Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer

Abstract

Purpose: Inflammatory breast cancer (IBC) is an aggressive subtype of breast cancer for which treatments vary, so we sought to identify factors that affect the receipt of guideline-concordant care.

Methods: Patients diagnosed with IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registries in seven states. Variation in guideline-concordant care for IBC, based on National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics.

Results: Of the 107 IBC patients in the study without distant metastasis at the time of diagnosis, only 25.8% received treatment concordant with guidelines. Predictors of non-concordance included patient age (≥70 years), non-white race, normal body mass index (BMI 18.5-25 kg/m(2)), patients with physicians graduating from medical school >15 years prior, and smaller hospital size (<200 beds). IBC patients survived longer if they received guideline-concordant treatment based on either 2003 (p=0.06) or 2013 (p=0.06) NCCN guidelines.

Conclusions: Targeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Prompt referral for neoadjuvant chemotherapy and post-operative radiation therapy is also crucial.

Keywords: Breast cancer; Epidemiology; Guideline; Healthcare disparities; Inflammatory breast cancer.

Figure 1

Flow diagram demonstrating the NCCN guideline-concordant treatment regimen for inflammatory breast cancer in 2004. Arrows indicate where patients diverted if they were not concordant for the indicated treatment modalities. Patients for whom treatment data were not available for a certain modality are included in the percentages but are not displayed in the figure. BCS = breast conserving surgery (alias lumpectomy).

Figure 2

Breast cancer-specific survival among inflammatory breast cancer patients based on receipt of care concordant with (A) 2003 or (B) 2013 NCCN guidelines using the Kaplan-Meier method. NPCR POC-BP, 2004–2009.

Figure 3

Breast cancer-specific survival among inflammatory breast cancer patients based on whether they did or did not receive guideline-concordant care based on 2003 NCCN guidelines for (A) chemotherapy, (B) radiation, and (C) hormone therapy using the Kaplan-Meier method. NPCR POC-BP, 2004–2009.