Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

Background Breast cancer is a significant cause of mortality and morbidity worldwide, although death rates in the United States and some other countries are beginning to fall. Methods Several sources of information in 1998, including publications and presentations at the 1998 meeting of the American Society of Clinical Oncology, are pertinent to contemporary breast cancer care. Results It is now possible to prescribe hormonal therapy that will reduce the incidence of breast cancer. Methods are available to reduce the morbidity from axillary node dissection, and improvements in adjuvant therapy and management of metastatic breast cancer are now at hand. Conclusions The information presented provides a broad-based platform for new standards of care for breast cancer that will serve as a sound base for further progress in this important disease.

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What Are the Ethical Implications of Understanding and Treating Breast Cancer?

10.1093/oso/9780190637033.003.0007 ◽

2018 ◽

Author(s):

Mary Ann G. Cutter

Keyword(s):

Breast Cancer ◽

Risk Assessment ◽

Informed Consent ◽

Cancer Care ◽

The United States ◽

Breast Cancer Patients ◽

Breast Cancer Care ◽

Ethical Implications ◽

Personalized Approach ◽

Limit Access

Philosophically speaking, the question “What are the ethical implications of understanding breast cancer?” raises a host of issues, including informed consent, risk assessment, and access to breast cancer care. What we find is that, initially, there are adequate guidelines for informed consent, adequate efforts to develop risk assessment measures, and a decent level of access to breast cancer care in the United States. But things can be improved from an ethical standpoint. Upon reflection, the informed consent process would benefit from a more explicit discussion of uncertainty in breast cancer medicine and the ways breast cancer patients make decisions about their care. Risk assessments would benefit from a more personalized approach. Access to breast cancer care could be improved by continued studies of the diverse forces that limit access to proper breast cancer care.

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Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

Clinical & Investigative Medicine ◽

10.25011/cim.v32i3.6113 ◽

2009 ◽

Vol 32 (3) ◽

pp. 239 ◽

Cited By ~ 33

Author(s):

Kevin M Gorey ◽

Isaac N Luginaah ◽

Eric J Holowaty ◽

Karen Y Fung ◽

Caroline Hamm

Keyword(s):

Breast Cancer ◽

Socioeconomic Status ◽

Low Income ◽

Cancer Care ◽

Radiation Treatment ◽

The United States ◽

Historical Study ◽

Adjuvant Radiation ◽

Breast Cancer Care ◽

Socioeconomic Inequity

Purpose. The demand for cancer care has increased among aging North American populations as cancer treatment innovations have proliferated. Gaps between supply and demand may be growing. This study examined whether socioeconomic status has a differential effect on waits for surgical and adjuvant radiation treatment (RT) of breast cancer in Canada and the US. Methods. Ontario and California cancer registries provided 929 and 984 breast cancer cases diagnosed between 1998 and 2000 in diverse urban and rural places. Residence-based socioeconomic data were taken from censuses. Cancer care variables were reliably abstracted from health records: stage, receipt of surgery and RT, and waits from diagnosis to initial and initial to adjuvant treatment. Median waits were compared within- and between-country with the non-parametric Mann-Whitney U-test. Categorically long, age-adjusted wait comparisons used the Mantel-Haenszel chi-square test. Results. There were significant associations between lower socioeconomic status and longer surgical waits, lower access to adjuvant RT and to longer RT waits across diverse places in California. None were observed in Ontario. The two cohorts did not practically differ on access to surgery or on surgical waits. Compared with their counterparts in California, low-income Ontarians, particularly those in small urban places, gained greater access to RT, while high-income Americans had shorter waits for RT. Conclusions. This historical study contextualized Canada’s “waiting-list problems” with evidence on breast cancer care, where lower income Americans seemed to have waited as long as similar Canadians. Many more low-income Americans seemed to experience the longest wait of all for adjuvant care. They simply did not receive it. In contrast to stark American socioeconomic inequity, this study evidenced remarkable equity in Canadian breast cancer care.

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Effect of shorter time to treatment on survival in rural patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7027 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7027-7027

Author(s):

Suneel Deepak Kamath ◽

Wei Wei ◽

Katherine Tullio ◽

Gregory S. Cooper ◽

Alok A. Khorana

Keyword(s):

Breast Cancer ◽

United States ◽

Socioeconomic Factors ◽

Cancer Care ◽

The United States ◽

Disease Stage ◽

Cancer Center ◽

Median Income ◽

Cox Models ◽

Rural Patients

7027 Background: Rural cancer care in the United States has unique challenges from variable access to care. This study examined differences in time to first treatment (TTT), a potential surrogate for access, and predictors of overall survival (OS) between rural and non-rural patients with breast cancer. Methods: Women with stage I-III breast cancer from 2004-2012 in the National Cancer Database of Commission on Cancer (CoC)-accredited facilities were included and categorized as rural and non-rural. Differences in demographic, disease and treatment characteristics, socioeconomic factors and TTT (< 4 weeks, 4-8 weeks and > 8 weeks) between rural and non-rural patients were assessed by Chi-square test. The effect of age, insurance status, cancer center type, community median income, community % no high school, and TTT on OS were assessed using univariate and multivariate Cox models. Results: The study included 1,205,031 patients, 18,417 (2%) of whom were rural. Compared to non-rural patients, rural patients were more likely to be age > 65, Caucasian, receive care at non-academic centers, have government insurance, have lower income and less education (p < 0.0001 for all). Significant demographic and socioeconomic differences are shown in Table. Rural patients had shorter mean TTT (3.72 vs. 4.35 weeks, p < 0.0001). More rural patients had TTT < 4 weeks (67% vs. 57%) and < 8 weeks (94% vs. 90%), p < 0.0001 for both. Shorter TTT (both < 4 weeks vs. 8 weeks and 4-8 weeks vs. > 8 weeks) was associated with improved OS (HR: 0.84, 95% CI: 0.82-0.86, p < 0.0001 and HR: 0.82, 95% CI: 0.81-0.83, p < 0.0001, respectively). After adjusting for demographic, socioeconomic, disease stage and treatment factors, rural status was associated with significantly better OS compared to non-rural status (HR: 0.92, 95% CI: 0.89-0.96, p < 0.0001). Conclusions: Despite several adverse socioeconomic factors, rural patients with breast cancer with access to CoC-accredited facilities had significantly shorter TTT and better OS compared to non-rural patients. These data suggest improving TTT can mitigate disparities in rural cancer care. It is unclear whether our data apply to non-CoC-accredited facilities in rural United States. [Table: see text]

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Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.3365 ◽

2006 ◽

Vol 24 (4) ◽

pp. 626-634 ◽

Cited By ~ 214

Author(s):

Jennifer L. Malin ◽

Eric C. Schneider ◽

Arnold M. Epstein ◽

John Adams ◽

Ezekiel J. Emanuel ◽

...

Keyword(s):

Breast Cancer ◽

Colorectal Cancer ◽

United States ◽

Cancer Care ◽

Medical Records ◽

Significant Variation ◽

Quality Measures ◽

The United States ◽

Recommended Care

Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures. Results Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs. Conclusion Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.

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Rural health cancer care: A literature review.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18500 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18500-e18500

Author(s):

Wade T. Swenson ◽

Emily Westergard ◽

Abigail Paige Swenson

Keyword(s):

Breast Cancer ◽

United States ◽

Rural Health ◽

Rural Population ◽

Cancer Care ◽

Care Delivery ◽

The United States ◽

Colorectal Cancers ◽

Major Topic ◽

Mesh Terms

e18500 Background: A recent review of the medical literature of rural health cancer care delivery has not been published. We conducted a preliminary review of the last twenty years of rural health cancer care delivery literature utilizing medical subject headings (MeSH) within the PubMed NCBI) database. Methods: Using PubMed MeSH Major Topic terms “rural population” and “cancer” we identified publications published from 2000 to 2020. We searched PubMed for publications that included the major topic MeSH terms “rural population” and “cancer”. We individually reviewed articles, confirmed the focus of the article, and subcategorized the articles. Results: We identified 580 publications which met the search criteria, the majority were focused on the United States (266), followed by China (56), Australia (54), and India (27). Among the publications focusing on the United States, 76 involved Appalachian States. Kentucky (18) and Georgia (10) were the states most frequently represented. Malignancies most commonly represented were: breast cancer (148), uterine/cervical (84), and colorectal cancers (68). The journals which published the most rural health cancer care delivery were The Journal of Rural Health (42), Asian Pacific Journal of Cancer Prevention (20), Cancer (14), Rural and Remote Health (13), Journal of Cancer Education (13), Australian Journal of Rural Health (12). Conclusions: The rural health cancer care literature in the last two decades focuses primarily on the United States, China, Australia, and India. Within the United States, the research focus is Appalachia. The majority of articles focus on breast cancer, uterine/cervical, and colorectal cancers. The journal which published the majority of rural health cancer care articles was the Journal of Rural Health.

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