [Indexed: 01/04/2023]
Abstract
PURPOSE To quantify the demographic and clinical factors associated with an increased risk of multiple primary cancers (MPCs) among colorectal cancer survivors. METHODS Standardized incidence ratios for MPCs were calculated for residents of Queensland, Australia, who were diagnosed with a first primary colorectal cancer between 1996 and 2005 and survived for at least 2 months. Relative risk ratios were calculated for all MPCs combined and selected individual sites using multivariate Poisson models. RESULTS A total of 1,615 MPCs were observed among 15,755 study patients. The cohort had a significant excess risk of developing subsequent colorectal (SIR = 1.47, 95 % CI 1.30-1.66) or non-colorectal (SIR = 1.24, 95 % CI 1.18-1.31) cancers relative to the incidence of cancer in the general population. Age at initial diagnosis, follow-up time, initial colorectal subsite, and surgical treatment were independently associated (p < 0.01) with the overall risk of developing MPCs after adjustment. The relative risk ratio was 1.23 (95 % CI 1.07-1.41) for those aged 20-59 years compared with the 70-79 age group and 0.82 (95 % CI 0.72-0.92) for 1-5-year follow-up relative to the first year. The likelihood of being diagnosed with a MPC was 33 % higher (95 % CI 1.12-1.56) for surgically treated patients and 45 % higher (95 % CI 1.29-1.64) after proximal colon cancers relative to rectal cancer. CONCLUSIONS While these population-based results do not incorporate all possible risk factors, they form an important foundation from which to further investigate the etiological causes that result in the development of MPCs among colorectal cancer survivors.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, QLD 4001, Australia
| | | | | |
Collapse
|
18
|
Martin JH, Coory M, Baade P. Challenges of an ageing and dispersed population for delivering cancer services in Australia: more than just doctors needed. Intern Med J 2012; 42:349-51. [DOI: 10.1111/j.1445-5994.2012.02746.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
19
|
Thompson B, Watson M, Bowman R, Fong K, Coory M. Hospital-activity data inaccurate for determining spread-of-disease at diagnosis for non-small cell lung cancer. Aust N Z J Public Health 2012; 36:212-7. [PMID: 22672025 DOI: 10.1111/j.1753-6405.2012.00850.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Accurate information on spread-of-disease at diagnosis would increase the usefulness of hospital-activity data for cancer research. This study evaluates the accuracy of codes recorded in hospital-activity data to assign spread-of-disease at diagnosis for non-small cell lung cancer (NSCLC). METHODS The reference (gold) standard was TNM stage as assigned at a multi-disciplinary meeting. To allow comparison with hospital-activity data, TNM stage was mapped to spread-of-disease (local, regional, distant). Sensitivity, specificity and positive-predictive values were stratified by whether the patient had surgery. RESULTS Data from the reference standard and hospital-activity database were available for 2,184 patients. According to the reference standard, local disease was present for 57.0% of surgical patients and 12.6% of non-surgical patients at diagnosis. Hospital-activity data over-estimated patients with local disease (surgical: 71.9%, non-surgical: 48.5%). There was a corresponding underestimation of distant spread-of-disease: surgical (reference standard: 4.0%, hospital-activity data: 2.7%); non-surgical (reference standard: 45.9%, hospital-activity data: 36.8%). This meant that hospital-activity data had good sensitivity but poor specificity for local disease; and poor sensitivity, but good specificity for metastatic disease. CONCLUSION Secondary diagnosis codes in hospital activity data do not accurately capture spread-of-disease at diagnosis for patients with non-small cell lung cancer; even when the clinical notes contain TNM clinical stage as documented at a multidisciplinary meeting. IMPLICATIONS Changes are needed to coding rules, and the ICD codes themselves, to allow for coding of regional and distant spread without specification of the precise site.
Collapse
Affiliation(s)
- Bridie Thompson
- School of Population Health, University of Queensland, Victoria
| | | | | | | | | |
Collapse
|
20
|
He ZY, Tong Q, Wu SG, Li FY, Lin HX, Guan XX. A comparison of quality of life and satisfaction of women with early-stage breast cancer treated with breast conserving therapy vs. mastectomy in southern China. Support Care Cancer 2012; 20:2441-9. [DOI: 10.1007/s00520-011-1364-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022]
|
21
|
Dasgupta P, Baade PD, Aitken JF, Turrell G. Multilevel determinants of breast cancer survival: association with geographic remoteness and area-level socioeconomic disadvantage. Breast Cancer Res Treat 2011; 132:701-10. [PMID: 22160639 DOI: 10.1007/s10549-011-1899-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/23/2011] [Indexed: 01/18/2023]
Abstract
A major priority for cancer control agencies is to reduce geographical inequalities in cancer outcomes. While the poorer breast cancer survival among socioeconomically disadvantaged women is well established, few studies have looked at the independent contribution that area- and individual-level factors make to breast cancer survival. Here, we examine relationships between geographic remoteness, area-level socioeconomic disadvantage and breast cancer survival after adjustment for patients' socio-demographic characteristics and stage at diagnosis. Multilevel logistic regression and Markov chain Monte Carlo simulation were used to analyze 18,568 breast cancer cases extracted from the Queensland Cancer Registry for women aged 30-70 years diagnosed between 1997 and 2006 from 478 Statistical Local Areas in Queensland, Australia. Independent of individual-level factors, area-level disadvantage was associated with breast cancer survival (P = 0.032). Compared to women in the least disadvantaged quintile (quintile 5), women diagnosed while resident in one of the remaining four quintiles had significantly worse survival (OR 1.23, 1.27, 1.30, 1.37 for quintiles 4, 3, 2, and 1, respectively). Geographic remoteness was not related to lower survival after multivariable adjustment. There was no evidence that the impact of area-level disadvantage varied by geographic remoteness. At the individual-level, Indigenous status, blue collar occupations and advanced disease were important predictors of poorer survival. A woman's survival after a diagnosis of breast cancer depends on the socio-economic characteristics of the area where she lives, independently of her individual-level characteristics. It is crucial that the underlying reasons for these inequalities be identified to appropriately target policies, resources and effective intervention strategies.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, 4004, Spring Hill, Brisbane, QLD, Australia
| | | | | | | |
Collapse
|
22
|
The effect of junior residents on surgical quality: a study of surgical outcomes in breast surgery. Am J Surg 2011; 202:654-7; discussion 657-8. [DOI: 10.1016/j.amjsurg.2011.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 11/15/2022]
|
23
|
Youl PH, Baade PD, Aitken JF, Chambers SK, Turrell G, Pyke C, Dunn J. A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer. BMC Cancer 2011; 11:415. [PMID: 21951320 PMCID: PMC3195770 DOI: 10.1186/1471-2407-11-415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/28/2011] [Indexed: 12/02/2022] Open
Abstract
Background In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes. Methods/Design This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling. Discussion The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.
Collapse
Affiliation(s)
- Philippa H Youl
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, QLD, Australia.
| | | | | | | | | | | | | |
Collapse
|
24
|
Zhang L, Jiang M, Zhou Y, Du XB, Yao WX, Yan X, Jiang Y, Zou LQ. Survey on breast cancer patients in China toward breast-conserving surgery. Psychooncology 2011; 21:488-95. [DOI: 10.1002/pon.1922] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 12/26/2010] [Accepted: 12/27/2010] [Indexed: 11/05/2022]
|
25
|
Baade PD, Turrell G, Aitken JF. A multilevel study of the determinants of area-level inequalities in colorectal cancer survival. BMC Cancer 2010; 10:24. [PMID: 20109230 PMCID: PMC2837617 DOI: 10.1186/1471-2407-10-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 01/28/2010] [Indexed: 12/01/2022] Open
Abstract
Background In Australia, associations between geographic remoteness, socioeconomic disadvantage, and colorectal cancer (CRC) survival show that survival rates are lowest among residents of geographically remote regions and those living in disadvantaged areas. At present we know very little about the reasons for these inequalities, hence our capacity to intervene to reduce the inequalities is limited. Methods/Design This study, the first of its type in Australia, examines the association between CRC survival and key area- and individual-level factors. Specifically, we will use a multilevel framework to investigate the possible determinants of area- and individual-level inequalities in CRC survival and quantify the relative contribution of geographic remoteness, socioeconomic and demographic factors, disease stage, and access to diagnostic and treatment services, to these inequalities. The multilevel analysis will be based on survival data relating to people diagnosed with CRC in Queensland between 1996 and 2005 (n = 22,723) from the Queensland Cancer Registry (QCR), area-level data from other data custodians such as the Australian Bureau of Statistics, and individual-level data from the QCR (including extracting stage from pathology records) and Queensland Hospitals. For a subset of this period (2003 and 2004) we will utilise more detailed, individual-level data (n = 1,966) covering a greater range of risk factors from a concurrent research study. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to treatment centres. The analyses will be conducted using a multilevel Cox proportional hazards model with Level 1 comprising individual-level factors (e.g. occupation) and level 2 area-level indicators of remoteness and area socioeconomic disadvantage. Discussion This study focuses on the health inequalities for rural and disadvantaged populations that have often been documented but poorly understood, hence limiting our capacity to intervene. This study utilises and develops emerging statistical and spatial technologies that can then be applied to other cancers and health outcomes. The findings of this study will have direct implications for the targeting and resourcing of cancer control programs designed to reduce the burden of colorectal cancer, and for the provision of diagnostic and treatment services.
Collapse
Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, Spring Hill QLD 4004, Australia.
| | | | | |
Collapse
|
26
|
DiSipio T, Hayes SC, Newman B, Aitken J, Janda M. Does quality of life among breast cancer survivors one year after diagnosis differ depending on urban and non-urban residence? A comparative study. Health Qual Life Outcomes 2010; 8:3. [PMID: 20059768 PMCID: PMC2821367 DOI: 10.1186/1477-7525-8-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 01/07/2010] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study examined the quality of life (QOL), measured by the Functional Assessment of Cancer Therapy (FACT) questionnaire, among urban (n = 277) and non-urban (n = 323) breast cancer survivors and women from the general population (n = 1140) in Queensland, Australia. METHODS Population-based samples of breast cancer survivors aged < 75 years who were 12 months post-diagnosis and similarly-aged women from the general population were recruited between 2002 and 2007. RESULTS Age-adjusted QOL among urban and non-urban breast cancer survivors was similar, although QOL related to breast cancer concerns was the weakest domain and was lower among non-urban survivors than their urban counterparts (36.8 versus 40.4, P < 0.01). Irrespective of residence, breast cancer survivors, on average, reported comparable scores on most QOL scales as their general population peers, although physical well-being was significantly lower among non-urban survivors (versus the general population, P < 0.01). Overall, around 20%-33% of survivors experienced lower QOL than peers without the disease. The odds of reporting QOL below normative levels were increased more than two-fold for those who experienced complications following surgery, reported upper-body problems, had higher perceived stress levels and/or a poor perception of handling stress (P < 0.01 for all). CONCLUSIONS Results can be used to identify subgroups of women at risk of low QOL and to inform components of tailored recovery interventions to optimize QOL for these women following cancer treatment.
Collapse
Affiliation(s)
- Tracey DiSipio
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.
| | | | | | | | | |
Collapse
|