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Variations in Guideline‐Concordant Breast Cancer Adjuvant Therapy in Rural Georgia
Author(s) -
Guy Gery P.,
Lipscomb Joseph,
Gillespie Theresa W.,
Goodman Michael,
Richardson Lisa C.,
Ward Kevin C.
Publication year - 2015
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12269
Subject(s) - medicine , guideline , breast cancer , hormonal therapy , adjuvant therapy , context (archaeology) , radiation therapy , cancer , hormone therapy , oncology , family medicine , pathology , paleontology , biology
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 G eorgia. 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.