Timeliness and acceptance of recommended treatment in newly diagnosed breast cancer patients
Dong, Jinghui.
2017
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Abstract: Breast
cancer is the most common cancer in women and it is the second leading cause of
cancer-related death in women in the United States. Although evidence-based
recommendations for breast cancer care are well established, scant literature has
documented patients' acceptance of recommended treatments. Disease and non-disease
factors associated with non-acceptance remain unclear. ... read moreNon-acceptance of recommended
treatments can result in delayed initiation of effective treatment and failure to
complete planned treatment. Both are known to be associated with a higher recurrence
rate and may be reasons for disparities in breast cancer related survival. This study
aimed to develop a metric to evaluate timeliness and patients' acceptance of recommended
treatment in newly diagnosed breast cancer patients and to identify factors associated
with meeting the quality benchmarks and patients' acceptance of the treatment. We
reviewed 247 newly diagnosed breast cancer patients presented to Tufts Medical Center
between January 2009 and June 2013. Of the patients who had surgery recommended as the
first treatment, 80% (176/219) met the 45-day time-to-surgery benchmark with a median of
28 days to surgery. Of the patients who were stage I-III hormone receptor-positive, 92%
(138/150) met the 365-day hormone therapy benchmark with a median of 145 days to hormone
therapy. Analysis of acceptance by a single modality showed that 74% (17/23) of patients
accepted neoadjuvant chemotherapy, 97% (232/240) accepted surgery, 83% (130/157)
accepted radiation, 71% (85/119) accepted adjuvant chemotherapy, and 85% (155/183)
accepted hormonal therapy. Overall, among 238 patients with known initiation of
treatment, 61% accepted all recommended treatments, 21% rejected at least one treatment,
and 18% had incomplete information. Multivariable regression showed that after adjusting
for insurance, family history of breast cancer, prior history of breast cancer
treatment, and comorbidity, older age (OR, 95%CI: 1.30, 1.12-1.53) and higher median
household income by census tract (OR, 95%CI: 1.11, 1.03-1.19) were associated with
meeting the 45-day time-to-surgery benchmark. These findings may help us identify
patient populations at increased risk of delaying and/or not accepting recommended
treatments and to inform the development of interventions and policies that are aimed
toward improving timely and quality of breast cancer
care.
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Susan Parsons.
Committee: Karen Freund, and Farzad Noubary.
Keyword: Health care management.read less - ID:
- 5d86pb668
- Component ID:
- tufts:22745
- To Cite:
- TARC Citation Guide EndNote
