Access to multidisciplinary cancer care - Is it linked to the use of breast-conserving surgery with radiation for early-stage breast carcinoma

被引:60
作者
Baldwin, LM
Taplin, SH
Friedman, H
Moe, R
机构
[1] Univ Washington, Dept Family Med, Seattle, WA 98195 USA
[2] Univ Washington, Dept Surg, Seattle, WA 98195 USA
[3] Grp Hlth Cooperat Puget Sound, Prevent Care Res, Seattle, WA 98121 USA
关键词
breast carcinoma; radiation; Medicare; treatment;
D O I
10.1002/cncr.20030
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND. Breast-conserving surgery (BCS) with radiation (BCSR) requires a multidisciplinary care approach between surgeons and radiation oncologists. METHODS. This retrospective cohort study examined the use of preoperative radiation oncology consultation and whether use of or distance to this care was associated with treatment choice among 1188 women age 65 years who were diagnosed with local or regional breast carcinoma in Washington State in 1994 and 1995. Study outcomes included rates of BCSR; BCS alone; and mastectomy; and radiation therapy among women who underwent BCS. RESULTS. Only 29% of patients in the current study consulted with a radiation oncologist preoperatively, and less than half of the patients (46.6%) consulted with either a medical oncologist or a radiation oncologist. Among women who underwent either BCSR or mastectomy, the odds of undergoing BCSR among women who had a preoperative radiation oncology consultation were 6.7 times the odds of women who did not have the consultation (P less than or equal to 0.001). Similarly, the odds of receiving radiation therapy among women who underwent BCS and had a preoperative radiation oncology consultation were 5 times the odds of women who did not have the consultation (P < 0.001). The 3.4% of women who lived > 50 miles from the radiation therapy center had the lowest BCSR rate (15.8%) and had the lowest radiation therapy rate among women who underwent BCS (54.5%), although these findings were not statistically significant in adjusted analyses. CONCLUSIONS. A preoperative visit with a radiation oncologist was associated strongly with BCSR use. More should be done to evaluate the role of multidisciplinary consultation in the decision to use BCSR. (C) 2004 American Cancer Society.
引用
收藏
页码:701 / 709
页数:9
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