Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors.

Arup K Sinha,Debu Tripathy,Sharon H Giordano,Carlos H Barcenas,Yu Shen,Jenil R Patel,Naoto T Ueno,David S Lopez,Nancy Lan Guo

doi:10.1371/journal.pone.0170081

Abstract

PurposeCancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment.MethodsWe retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).ResultsWe identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6).ConclusionLong-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.

Highlights

The impact of the location or hospital setting where a cancer patient receives treatment on the patient’s health outcomes has been studied with great interest owing to concerns about cost and quality of care [1,2,3]
We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: hazard ratios (HR) = 4.8, 95% confidence intervals (CI) = 3.9–6.0; recurrence-free survival (RFS): HR = 5.8, 95% CI = 4.8– 7.0; distant relapse-free survival (DRFS): HR = 5.4, 95% CI = 4.5–6.6)
Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes

Summary

Introduction

The impact of the location or hospital setting where a cancer patient receives treatment on the patient’s health outcomes has been studied with great interest owing to concerns about cost and quality of care [1,2,3]. Specialty care hospitals commonly treat a heterogeneous group of patients where some patients may receive their initial treatment within these specialty care hospitals and others may initiate their treatment in community hospitals and eventually establish follow-up care in the specialty care hospital This heterogeneity of location of initial treatment could potentially lead to substantial differences in outcomes within a specialty care hospital. In the current study, we sought to determine whether the location of receipt of the initial treatment affected late (>5 years) cancer outcomes among BC survivors who had presented to a single specialty care hospital and had not experienced recurrence for at least 5 years after diagnosis. We assessed recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS)

Methods

Results

Conclusion