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For patients with breast cancer, geographic and social disparities are independent determinants of access to specialized surgeons. A eleven-year population-based multilevel analysis.

Gentil J, Dabakuyo TS, Ouedraogo S, Poillot ML, Dejardin O, Arveux P - BMC Cancer (2012)

Bottom Line: Why then do all patients not benefit from treatment by these experienced surgeons?This was also the case for patients living in rural areas compared with those living in urban areas (OR = 0.68 [0.53; 0.87]), and for patients living in the two most deprived areas (OR = 0.69 [0.48; 0.97] and 0.61 [0.44; 0.85] respectively) compared with those who lived in the most affluent area.Not being treated by a specialist surgeon implies a less favourable outcome in terms of survival.

View Article: PubMed Central - HTML - PubMed

Affiliation: Côte d'Or Breast and Gynaecological Cancers Registry, Centre de Lutte Contre le Cancer Georges-François Leclerc, Dijon, France. jgentil@cgfl.fr

ABSTRACT

Background: It has been shown in several studies that survival in cancer patients who were operated on by a high-volume surgeon was better. Why then do all patients not benefit from treatment by these experienced surgeons? The aim of our work was to study the hypothesis that in breast cancer, geographical isolation and the socio-economic level have an impact on the likelihood of being treated by a specialized breast-cancer surgeon.

Methods: All cases of primary invasive breast cancer diagnosed in the Côte d'Or from 1998 to 2008 were included. Individual clinical data and distance to the nearest reference care centre were collected. The Townsend Index of each residence area was calculated. A Log Rank test and a Cox model were used for survival analysis, and a multilevel logistic regression model was used to determine predictive factors of being treated or not by a specialized breast cancer surgeon.

Results: Among our 3928 patients, the ten-year survival of the 2931 (74.6 %) patients operated on by a high-volume breast cancer surgeon was significantly better (LogRank p < 0.001), independently of age at diagnosis, the presence of at least one comorbidity, circumstances of diagnosis (screening or not) and TNM status (Cox HR = 0.81 [0.67-0.98]; p = 0.027). In multivariate logistic regression analysis, patients who lived 20 to 35 minutes, and more than 35 minutes away from the nearest reference care centre were less likely to be operated on by a specialized surgeon than were patients living less than 10 minutes away (OR = 0.56 [0.43; 0.73] and 0.38 [0.29; 0.50], respectively). This was also the case for patients living in rural areas compared with those living in urban areas (OR = 0.68 [0.53; 0.87]), and for patients living in the two most deprived areas (OR = 0.69 [0.48; 0.97] and 0.61 [0.44; 0.85] respectively) compared with those who lived in the most affluent area.

Conclusions: A disadvantageous socio-economic environment, a rural lifestyle and living far from large specialized treatment centres were significant independent predictors of not gaining access to surgeons specialized in breast cancer. Not being treated by a specialist surgeon implies a less favourable outcome in terms of survival.

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Related in: MedlinePlus

Overall survival curves (Kaplan-Meier) according to surgeon class, high-volume breast cancer surgeon (surgeon class = 1) or not (surgeon class = 2) (p < 0.001).
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Figure 1: Overall survival curves (Kaplan-Meier) according to surgeon class, high-volume breast cancer surgeon (surgeon class = 1) or not (surgeon class = 2) (p < 0.001).

Mentions: Figure 1 shows the overall survival curves (Kaplan-Meier) according to the surgeon class: high-volume breast-cancer surgeon (surgeon class = 1) or not (surgeon class = 2). Table 2 shows the proportions, the Log-Rank test and the results of the Cox multivariate analysis for overall survival according to the surgeon’s class.


For patients with breast cancer, geographic and social disparities are independent determinants of access to specialized surgeons. A eleven-year population-based multilevel analysis.

Gentil J, Dabakuyo TS, Ouedraogo S, Poillot ML, Dejardin O, Arveux P - BMC Cancer (2012)

Overall survival curves (Kaplan-Meier) according to surgeon class, high-volume breast cancer surgeon (surgeon class = 1) or not (surgeon class = 2) (p < 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475100&req=5

Figure 1: Overall survival curves (Kaplan-Meier) according to surgeon class, high-volume breast cancer surgeon (surgeon class = 1) or not (surgeon class = 2) (p < 0.001).
Mentions: Figure 1 shows the overall survival curves (Kaplan-Meier) according to the surgeon class: high-volume breast-cancer surgeon (surgeon class = 1) or not (surgeon class = 2). Table 2 shows the proportions, the Log-Rank test and the results of the Cox multivariate analysis for overall survival according to the surgeon’s class.

Bottom Line: Why then do all patients not benefit from treatment by these experienced surgeons?This was also the case for patients living in rural areas compared with those living in urban areas (OR = 0.68 [0.53; 0.87]), and for patients living in the two most deprived areas (OR = 0.69 [0.48; 0.97] and 0.61 [0.44; 0.85] respectively) compared with those who lived in the most affluent area.Not being treated by a specialist surgeon implies a less favourable outcome in terms of survival.

View Article: PubMed Central - HTML - PubMed

Affiliation: Côte d'Or Breast and Gynaecological Cancers Registry, Centre de Lutte Contre le Cancer Georges-François Leclerc, Dijon, France. jgentil@cgfl.fr

ABSTRACT

Background: It has been shown in several studies that survival in cancer patients who were operated on by a high-volume surgeon was better. Why then do all patients not benefit from treatment by these experienced surgeons? The aim of our work was to study the hypothesis that in breast cancer, geographical isolation and the socio-economic level have an impact on the likelihood of being treated by a specialized breast-cancer surgeon.

Methods: All cases of primary invasive breast cancer diagnosed in the Côte d'Or from 1998 to 2008 were included. Individual clinical data and distance to the nearest reference care centre were collected. The Townsend Index of each residence area was calculated. A Log Rank test and a Cox model were used for survival analysis, and a multilevel logistic regression model was used to determine predictive factors of being treated or not by a specialized breast cancer surgeon.

Results: Among our 3928 patients, the ten-year survival of the 2931 (74.6 %) patients operated on by a high-volume breast cancer surgeon was significantly better (LogRank p < 0.001), independently of age at diagnosis, the presence of at least one comorbidity, circumstances of diagnosis (screening or not) and TNM status (Cox HR = 0.81 [0.67-0.98]; p = 0.027). In multivariate logistic regression analysis, patients who lived 20 to 35 minutes, and more than 35 minutes away from the nearest reference care centre were less likely to be operated on by a specialized surgeon than were patients living less than 10 minutes away (OR = 0.56 [0.43; 0.73] and 0.38 [0.29; 0.50], respectively). This was also the case for patients living in rural areas compared with those living in urban areas (OR = 0.68 [0.53; 0.87]), and for patients living in the two most deprived areas (OR = 0.69 [0.48; 0.97] and 0.61 [0.44; 0.85] respectively) compared with those who lived in the most affluent area.

Conclusions: A disadvantageous socio-economic environment, a rural lifestyle and living far from large specialized treatment centres were significant independent predictors of not gaining access to surgeons specialized in breast cancer. Not being treated by a specialist surgeon implies a less favourable outcome in terms of survival.

Show MeSH
Related in: MedlinePlus