141st APHA Annual Meeting

In This section

287364
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 PM - 1:30 PM

Chris S Bartlett, BS , University of Miami Miller School of Medicine, Miami, FL
Tulay Koru-Sengul, MHS, PhD , Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Feng Miao, MSc , University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
Stacey L. Tannenbaum, PhD, RD, LD/N , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
David J. Lee, PhD , Department of Epidemiology & Public Health, University of Miami Miller School of Medicine, Miami, FL
Margaret M. Byrne, PhD , Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
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.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Provision of health care to the public
Public health or related research

Learning Objectives:
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 medical student and a MPH student working under a federally funded grant on lung and breast cancer disparities. I have been studying this in my classes and in the work with the research group.
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.