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Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer

  • Epidemiology
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Abstract

Significant age-related variation in chemotherapy use has been observed among elderly patients with metastatic breast cancer (MBC), which may be partly attributable to geographic access factors such as local area physician practice culture and local health care system capacity. The purpose of the paper was to examine how age may modify the effect of geographic access on chemotherapy use in elderly patients with MBC. This was a retrospective cohort study based on the surveillance, epidemiology, and end results—Medicare-linked database of 1992–2002. Chemotherapy use was defined as at least one chemotherapy-related claim within 6-month post-diagnosis. Geographic access to cancer care was measured by four variables: patient travel time to the nearest oncologist practice, local area per capita number of oncologists, local area per capita number of hospices, and local area chemotherapy rate. Using multivariate logistic regression model, both aggregate models with interaction terms and subgroup analyses were conducted. Among 4,533 elderly with MBC, 30.16 % used chemotherapy. Chemotherapy use decreased with age. Both the aggregate model with interaction terms and the subgroup analysis showed that local area chemotherapy rate was positively associated with chemotherapy use (P = .0004 in the whole group; in the subgroup analyses, P < .0001, P = .0006, P = .0006, P = .18, P = .026, respectively). In addition, subgroup analysis showed that, among patients aged 85+ years old, local area oncologist supply was negatively associated with chemotherapy use (P = .028). The impact of geographic access to cancer care is the greatest among the oldest group, for whom the clinical evidence is the least certain.

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Acknowledgments

The authors acknowledge the constructive comments of Dr. John Brooks, Dr. Elizabeth Chrischilles, Dr. Linnea Polgreen, Dr. Alexandra Thomas, and Dr. Bernard Sorofman at the University of Iowa College of Pharmacy. The authors would like to thank Ms. Chris Welch for her support during the manuscript submission. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

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None.

Ethical standards

The study complies with the current laws in the U.S.A where the study was performed.

Funding

This work was supported by the University of Iowa College of Pharmacy Dissertation Fellowship.

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Authors and Affiliations

  1. Department of Pharmaceutical and Administrative Sciences, The University of Charleston School of Pharmacy, 2300 MacCorkle Ave. SE, Charleston, WV, 25304, USA

    Shaowei Wan

  2. West Virginia University Charleston Division, David Lee Cancer Center, Charleston Area Medical Center, Charleston, WV, 25304, USA

    Steven Jubelirer

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  1. Shaowei Wan
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Correspondence to Shaowei Wan.

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Wan, S., Jubelirer, S. Geographic access and age-related variation in chemotherapy use in elderly with metastatic breast cancer. Breast Cancer Res Treat 149, 199–209 (2015). https://doi.org/10.1007/s10549-014-3220-3

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