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Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer
Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the pa...
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| Published in: | Breast cancer research and treatment 2015-01, Vol.149 (1), p.199-209 |
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| container_title | Breast cancer research and treatment |
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| creator | Wan, Shaowei Jubelirer, Steven |
| description | Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the paper was to examine how age may modify the effect of geographic access on chemotherapy use in elderly patients with MBC. This was a retrospective cohort study based on the surveillance, epidemiology, and end results—Medicare-linked database of 1992–2002. Chemotherapy use was defined as at least one chemotherapy-related claim within 6-month post-diagnosis. Geographic access to cancer care was measured by four variables: patient travel time to the nearest oncologist practice, local area per capita number of oncologists, local area per capita number of hospices, and local area chemotherapy rate. Using multivariate logistic regression model, both aggregate models with interaction terms and subgroup analyses were conducted. Among 4,533 elderly with MBC, 30.16 % used chemotherapy. Chemotherapy use decreased with age. Both the aggregate model with interaction terms and the subgroup analysis showed that local area chemotherapy rate was positively associated with chemotherapy use (
P
= .0004 in the whole group; in the subgroup analyses,
P
|
| doi_str_mv | 10.1007/s10549-014-3220-3 |
| format | article |
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P
= .0004 in the whole group; in the subgroup analyses,
P
< .0001,
P
= .0006,
P
= .0006,
P
= .18,
P
= .026, respectively). In addition, subgroup analysis showed that, among patients aged 85+ years old, local area oncologist supply was negatively associated with chemotherapy use (
P
= .028). The impact of geographic access to cancer care is the greatest among the oldest group, for whom the clinical evidence is the least certain.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-014-3220-3</identifier><identifier>PMID: 25472915</identifier><identifier>CODEN: BCTRD6</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Aged ; Analysis ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - epidemiology ; Breast Neoplasms - pathology ; Cancer ; Cancer research ; Cancer therapies ; Chemotherapy ; Epidemiology ; Female ; Health care access ; Humans ; Medicare ; Medicine ; Medicine & Public Health ; Metastasis ; Middle Aged ; Neoplasm Metastasis ; Older people ; Oncology ; Patient Acceptance of Health Care ; SEER Program ; United States ; Urban Population</subject><ispartof>Breast cancer research and treatment, 2015-01, Vol.149 (1), p.199-209</ispartof><rights>Springer Science+Business Media New York 2014</rights><rights>COPYRIGHT 2015 Springer</rights><rights>Springer Science+Business Media New York 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-21474fcdc9b60cfbe519dd2ad9b60aa9aac317d9c99ba477d09383196521b95a3</citedby><cites>FETCH-LOGICAL-c540t-21474fcdc9b60cfbe519dd2ad9b60aa9aac317d9c99ba477d09383196521b95a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25472915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wan, Shaowei</creatorcontrib><creatorcontrib>Jubelirer, Steven</creatorcontrib><title>Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><addtitle>Breast Cancer Res Treat</addtitle><description>Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the paper was to examine how age may modify the effect of geographic access on chemotherapy use in elderly patients with MBC. This was a retrospective cohort study based on the surveillance, epidemiology, and end results—Medicare-linked database of 1992–2002. Chemotherapy use was defined as at least one chemotherapy-related claim within 6-month post-diagnosis. Geographic access to cancer care was measured by four variables: patient travel time to the nearest oncologist practice, local area per capita number of oncologists, local area per capita number of hospices, and local area chemotherapy rate. Using multivariate logistic regression model, both aggregate models with interaction terms and subgroup analyses were conducted. Among 4,533 elderly with MBC, 30.16 % used chemotherapy. Chemotherapy use decreased with age. Both the aggregate model with interaction terms and the subgroup analysis showed that local area chemotherapy rate was positively associated with chemotherapy use (
P
= .0004 in the whole group; in the subgroup analyses,
P
< .0001,
P
= .0006,
P
= .0006,
P
= .18,
P
= .026, respectively). In addition, subgroup analysis showed that, among patients aged 85+ years old, local area oncologist supply was negatively associated with chemotherapy use (
P
= .028). The impact of geographic access to cancer care is the greatest among the oldest group, for whom the clinical evidence is the least certain.</description><subject>Aged</subject><subject>Analysis</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - epidemiology</subject><subject>Breast Neoplasms - pathology</subject><subject>Cancer</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health care access</subject><subject>Humans</subject><subject>Medicare</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neoplasm Metastasis</subject><subject>Older people</subject><subject>Oncology</subject><subject>Patient Acceptance of Health Care</subject><subject>SEER Program</subject><subject>United States</subject><subject>Urban Population</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kkFvFSEUhUmjaZ_VH-DGkJgYN1NhGIaybBqtJk3ctGtyB-68oZkZnsDYvH8vk1fNq9GwAC7fOeHCIeQtZxecMfUpcSYbXTHeVKKuWSVOyIZLJSpVc_WCbBhvVdVesvaMvErpgTGmFdOn5KyWjao1lxsy3GDYRtgN3lKwFlOiMDsKW6wijpDR0Z8QPWQfZupnagecQh6wSPZ0SbjWcHQYxz199HmgE2ZIufCWdhHLklqYLcbX5GUPY8I3T_M5uf_y-e76a3X7_ebb9dVtZWXDclXzRjW9dVZ3LbN9h5Jr52pw6x5AA1jBldNW6w4apRzT4lJw3cqad1qCOCcfD767GH4smLKZfLI4jjBjWJLhhRRaScUK-v4v9CEscS63K1TTSinEMbWFEY2f-5Aj2NXUXDVMa6U5l4W6-AdVhsPJ2zBj70v9meDDkWBAGPOQwrisD52eg_wA2hhSitibXfQTxL3hzKwxMIcYmBIDs8bAiKJ599TZ0k3o_ih-_3sB6gOQytG8xXjU-n9dfwEKSrsv</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Wan, Shaowei</creator><creator>Jubelirer, Steven</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20150101</creationdate><title>Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer</title><author>Wan, Shaowei ; Jubelirer, Steven</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-21474fcdc9b60cfbe519dd2ad9b60aa9aac317d9c99ba477d09383196521b95a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Analysis</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - epidemiology</topic><topic>Breast Neoplasms - pathology</topic><topic>Cancer</topic><topic>Cancer research</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health care access</topic><topic>Humans</topic><topic>Medicare</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Neoplasm Metastasis</topic><topic>Older people</topic><topic>Oncology</topic><topic>Patient Acceptance of Health Care</topic><topic>SEER Program</topic><topic>United States</topic><topic>Urban Population</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wan, Shaowei</creatorcontrib><creatorcontrib>Jubelirer, Steven</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wan, Shaowei</au><au>Jubelirer, Steven</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer</atitle><jtitle>Breast cancer research and treatment</jtitle><stitle>Breast Cancer Res Treat</stitle><addtitle>Breast Cancer Res Treat</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>149</volume><issue>1</issue><spage>199</spage><epage>209</epage><pages>199-209</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><coden>BCTRD6</coden><abstract>Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the paper was to examine how age may modify the effect of geographic access on chemotherapy use in elderly patients with MBC. This was a retrospective cohort study based on the surveillance, epidemiology, and end results—Medicare-linked database of 1992–2002. Chemotherapy use was defined as at least one chemotherapy-related claim within 6-month post-diagnosis. Geographic access to cancer care was measured by four variables: patient travel time to the nearest oncologist practice, local area per capita number of oncologists, local area per capita number of hospices, and local area chemotherapy rate. Using multivariate logistic regression model, both aggregate models with interaction terms and subgroup analyses were conducted. Among 4,533 elderly with MBC, 30.16 % used chemotherapy. Chemotherapy use decreased with age. Both the aggregate model with interaction terms and the subgroup analysis showed that local area chemotherapy rate was positively associated with chemotherapy use (
P
= .0004 in the whole group; in the subgroup analyses,
P
< .0001,
P
= .0006,
P
= .0006,
P
= .18,
P
= .026, respectively). In addition, subgroup analysis showed that, among patients aged 85+ years old, local area oncologist supply was negatively associated with chemotherapy use (
P
= .028). The impact of geographic access to cancer care is the greatest among the oldest group, for whom the clinical evidence is the least certain.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25472915</pmid><doi>10.1007/s10549-014-3220-3</doi><tpages>11</tpages></addata></record> |
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| ispartof | Breast cancer research and treatment, 2015-01, Vol.149 (1), p.199-209 |
| issn | 0167-6806 1573-7217 |
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| source | Springer Nature |
| subjects | Aged Analysis Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - epidemiology Breast Neoplasms - pathology Cancer Cancer research Cancer therapies Chemotherapy Epidemiology Female Health care access Humans Medicare Medicine Medicine & Public Health Metastasis Middle Aged Neoplasm Metastasis Older people Oncology Patient Acceptance of Health Care SEER Program United States Urban Population |
| title | Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer |
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