Abstract
IntroductionReducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks.MethodsA retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan–Meier product-limit estimates and multivariate competing risk regression.ResultsResults indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival.ConclusionThis study provides benchmarks for monitoring future variations in treatment and survival.
Highlights
Reducing variations in cancer treatment and survival is a key aim of the New South Wales (NSW) Cancer Plan
Data on histologically confirmed breast cancers (ICD-O-3 C50) from the NSW Cancer Registry (NSWCR) were linked to the NSW Admitted Patient Data Collection (APDC), health insurance claims data from the Medicare Benefits (MBS) and Pharmaceutical Benefits (PBS) schemes, and data from the National Death Index to include deaths occurring outside NSW, as described previously [10, 11]
Crude associations were calculated by logistic regression, and with adjustment for sociodemographic and clinical factors
Summary
Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Among these women who had breast conserving surgery, there was higher use of chemotherapy. Women living in areas of socioeconomic disadvantage have been less likely to participate in screening and more likely to experience poorer outcomes [4,5,6,7]
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