European Journal of Epidemiology

, Volume 27, Issue 11, pp 857–866 | Cite as

Survival from breast cancer in relation to access to tertiary healthcare, body mass index, tumor characteristics and treatment: a Hellenic Cooperative Oncology Group (HeCOG) study

  • Paraskevi Panagopoulou
  • Helen Gogas
  • Nick Dessypris
  • Nikos Maniadakis
  • George Fountzilas
  • Eleni Th. Petridou


Apart from tumour, treatment and patient characteristics at diagnosis, access to healthcare delivery may as well play a significant role in breast cancer prognosis. This study aimed to assess the additional impact exerted on survival by travel burden—a surrogate indicator of limited access to healthcare- expressed as geographical distance and/or time needed to reach the tertiary healthcare center from the patient’s residence. Between 1997 and 2005, 2,789 women participated in therapeutic clinical trials conducted by the Hellenic Cooperative Oncology Group. The effect of geographical distance and travel time between patient’s residence and treating hospital on survival was estimated using Cox proportional hazards regression adjusting for age, menopausal status, tumour size/grade, positive nodes (number), hormonal receptor status, HER2 overexpression, surgery type/treatment protocol as well as for body mass index >30 kg/m2. More aggressive tumour features, older treatment protocols and modifiable patient characteristics, such as obesity (HR: 1.27) adversely impacted on breast cancer survival. In addition, less studied indicators of access to healthcare, such as geographic distance >350 km and travel time >4 h were independently and significantly associated with worse outcomes (HR = 1.43 and 1.34 respectively). In conclusion, to address inequalities in breast cancer survival, improvements in access to healthcare services related to increased travel burden especially for patients of lower socioeconomic status should be considered, more than ever at times of financial crisis and independently of already known modifiable patient characteristics.


Breast cancer Survival Prognosis Healthcare access Healthcare inequalities Obesity Socioeconomic status (SES) 


Ethical standards

The present study complies with the current laws of the Greece.

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10654_2012_9737_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Paraskevi Panagopoulou
    • 1
  • Helen Gogas
    • 2
  • Nick Dessypris
    • 1
  • Nikos Maniadakis
    • 3
  • George Fountzilas
    • 4
  • Eleni Th. Petridou
    • 1
  1. 1.Department of Hygiene, Epidemiology and Medical StatisticsAthens University Medical SchoolAthensGreece
  2. 2.1st Department of Medicine, “Laiko” General HospitalUniversity of AthensAthensGreece
  3. 3.Department of Health Services Organisation and ManagementNational School of Public HealthAthensGreece
  4. 4.Department of Medical Oncology, “Papageorgiou” General HospitalAristotle University of Thessaloniki School of MedicineThessalonikiGreece

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