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. 2024 Aug 20;31(8):4728-4745.
doi: 10.3390/curroncol31080353.

Impact of Location of Residence and Distance to Cancer Centre on Medical Oncology Consultation and Neoadjuvant Chemotherapy for Triple-Negative and HER2-Positive Breast Cancer

Elliott K Yee  1 , Julie Hallet  2   3 , Nicole J Look Hong  2   3   4 , Lena Nguyen  4 , Natalie Coburn  2   3   4 , Frances C Wright  2   3 , Sonal Gandhi  5   6 , Katarzyna J Jerzak  3   5   6 , Andrea Eisen  3   5   6 , Amanda Roberts  2   3
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Impact of Location of Residence and Distance to Cancer Centre on Medical Oncology Consultation and Neoadjuvant Chemotherapy for Triple-Negative and HER2-Positive Breast Cancer

Elliott K Yee et al. Curr Oncol. .

Abstract

Despite consensus guidelines, most patients with early-stage triple-negative (TN) and HER2-positive (HER2+) breast cancer do not see a medical oncologist prior to surgery and do not receive neoadjuvant chemotherapy (NAC). To understand barriers to care, we aimed to characterize the relationship between geography (region of residence and cancer centre proximity) and receipt of a pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Using linked administrative datasets in Ontario, Canada, we performed a retrospective population-based analysis of women diagnosed with stage I-III TN or HER2+ breast cancer from 2012 to 2020. The outcomes were a pre-treatment medical oncology consultation and the initiation of NAC. We created choropleth maps to assess the distribution of the outcomes and cancer centres across census divisions. To assess the relationship between distance to the nearest cancer centre and outcomes, we performed multivariable regression analyses adjusted for relevant factors, including tumour extent and nodal status. Of 14,647 patients, 29.9% received a pre-treatment medical oncology consultation and 77.7% received NAC. Mapping demonstrated high interregional variability, ranging across census divisions from 12.5% to 64.3% for medical oncology consultation and from 8.8% to 64.3% for NAC. In the full cohort, compared to a distance of ≤5 km from the nearest cancer centre, only 10-25 km was significantly associated with lower odds of NAC (OR 0.83, 95% CI 0.70-0.99). Greater distances were not associated with pre-treatment medical oncology consultation. The interregional variability in medical oncology consultation and NAC for patients with TN and HER2+ breast cancer suggests that regional and/or provider practice patterns underlie discrepancies in the referral for and receipt of NAC. These findings can inform interventions to improve equitable access to NAC for eligible patients.

Keywords: HER2-positive; breast; chemotherapy; geography; neoadjuvant; triple-negative.

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Conflict of interest statement

K.J.J. reports as a speaker/advisor board/consultant for Amgen, AstraZeneca, Apo Biologix, Daichy Sanchyo, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc., Pfizer, Roche, Seagen, Novartis, and Organon, and has received research funding from Astra Zeneca, Eli Lilly, and Seagen. N.J.L.H. reports as a consultant for MOLLI Surgical. S.G. reports on the advisory board for AstraZeneca, Knight, Novartis, and Lilly. A.R. reports grant funding from a Canadian Cancer Society Challenge grant (#707337) and research funding support from the Sunnybrook AFP Association Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. E.K.Y., J.H., L.N., N.C., F.C.W., and A.E. declare no conflicts of interest.

Figures

Figure 1
Figure 1
Diagram of cohort creation.
Figure 2
Figure 2
Choropleth map of cancer centres and distribution of pre-treatment medical oncology consultation across census divisions in Ontario for full cohort (2012–2020). Inset map magnifies area with highest cancer centre density.
Figure 3
Figure 3
Choropleth map of cancer centres and distribution of neoadjuvant chemotherapy use across census divisions in Ontario for full cohort (2012–2020). Inset map magnifies area with highest cancer centre density.
Figure 4
Figure 4
Results of multivariable logistic regression of the association between distance to the nearest cancer centre and receipt of pre-treatment medical oncology consultation for the full cohort, 2019–2020 sub-cohort, and NAC-eligible (≥cT2 and/or node-positive) sub-cohort, reported as the odds ratio (95% confidence interval) and p value, and adjusted for age, comorbidity burden, previous breast cancer diagnosis, first consultation at regional cancer centre, deprivation, year of diagnosis (except for the 2019–2020 sub-cohort), tumour stage, and node stage.
Figure 5
Figure 5
Results of multivariable logistic regression of the association between distance to the nearest cancer centre and receipt of NAC for the full cohort, 2019–2020 sub-cohort, and NAC-eligible (≥cT2 and/or node-positive) sub-cohort, reported as the odds ratio (95% confidence interval) and p value, and adjusted for age, comorbidity burden, previous breast cancer diagnosis, first consultation at regional cancer centre, deprivation, year of diagnosis (except for the 2019–2020 sub-cohort), tumour stage, and node stage.
Figure 6
Figure 6
Choropleth map of cancer centres and distribution of pre-treatment medical oncology consultation across census divisions in Ontario for the 2019–2020 sub-cohort. The inset map magnifies the area with the highest cancer centre density.
Figure 7
Figure 7
Choropleth map of cancer centres and distribution of neoadjuvant chemotherapy use across census divisions in Ontario for the 2019–2020 sub-cohort. The inset map magnifies the area with the highest cancer centre density.
Figure 8
Figure 8
Choropleth map of cancer centres and distribution of pre-treatment medical oncology consultation across census divisions in Ontario for the ≥cT2 and/or node-positive sub-cohorts. The inset map magnifies the area with the highest cancer centre density.
Figure 9
Figure 9
Choropleth map of cancer centres and distribution of neoadjuvant chemotherapy use across census divisions in Ontario for the ≥cT2 and/or node-positive sub-cohorts. The inset map magnifies the area with the highest cancer centre density.
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