Cross-Canada differences in early-stage breast cancer treatment and acute-care use

Canadian Team to Improve Community-Based Cancer Care Along the Continuum

doi:10.3747/co.26.5003

Cross-Canada differences in early-stage breast cancer treatment and acute-care use

Canadian Team to Improve Community-Based Cancer Care Along the Continuum

Medicine

Medicine

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

5 Citas (Scopus)

Resumen

Background Chemotherapy has improved outcomes in early-stage breast cancer, but treatment practices vary, and use of acute care is common. We conducted a pan-Canadian study to describe treatment differences and the incidence of emergency department visits (edvs), edvs leading to hospitalization (EDVHS), and direct hospitalizations (hs) during adjuvant chemotherapy. Methods The cohort consisted of women diagnosed with early-stage breast cancer (stages I-III) during 2007-2012 in British Columbia, Manitoba, Ontario, or Nova Scotia who underwent curative surgery. Parallel provincial analyses were undertaken using linked clinical, registry, and administrative databases. The incidences of edvs, edvhs, and hs in the 6 months after treatment initiation were examined for patients treated with adjuvant chemotherapy. Results The cohort consisted of 50,224 patients. The proportion of patients who received chemotherapy varied by province, with Ontario having the highest proportion (46.4%), and Nova Scotia, the lowest proportion (38.0%). Age, stage, receptor status, comorbidities, and geographic location were associated with receipt of chemotherapy in all provinces. Ontario had the highest proportion of patients experiencing an edv (36.1%), but the lowest proportion experiencing h (6.4%). Conversely, British Columbia had the lowest proportion of patients experiencing an edv (16.0%), but the highest proportion experiencing h (26.7%). The proportion of patients having an edvh was similar across provinces (13.9%-16.8%). Geographic location was associated with edvs, edvhs, and hs in all provinces. Conclusions Intra- and inter-provincial differences in the use of chemotherapy and acute care were observed. Understanding variations in care can help to identify gaps and opportunities for improvement and shared learnings.

Idioma original	English
Páginas (desde-hasta)	e624-e639
Publicación	Current Oncology
Volumen	26
N.º	5
DOI	https://doi.org/10.3747/co.26.5003
Estado	Published - 2019

Nota bibliográfica

Funding Information:
In addition to the authors, the membership of the CANIMPACT Administrative Health Data Group who undertook this work include: Dongdong Li, BC Cancer, Vancouver, BC; Aisha Lofters, University of Toronto, Toronto, ON; Sharon Matthias, canimpact Patient Advisory Committee, AB; Nicole Mittmann, Cancer Care Ontario, Toronto, ON; Rahim Moineddin, University of Toronto, Toronto, ON; Dawn Powell, canimpact Patient Advisory Committee, ON; Donna Turner, CancerCare Manitoba, Winnipeg, MB; Bonnie Vick, canimpact Patient Advisory Committee, SK; Yan Yuan, University of Alberta, Edmonton, AB. The authors also thank Emma Shu, Marlo Whitehead, and Yan Wang for conducting data processing and statistical analyses. This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database. Data for this study were also provided by Population Data BC and BC Cancer. All inferences, opinions, and conclusions drawn in this study are those of the authors, and do not reflect the opinions or policies of the B.C. Data Steward(s) [BC Cancer Registry; Population Data BC, Vital Statistics, Deaths; Population Data BC, Medical Services Plan Payment Information File (http:// www.popdata.bc.ca/data). This study was approved by the University of Manitoba’s Health Research Ethics Board and Manitoba Health’s Health Information and Privacy Committee. We gratefully acknowledge CancerCare Manitoba for their ongoing support and Manitoba Health for the provision of data. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred. Portions of the data used in this report were made available by Health Data Nova Scotia of Dalhousie University and the Nova Scotia Department of Health and Wellness. However, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Department of Health and Wellness.

Funding Information:
This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (mohltc). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (cco). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of cco. No endorsement by cco is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database.

Publisher Copyright:
© 2019 Multimed Inc.

ASJC Scopus Subject Areas

Oncology

PubMed: MeSH publication types

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

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@article{457c0cc6289f423386b3f579241de758,

title = "Cross-Canada differences in early-stage breast cancer treatment and acute-care use",

abstract = "Background Chemotherapy has improved outcomes in early-stage breast cancer, but treatment practices vary, and use of acute care is common. We conducted a pan-Canadian study to describe treatment differences and the incidence of emergency department visits (edvs), edvs leading to hospitalization (EDVHS), and direct hospitalizations (hs) during adjuvant chemotherapy. Methods The cohort consisted of women diagnosed with early-stage breast cancer (stages I-III) during 2007-2012 in British Columbia, Manitoba, Ontario, or Nova Scotia who underwent curative surgery. Parallel provincial analyses were undertaken using linked clinical, registry, and administrative databases. The incidences of edvs, edvhs, and hs in the 6 months after treatment initiation were examined for patients treated with adjuvant chemotherapy. Results The cohort consisted of 50,224 patients. The proportion of patients who received chemotherapy varied by province, with Ontario having the highest proportion (46.4%), and Nova Scotia, the lowest proportion (38.0%). Age, stage, receptor status, comorbidities, and geographic location were associated with receipt of chemotherapy in all provinces. Ontario had the highest proportion of patients experiencing an edv (36.1%), but the lowest proportion experiencing h (6.4%). Conversely, British Columbia had the lowest proportion of patients experiencing an edv (16.0%), but the highest proportion experiencing h (26.7%). The proportion of patients having an edvh was similar across provinces (13.9%-16.8%). Geographic location was associated with edvs, edvhs, and hs in all provinces. Conclusions Intra- and inter-provincial differences in the use of chemotherapy and acute care were observed. Understanding variations in care can help to identify gaps and opportunities for improvement and shared learnings.",

author = "{Canadian Team to Improve Community-Based Cancer Care Along the Continuum} and M. Powis and P. Groome and N. Biswanger and C. Kendell and Decker, {K. M.} and E. Grunfeld and McBride, {M. L.} and R. Urquhart and M. Winget and Porter, {G. A.} and Krzyzanowska, {Monika K.}",

note = "Funding Information: In addition to the authors, the membership of the CANIMPACT Administrative Health Data Group who undertook this work include: Dongdong Li, BC Cancer, Vancouver, BC; Aisha Lofters, University of Toronto, Toronto, ON; Sharon Matthias, canimpact Patient Advisory Committee, AB; Nicole Mittmann, Cancer Care Ontario, Toronto, ON; Rahim Moineddin, University of Toronto, Toronto, ON; Dawn Powell, canimpact Patient Advisory Committee, ON; Donna Turner, CancerCare Manitoba, Winnipeg, MB; Bonnie Vick, canimpact Patient Advisory Committee, SK; Yan Yuan, University of Alberta, Edmonton, AB. The authors also thank Emma Shu, Marlo Whitehead, and Yan Wang for conducting data processing and statistical analyses. This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database. Data for this study were also provided by Population Data BC and BC Cancer. All inferences, opinions, and conclusions drawn in this study are those of the authors, and do not reflect the opinions or policies of the B.C. Data Steward(s) [BC Cancer Registry; Population Data BC, Vital Statistics, Deaths; Population Data BC, Medical Services Plan Payment Information File (http:// www.popdata.bc.ca/data). This study was approved by the University of Manitoba{\textquoteright}s Health Research Ethics Board and Manitoba Health{\textquoteright}s Health Information and Privacy Committee. We gratefully acknowledge CancerCare Manitoba for their ongoing support and Manitoba Health for the provision of data. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred. Portions of the data used in this report were made available by Health Data Nova Scotia of Dalhousie University and the Nova Scotia Department of Health and Wellness. However, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Department of Health and Wellness. Funding Information: This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (mohltc). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (cco). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of cco. No endorsement by cco is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database. Publisher Copyright: {\textcopyright} 2019 Multimed Inc.",

year = "2019",

doi = "10.3747/co.26.5003",

language = "English",

volume = "26",

pages = "e624--e639",

journal = "Current Oncology",

issn = "1198-0052",

publisher = "Multimed Inc.",

number = "5",

}

TY - JOUR

T1 - Cross-Canada differences in early-stage breast cancer treatment and acute-care use

AU - Canadian Team to Improve Community-Based Cancer Care Along the Continuum

AU - Powis, M.

AU - Groome, P.

AU - Biswanger, N.

AU - Kendell, C.

AU - Decker, K. M.

AU - Grunfeld, E.

AU - McBride, M. L.

AU - Urquhart, R.

AU - Winget, M.

AU - Porter, G. A.

AU - Krzyzanowska, Monika K.

N1 - Funding Information: In addition to the authors, the membership of the CANIMPACT Administrative Health Data Group who undertook this work include: Dongdong Li, BC Cancer, Vancouver, BC; Aisha Lofters, University of Toronto, Toronto, ON; Sharon Matthias, canimpact Patient Advisory Committee, AB; Nicole Mittmann, Cancer Care Ontario, Toronto, ON; Rahim Moineddin, University of Toronto, Toronto, ON; Dawn Powell, canimpact Patient Advisory Committee, ON; Donna Turner, CancerCare Manitoba, Winnipeg, MB; Bonnie Vick, canimpact Patient Advisory Committee, SK; Yan Yuan, University of Alberta, Edmonton, AB. The authors also thank Emma Shu, Marlo Whitehead, and Yan Wang for conducting data processing and statistical analyses. This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database. Data for this study were also provided by Population Data BC and BC Cancer. All inferences, opinions, and conclusions drawn in this study are those of the authors, and do not reflect the opinions or policies of the B.C. Data Steward(s) [BC Cancer Registry; Population Data BC, Vital Statistics, Deaths; Population Data BC, Medical Services Plan Payment Information File (http:// www.popdata.bc.ca/data). This study was approved by the University of Manitoba’s Health Research Ethics Board and Manitoba Health’s Health Information and Privacy Committee. We gratefully acknowledge CancerCare Manitoba for their ongoing support and Manitoba Health for the provision of data. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred. Portions of the data used in this report were made available by Health Data Nova Scotia of Dalhousie University and the Nova Scotia Department of Health and Wellness. However, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Department of Health and Wellness. Funding Information: This study was funded by the Canadian Institutes of Health Research (grant no. 128272). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funder. This study was supported by ices, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (mohltc). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from those sources of support. No endorsement by ices or the Ontario mohltc is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (cco). The opinions, results, views, and conclusions reported here are those of the authors and do not necessarily reflect those of cco. No endorsement by cco is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information [cihi (https://www.cihi.ca/en/ discharge-abstract-database-metadata)]. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of cihi. We thank IMS Brogan Inc. for use of their drug information database. Publisher Copyright: © 2019 Multimed Inc.

PY - 2019

Y1 - 2019

N2 - Background Chemotherapy has improved outcomes in early-stage breast cancer, but treatment practices vary, and use of acute care is common. We conducted a pan-Canadian study to describe treatment differences and the incidence of emergency department visits (edvs), edvs leading to hospitalization (EDVHS), and direct hospitalizations (hs) during adjuvant chemotherapy. Methods The cohort consisted of women diagnosed with early-stage breast cancer (stages I-III) during 2007-2012 in British Columbia, Manitoba, Ontario, or Nova Scotia who underwent curative surgery. Parallel provincial analyses were undertaken using linked clinical, registry, and administrative databases. The incidences of edvs, edvhs, and hs in the 6 months after treatment initiation were examined for patients treated with adjuvant chemotherapy. Results The cohort consisted of 50,224 patients. The proportion of patients who received chemotherapy varied by province, with Ontario having the highest proportion (46.4%), and Nova Scotia, the lowest proportion (38.0%). Age, stage, receptor status, comorbidities, and geographic location were associated with receipt of chemotherapy in all provinces. Ontario had the highest proportion of patients experiencing an edv (36.1%), but the lowest proportion experiencing h (6.4%). Conversely, British Columbia had the lowest proportion of patients experiencing an edv (16.0%), but the highest proportion experiencing h (26.7%). The proportion of patients having an edvh was similar across provinces (13.9%-16.8%). Geographic location was associated with edvs, edvhs, and hs in all provinces. Conclusions Intra- and inter-provincial differences in the use of chemotherapy and acute care were observed. Understanding variations in care can help to identify gaps and opportunities for improvement and shared learnings.

AB - Background Chemotherapy has improved outcomes in early-stage breast cancer, but treatment practices vary, and use of acute care is common. We conducted a pan-Canadian study to describe treatment differences and the incidence of emergency department visits (edvs), edvs leading to hospitalization (EDVHS), and direct hospitalizations (hs) during adjuvant chemotherapy. Methods The cohort consisted of women diagnosed with early-stage breast cancer (stages I-III) during 2007-2012 in British Columbia, Manitoba, Ontario, or Nova Scotia who underwent curative surgery. Parallel provincial analyses were undertaken using linked clinical, registry, and administrative databases. The incidences of edvs, edvhs, and hs in the 6 months after treatment initiation were examined for patients treated with adjuvant chemotherapy. Results The cohort consisted of 50,224 patients. The proportion of patients who received chemotherapy varied by province, with Ontario having the highest proportion (46.4%), and Nova Scotia, the lowest proportion (38.0%). Age, stage, receptor status, comorbidities, and geographic location were associated with receipt of chemotherapy in all provinces. Ontario had the highest proportion of patients experiencing an edv (36.1%), but the lowest proportion experiencing h (6.4%). Conversely, British Columbia had the lowest proportion of patients experiencing an edv (16.0%), but the highest proportion experiencing h (26.7%). The proportion of patients having an edvh was similar across provinces (13.9%-16.8%). Geographic location was associated with edvs, edvhs, and hs in all provinces. Conclusions Intra- and inter-provincial differences in the use of chemotherapy and acute care were observed. Understanding variations in care can help to identify gaps and opportunities for improvement and shared learnings.

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SP - e624-e639

JO - Current Oncology

JF - Current Oncology

IS - 5

ER -

Cross-Canada differences in early-stage breast cancer treatment and acute-care use

Resumen

Nota bibliográfica

ASJC Scopus Subject Areas

PubMed: MeSH publication types

ODS de las Naciones Unidas

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