Variation in receipt of adjuvant chemotherapy among breast cancer patients in Georgia utilizing augmented Georgia Cancer Registry data Público
Gombolay, Alli (2015)
Abstract
Objectives: To analyze the factors that are associated with receipt of the National Quality Forum breast cancer quality measure for adjuvant chemotherapy among breast cancer patients in Georgia and to measure the degree to which augmenting state cancer registry data improves the completeness of data capture for receipt of therapy.
Background: Despite the health benefits of adjuvant chemotherapy, many women do not receive adequate breast cancer treatment. We present the first evaluation of variation in receipt of guideline-concordant adjuvant chemotherapy among breast cancer patients in Georgia using data from the Georgia Cancer Registry (GCR) augmented with medical insurance claims data.
Data Sources : Case-specific data for 1,090 women who were diagnosed with their first primary, early-stage hormone receptor negative breast cancer between 2002-2005 were bilaterally linked between the GCR and Medicare, Medicaid, State Health Benefit Plan (SHBP), and Kaiser Permanente of Georgia (KPG) claims data.
Study Design : Using predictive multivariable logistic regression, we analyzed the factors that are associated with receipt of guideline-concordant adjuvant chemotherapy.
Findings: As indicated by the augmented GCR data, nearly 90% of the patients received guideline-concordant adjuvant chemotherapy compared to only 79.17% of the patients as indicated by the GCR data. Over 90% of the patients with stage II and stage III disease adhered to therapy. The gain in completeness of data capture for adjuvant chemotherapy varied depending on the source (Medicare 7.23%; Medicaid 8.50%; SHBP 12.27%; and KPG 29.00%). In multivariate analysis, women age 55-64 years (OR = 0.54) and women age 65-83 years (OR = 0.32) were less likely to receive guideline-concordant therapy compared to younger women. Non-white women (OR = 0.59) were less likely to receive guideline-concordant therapy compared to white women. Unmarried women (OR = 0.44) were less likely to receive guideline-concordant therapy compared to married women. Women with stage II disease (OR = 3.69) were more likely to receive guideline-concordant therapy compared to women with stage I disease.
Conclusions: Younger age, being white, being married, and later stage of disease were associated with receipt of guideline-concordant adjuvant chemotherapy. Addressing the factors that lead to non-concordance may reduce variation in treatment and survival.
Table of Contents
Chapter I: Background and Literature Review- page 1
Chapter II: Manuscript- page 5
Introduction- page 6
Methods- page 8
Results- page 11
Discussion- page 13
References- page 17
Tables- page 20
Chapter III:
Summary- page 23
Public Health Implications- page 24
Possible Future Directions- page 24
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