Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia

Abstract

Objective: To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments.

Data sources: Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia.

Study design: Using multivariable logistic regression, we examined predictors of adjuvant chemo-, radiation, and hormonal therapy regimens defined as guideline-concordant according to the 2000 National Institutes of Health Consensus Development Conference Statement.

Principal findings: Overall, 35.2 percent of women received guideline-concordant care for all three adjuvant therapies. Higher socioeconomic status was associated with receiving guideline-concordant care for all three adjuvant therapies jointly, and for chemotherapy. Compared with private insurance, having Medicaid was associated with guideline-concordant chemotherapy. Unmarried women were more likely to be nonconcordant for chemotherapy and radiation therapy. Increased age predicted nonconcordance for adjuvant therapies jointly, for chemotherapy, and for hormonal therapy.

Conclusions: A number of factors were independently associated with receiving guideline-concordant adjuvant therapy. Identifying and addressing factors that lead to nonconcordance may reduce disparities in treatment and survival.

Keywords: Quality assessment; breast cancer; cancer care; quality of care; rural health.

Figure 1

Receipt of Guideline-Concordant Therapy among Women with Early-Stage Breast Cancer Diagnosed and Treated in Southwest Georgia, 2001–2003Notes. Discretionary guidelines include those with recommendations stating the following: the decision should be individualized; the decision should consider the survival benefit, toxicity, existing comorbidities, and mortality from other causes; or the benefits of therapy are unclear. Missing cases includes women with missing data resulting in an inability to determine guideline-concordance.