Are treatment disparities the missing link between institution volume, hospital teaching status and survival for women with breast cancer?
Monday, November 4, 2013
: 1:10 p.m. - 1:30 p.m.
Background: Previous work has drawn links between breast cancer survival and institutional volume/hospital teaching status, but causal factors underlying these associations remain unclear. We explored the relationship between volume and teaching status with treatment patterns, in hope of revealing how these factors influence survival. Methods: Demographic, clinical and pathologic data for female breast cancer patients treated in Florida (1996-2009) were collected from the Florida Cancer Data System, Agency for Health Care Administration and Census. High-volume facilities (HVF), compared to low-volume (LVF), were defined as those treating ≥1% of patients; and teaching (TF) versus non-teaching (NTF) status was designated by 2005 AAMC. The association of facilities' volume, teaching status and receipt of treatment (surgery, radiation therapy, chemotherapy, hormone therapy) was assessed using multivariate logistic regression models. Results: Of 137,802 patients, 58.2% received care at LVF and 89.6% received care at NTF. Patients receiving care at LVF were more likely to have surgery (odds ratio [OR] 1.38 95% confidence interval [1.16-1.63]), and less likely to have chemotherapy (0.52 [0.37-0.73]) and hormone therapy (0.53 [0.36-0.78]), than their counterparts at HVF. NTF patients were also more likely to undergo surgery (1.46 [1.21-1.76]), and less likely to undergo hormone therapy (0.43 [0.26-0.73]). Radiation therapy was employed similarly for LVF/HVF and NTF/TF. Conclusion: Facility volume and teaching status influence treatment patterns for female breast cancer patients. Because LVF and NTF have previously been associated with poorer long-term survival, strategies for reducing disparities in treatments should be explored and could improve outcomes.
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public
Public health or related research
Compare treatments for breast cancer patients based on teaching status. Explain the difference in treatments given to women with breast cancer based on hospital volume. Compare the effects of hospital volume and teaching status on the most commonly used treatments for female breast cancer.
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am qualified to be an abstract author because I am a second year medical student studying epidemiology and working with an underserved population. I have been volunteering with this grant dealing with health disparities in breast and lung cancer patients for the past 8 months and I am learning about these topics in my classes and at the hospitals in which we work
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.