Document Detail

Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007.
MedLine Citation:
PMID:  23139057     Owner:  NLM     Status:  MEDLINE    
Chemotherapy regimens for early stage breast cancer have been tested by randomized clinical trials, and specified by evidence-based practice guidelines. However, little is known about the translation of trial results and guidelines to clinical practice. We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated healthcare system serving 29 % of the local population. We linked data to the California Cancer Registry, incorporating socio-demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. We identified 6,004 women diagnosed with Stage I-III breast cancer at KPNC during 2004-2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. Factors associated with receiving chemotherapy included <50 years of age [odds ratio (OR) 2.27, 95 % confidence interval (CI) 1.81-2.86], tumor >2 cm (OR 2.14, 95 % CI 1.75-2.61), involved lymph nodes (OR 11.3, 95 % CI 9.29-13.6), hormone receptor-negative (OR 6.94, 95 % CI 4.89-9.86), Her2/neu-positive (OR 2.71, 95 % CI 2.10-3.51), or high grade (OR 3.53, 95 % CI 2.77-4.49) tumors; comorbidities associated inversely with chemotherapy use [heart disease for anthracyclines (OR 0.24, 95 % CI 0.14-0.41), neuropathy for taxanes (OR 0.45, 95 % CI 0.22-0.89)]. Relative to high-socioeconomic status (SES) non-Hispanic Whites, we observed less anthracycline and taxane use by SES non-Hispanic Whites (OR 0.63, 95 % CI 0.49-0.82) and American Indians (OR 0.23, 95 % CI 0.06-0.93), and more anthracycline use by high-SES Asians/Pacific Islanders (OR 1.72, 95 % CI 1.02-2.90). In this equal-access healthcare system, chemotherapy use followed practice guidelines, but varied by race and socio-demographic factors. These findings may inform efforts to optimize quality in breast cancer care.
Allison W Kurian; Daphne Y Lichtensztajn; Theresa H M Keegan; Rita W Leung; Sarah J Shema; Dawn L Hershman; Lawrence H Kushi; Laurel A Habel; Tatjana Kolevska; Bette J Caan; Scarlett L Gomez
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2012-11-09
Journal Detail:
Title:  Breast cancer research and treatment     Volume:  137     ISSN:  1573-7217     ISO Abbreviation:  Breast Cancer Res. Treat.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-24     Completed Date:  2013-05-27     Revised Date:  2014-05-14    
Medline Journal Info:
Nlm Unique ID:  8111104     Medline TA:  Breast Cancer Res Treat     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  247-60     Citation Subset:  IM    
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MeSH Terms
Anthracyclines / therapeutic use
Antineoplastic Agents / therapeutic use
Breast Neoplasms / drug therapy*,  epidemiology,  pathology
California / epidemiology
Carcinoma, Ductal, Breast / drug therapy*,  epidemiology,  secondary
Carcinoma, Lobular / drug therapy*,  epidemiology,  secondary
Chemotherapy, Adjuvant / statistics & numerical data
Electronic Health Records
Health Personnel
Logistic Models
Lymphatic Metastasis
Middle Aged
Multivariate Analysis
Practice Guidelines as Topic
Taxoids / therapeutic use
Tumor Burden
Grant Support
261201000034C//PHS HHS; 261201000035C//PHS HHS; 261201000140C//PHS HHS; R01 CA098838/CA/NCI NIH HHS; R01 CA098838/CA/NCI NIH HHS; R01 CA105274/CA/NCI NIH HHS; R01 CA105274/CA/NCI NIH HHS
Reg. No./Substance:
0/Anthracyclines; 0/Antineoplastic Agents; 0/Taxoids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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